For the longest time it seems the generally held belief in the medical community was that de novo cancer, could be cured. Surgery was viewed as curative if imaging did not show spread outside the prostate.

Such was the case in 21014 when I was diagnosed, CT and MRI showed no spread outside the prostate, pathology report was excellent, surgeon told me in our first consult after surgery that given his surgery it's and my pathology report, I would not have any future problems...

Meanwhile I'm look at the T2CNoMx and thinking "I don't like that Mx" as it means they cannot say with any degree of assurance!"

15 months later after nothing but undetectable PSA, < .1, that same surgeon hesitates before he turns to face me after looking at his computer screen and seeing my PSA.

In January 17 we did triple therapy treatment, no cure but 4-1/2 years off treatment.

In April this year when it came back my oncologist initially talked about SBRT combined with 24 months of Orgovyx and Xtandi as being potentially curative.

I looked him in the eye and said, " given my clinical history, do you really think so, if you are, I'm on board with your recommendation!"

I said given my clinical history, three failed and elusive attempts at the gold ring, a cure, I see this as a chronic disease we actively treat as needed over time until as my radiologist says, you die of something else...!"

He looked at me and said, yeah, let's do a treatment that balances quality and quantity of life based on your clinical data and disease history."

So, SBRT, 6-12 months of Orgovyx, stop if PSA stays undetectable, then actively monitor with labs and consult every three months.

I do have friends who 10+ years after their surgeries are "cancer free" and see their urologist once a year for labs and consult.

Their cancer is not mine, particularly their Gleason Scores.

So is PCa curable, yes and no. I'm in the camp that says advanced PCa is not, but it is manageable and with the exception of the 27k or so who die each year of it, may be managed as a chronic disease, treated as necessary. I would liken it to AIDS, once a guaranteed death sentence, today, not so much.

So, follow the clinical data, if it's aggressive, GS, PSADT, time to BCR.....treat aggressively but maybe not continuously?

Kevin