"Remission" for oligometastatic prostate cancer

Its called liquid biopsy?

I think that might be for very small tumours. I'm talking about individual dormant cancer cells (there's nothing for that yet, but I understand they're working on it in the labs; it would be life-changing for cancer patients if it turns out to be possible).

I'm of the feeling that words can/should be used "loosely" with "general understanding" of their definitions as long as the entities in the conversation have the same relevant-level of knowledge to use this type of vocabulary. The latter point is critical as you would never want an uneducated entity interpreting vocabulary based on their perceived definitions.

In the world of finance, a full remission of debt is a cancellation, such that no money is owed. In this analogy, there is no supporting practice of revoking a full remission of debt, so there is a very black and white interpretation.

In the world of cancer, we are dealing with a shade of gray. With an understanding that if a technique results in the elimination of cancer (surgery, drugs) that is supported by biomarkers (blood test, scans), there should also be an understanding that medical science is evolving (so is the cancer) and a chance exists for the cancer to return.

I had successful surgery 11 years ago, but it came back. I've been on ADT for one year, and PSA < 0.1. In general public conversation, I am fine saying "the cancer is in remission". If the conversation opens up to more details, I explain things. As for me, I plan to live my life as fully as I can, blood tests every three months, and I really only get a bit anxious for a few hours when waiting for the lab work to come back.

hope this helps.

keep the faith!

But the technology can also be used to detect any residual or mutation in case of prostate cancer, is it not? The issue is how to deal with it?
Dont mind me. I am just another layman trying to make some sense of it.

Your attitude is great. My RALP was August 22. No BCR to date. Getting checked every 4 months now. Sad to say I get anxious a month before blood draw.... You mention ADT. No radiation?

Yes, I relate to the anxiety. I get my bloodwork done every 3 months instead of every 6 because I'm in the Ironman study, and the week before is always a difficult time. While PSA is the main thing, they test lots of other indicators as well, and I look closely (and nervously) at all of them.

Ironman study: https://ironmanregistry.org/

Thank you. When my PSA skyrocketed in Summer 2022 we did a series of tests (bone scan, CT scan, MRI scan) and then PSMA PET scan and determined that the cancer had spread to about 20 small areas in my Iliac lymph nodes so the idea of radiation was tossed out as a viable option. The health team indicated that "5 of reasonable size" is the magic quadrant for radiation. Onward.

That's my interest as well. Not all mutations show up in all imaging. PCMA PET/CT doesn't show all types of cancer cells. Specific info would be great

The answer from your oncologist would be that 1. mutations of any significance will show up in your PSA (0.2 or above) and the PSMA PET/CT scan (4mm and above). He will tell something is suspicious if either one or both are growing. The technology does not show lesions smaller than 4mm but for practical purposes it is not a matter of urgency. 2. You have to rely on other regular tests and scans to detect any other cancer, such as ultrasound for the kidney, blood tests for liver etc. You are right, unfortunately there is not one test that covers all. But a good oncologist with substantial experience should be able to give you a report with confidence whether you are OK.
That said, even doctors get into trouble with other cancers because they fail to detect it early.

When going over the pathology report from my surgery in 2014, my urologist did not use the word "cure." He did however say "he didn't "see" any "problems" in the future given my pathology report and what he saw during the surgery.

Meanwhile, I'm looking at the pathology report and the final staging T2CNoMx thinking, they don't know if it has metastasized...! Which, given the state of imaging at the time, was a fair staging.

I was right, it had, as evidenced by the BCR 18 months later. The rest as they say is "history," as in my clinical history (attached).

My medical team - radiologist and oncologist (I'm beyond a urologist) generally believe that we are managing my PCa as a chronic disease with specific criteria about when to go on treatment, with what, for how long, when to come off treatment. We have never discussed treatment in terms of a cure once it became advanced.

It's worked for my PCa, one that is high risk - GS 8, GG4, time to BCR, PSADT and PSAV. I am fortunate, no resistance yet, no involvement of bones or organs. The day may come when that changes.

I do have friends who were diagnosed around the same time as I was, had surgery by the same urologist as I did and 11 years later, they see their urologist once a year for a PSA test and go on their merry way. I also have a friend who is terminal with his PCa.

My take is there is a possibility of cure with De Novo diagnosis, once it is advanced, we can control it as I and my medical team have done for10-1/2 years, but a cure, not there yet.

Medical research since 2014 has changed greatly (for the better) the imaging and treatment landscape for PCa, particularly advanced both castrate sensitive and castrate resistant. Sadly, for the 30k or so who die each year because of PCa, it has not changed enough.

Kevin