Oligometastatic PCa

[Nyquist5]

Looking for more info on Oligometastatic PCa- wondering if that is what my dad will be defined as...he has 2 suspected spots in the lower spine that look suspicious with 2 other spots that they want to see on a MRI.

[pjoshea13]

Dr. Myers in 2014:

askdrmyers.wordpress.com/20...

& in 2016:

askdrmyers.wordpress.com/20...

-Patrick

[jdm3 in reply to pjoshea13]

I'm curious about this too. I know the answer is probably "it depends," but is the evolving standard of care and protocol to add taxotere/chemo early to oligometastatic disease? I had RP, failed salvage radiation, and had recurrence with one met to the hip treated with SBRT and they put me on Lurpon and Casodex. They waive off the chemo and other drugs for now - assuming they want to keep these for later if needed, but I wonder if they should be layered on now.

Thanks.

[pjoshea13 in reply to jdm3]

The pre-oligo view was that if one had a solitary known metastasis, there were actually many & there was no point picking off the one you could see. With oligo-mets, the idea is to treat with curative intent via radiation or surgery. i.e. to eliminate the known mets. ADT, chemo, etc. are not generally relevant in that context.

-Patrick

[Schwah in reply to jdm3]

Please read my earlier post about this specific subject. Do the chemo and the Lupron and the zytega now. You don't want to hold your best pitcher in the bullpen when the bases are loaded and nobody out.

[Nyquist5 in reply to Schwah]

That’s my thought!!! Schwah I’m new at this.. how can I find your post? Thanks!

[jdm3 in reply to Nyquist5]

I was just reading that post... here it is

healthunlocked.com/advanced...

[jdm3 in reply to Nyquist5]

Thanks. I appreciate the collective wisdom and experience in this group.

My thoughts exactly... let's hit it hard, now. Yet I don't know what I don't know and continue to defer to my MO because I believe he wants to see if the SBRT/Lupron/Casodex work before adding the other stuff.

I had SBRT to a single met in December 2017 and am in month four of the ADT. They want to stop ADT after six months and monitor. I'd like to find an MO on the east coast (I live in Maine) for a second opinion. Otherwise, I think a consultation with Dr. Sholz is in order. If the PSA comes back after they stop ADT, I will adopt a more aggressive protocol.

As an aside... My T went from 650+ to 6 after three months on ADT. ADT is definitely working. I am 6'4" and was a very fit 205 lbs. Still getting lots of exercise (maybe too much), but 193 this morning. Losing muscle mass :-(. My wife is terrific, but said she probably has more T than I do. She thought that was hilarious :-).

[Tall_Allen]

Definitions vary - some say 3 max, some up to 5. The evidence for it in prostate cancer is very poor. There is no evidence yet that metastases-directed treatment extends survival. It is hard to measure a benefit because metastases show up very slowly at first. It can take years for a second met to become detectable. There has been only one randomized clinical trial. It was a pilot trial and the results were statistically equivocal, and the endpoint (time until salvage ADT was used) was questionable. Even though the treated men had to have 3 new mets simultaneously before ADT was started, while the untreated men had to evince only one new met, there was only an 8-month difference in the time until ADT was started.

pcnrv.blogspot.com/2017/12/...

Until we have some real evidence, I think the decision to treat oligomets should depend on the answer to a few questions:

1. Is it safe to have radiation in that place?

2. Will the radiation relieve painful mets?

3. Might the radiation avert fractures in load-bearing bones and spinal compression?

4. If mets are only in pelvic LNs, should the entire pelvic LN area be treated and not just the few detectable ones?

5. Have mets been detected with a newer PET scan or just bone scan/CT?

6. Is systemic treatment, a proven therapy, more likely to increase survival? Should both be done simultaneously?

[Dayatatime]

Well if you have only a few mets and you don't do anything about it chances are it will spread. We don't need a controlled study to prove that is what happens. Each metastatic site will create more lethal cells that will spread and land then those cells multiply and rinse wash repeat. I think we all get the picture. It is a very personal decision but why would anyone, especially at a younger age not try and rid themselves of this thing. There are cases of durable remissions and cure that never would have happened if the parties involved would have only settled with "proven" treatment. This is not a one size fits all disease or treatment and all men should not be placed in the same category. There are far to many variables.

2016 at 46 years old I started with a PSA of 286, Gleason 9 and bulky disease in pelvic and abdominal nodes. 4 different doctors told me I was inoperable and it was palliative care for the 3 to 5 years I was predicted to be alive. Currently I have a PSA of <0.01, no evidence of disease and had my last shot of Lupron this past February if numbers stay the same. The true test will be when my testosterone comes back but no sense worrying about that until I need to. I also did the 6 rounds of early docetaxel protocol while remaining on Lupron when first diagnosed. At 46, in good shape with 3 children I was seeking something more than I was being offered. It was up to me to make that happen because it was more than obvious I was not going to get anything more than monthly Lupron shots out of my doctors at that time.

Through research I found The Mayo Clinic was offering treatments for advanced disease that other hospitals are not doing. I figured why not take one more chance and by the grace of God ended up in Dr. Karnes office and he decided I was a candidate for surgery. He offered me surgery consisting of a prostatectomy with an extended lymphadenectomy removing pelvic, paracaval and paraaortic nodes. He made no promises except that at the very least he could extend my life. In my case the surgery turned out better than I could have asked for. Dr. Karnes is very much involved in European Urology and not afraid to practice unconventional therapy. With a Stage IV diagnosis, if looking to beat this that is the type of doctor that is needed. With advanced disease there is not enough time to wait for the 10 years and 3 phases of a clinical trial.

Ron

[Schwah]

That is what They called mine. See my post earlier on the subject. Dr. Sholz has a specific chapter on Oligometastatic PC in his new book and in his opinion it can be curable or you can get a long term ( 10 years or more) remission about half the time if you hit it hard early as discussed in my earlier post.