Bone cancer = curable?

[TheTopBanana]

An x-ray for my father found two potential but not curtain bone metastases. The doctor said that they might be able, if its confirmes next week that it is bone metastaser, to still cure my father with x-ray. But I’m still confused about the matter, I though bone metastases were 100 % uncurable? Thankful for other people’s experiences or thoughts!!

[pjoshea13]

Traditionally, metastatic PCa to bone was not considered to be curable, but treatable - it can be managed for a significant period of time. Nowadays oligometastatic disease is considered by some to be curable. The proof isn't in, IMO, but I expect that treatment will eventually be found to improve survival & be a cure for some.

I had a bone met zapped by radiation 5 years ago. I am not cured, since I still have a PSA of 3, but I'm expecting to watch a lot of sunrises before I go.

I hope that his treatment will result in a durable remission - a cure, perhaps!. But don't lose hope if it doesn't.

Best, -Patrick

[TheTopBanana in reply to pjoshea13]

Thank you so very much for your kind reply! And all the best to you! Did you have an aggressive cancer? My father has a Gleason 9-tumor in 2018 removed with radical prostatectomy. This May his PSA went up to 0.24 (last check November 2019) and we are now terribly worried. We will know for certain regarding bone mets next Tuesday. I’m so afraid of him losing all hope.

[pjoshea13 in reply to TheTopBanana]

No, my Gleason 4+3 was considered treatable 16 years ago, but surgery & radiation were not successful. Eventually, the mets showed up. I never looked for them until I had pain, but the pain was not due to mets. Normally, mets would only be treated if they were causing pain.

About ten years ago, my doctor said "If you have one met, you have a lot of mets - you just can't see them!" That was the conventional view back then.

But some men have very few mets and do not accumulate more. Perhaps there are other cells in the body, but they don't seem to progress. Dormant cells can be ignored, for the present, IMO.

When I mentioned oligometastatic PCa to my doctor 5 years ago, his view had changed. He sent me to a radio-oncologist who had an open mind on the subject. He radiated.

When I met him again 4 years later, he had become convinced that oligometastatic cancer could be treated & would extend survival. If I wanted radiation, he would do it.

As you can see from the responses to your post, there are two opinions. One more hopeful than the other. But we are not Swedish doctors.

All the best, -Patrick

[TheTopBanana in reply to pjoshea13]

Thank you again! If you dont mind, what is the name of your doctor? (Also since my father’s initial diagnosis were wrong and then his PC have been mistreated, the fact that you are not Swedish doctors is quite a bonus, even though I of course know there is a lot of great doctors here)

[pjoshea13 in reply to TheTopBanana]

Well, I live in North Carolina and my doctors are local. If you were to travel to America, you would not be limited, as I am. There are men in this group who have been treated for oligometastatic PCa & might have opinions as to who is the best choice.

-Patrick

[TheTopBanana in reply to pjoshea13]

Especially with Covid-19 it seems distant to travel to America for treatments. But it seems you have a good doctor and I’m happy for you! And thank you for the recommendation to check in the group. I mostly want to google the doctors to see if they have written any “positive” articles that I can show my father (who tells me every day now that if the scan shows bone mets he does not think he will live more then 2 years..)

[Tall_Allen]

You are right that it is not curable. Spot radiation can provide local control, but it does nothing for the millions of other cancer cells in your body that have not yet grown into tumors large enough to be detected. That is why systemic therapy (hormone therapy or chemotherapy) is so important at this critical point.

[TheTopBanana in reply to Tall_Allen]

Thank you! We wont know for curtain before Tuesday. But the doctor suggested only radition either way (with or without mets) to be able to see if the PSA changes because of the radiation. But is there reason to maybe get a second opinion?

[Tall_Allen in reply to TheTopBanana]

It doesn't matter if the PSA changes because of the radiation. You want to treat the cancer, not the PSA. He needs immediate systemic therapy. He should be seen by a top urologic oncologist, if possible. Where are you located? I might be able to suggest someone.

[TheTopBanana in reply to Tall_Allen]

Sweden! But since cancer treatments have been on hold in Sweden because of Cubus-19 we have been in contact with a finnish hospital called Docrates and a doctor there named Jorma.

[Tall_Allen in reply to TheTopBanana]

Well, in Sweden, Karolinska has a great reputation. I've seen the names Jeffrey Yachnin and Anders Ullén have come up several times. In Finland, Tampere University has a great reputation, and I've seen the name Pirkko Kellokumpu-Lehtinen come up a lot.

[TheTopBanana in reply to Tall_Allen]

I talked with my father and since he still does not have confirmed metastases he said that he wanted to wait with systemic therapy (since he still has a hope of curing the cancer coming back) but we will know after Tuesday..

[Tall_Allen in reply to TheTopBanana]

A bone scan will provide better information than just an X-ray or a CT.

[TheTopBanana in reply to Tall_Allen]

He will do a naf pet ct bone scan on Monday! And thank you so much for the recommendations. Curios: what have you heard about Docrates? It’s quite expensive so sometimes I worry if they are over-optimistic so that we will buy all the treatments.

[Tall_Allen in reply to TheTopBanana]

Sorry, I'm unfamiliar with Docrates. I've only heard about Tampere and Turku in Finland. I'm just a provincial American, and if I've heard of one major center in a foreign country, it's a lot.

[Hotrod65]

Metastatic stage 4 PC with possibly bone mets at this point is not curable, best hope is to control the disease to prolong your Dad,s life and treat the bone pain with forms of Radiotherapy..Good Luck

[Patrick-Turner]

I read some years ago that when CT scans found Pca bone mets, he had only 5% chance of living another 5 years.

But my first bone mets were found in 2017, and since then the number increased to countless, and I remained on ADT, and although added Zytiga suppressed Psa, the number of mets increased, so I had Docetaxel ( chemo ) and Psa kept rising to 50 after 5 shots.

I then had 4 shots of Lu177 which made my countless soft tissue mets invisible to PsMa scans, and bone mets began to heal, Psa went to 0.32 in 12 months, with added Xtandi, ie, enzalutamide.

But now Psa is about 11, and I have my 7th PsMa scan next week and I might have more Lu177. I have ZERO idea what this next scan will show, or won't show, or what exact treatment I might get.

But last week I cycled 208km at good speed and at 72, I often feel 27 despite all the treatments and Pca growth since diagnosis with Gleason 9 in late 2009.

Remission or a cure seems impossible for me and most Pca patients, and this is true for those who don't have early enough RP where ALL the prostate gland tissue is removed, leaving not one bit behind.

If one bit of PG tissue is not removed, it may develop Pca and cause an endless chase to limit the spread and speed of Pca growth.

Men who have a successful RP don't posy here.

After their RP, their Psa remains undetectable for the rest of their life. But often Psa is undetectable for say 3 years, ie it is < 0.01, then it begins to rise, so the man sure has Pca, and a chase begins to find where it is, and how to treat it.

Patrick Turner.

[Ausi]

My experience is similar to PJs. I’ve had bone mets zapped on 3 occasions, my last was in Dec last year, PSA was 16 at commencement but has come down to now 1.8 which is a better outcome than the previous occasions.

For me radiation was easy with no side effects, although it was every day, 5 days a week, 30 in total.

[TheTopBanana in reply to Ausi]

Wonderful that it didnt have any side effects! No additional treatments?

[Ausi in reply to TheTopBanana]

My last PSA reading of 1.8 was just a week ago so no need for further treatment YET! although chemo will happen sooner or later. I have responded well to the radiation as both my Radiation Oncologist and MO suggested that it was unlikely that my PSA would come down any further after my first reading after 6 weeks finishing ie in January, which was 11. I am still on an ADT, Zoladex and have been for 7 years. I was diagnosed 10 years ago, PSA 5.9, and had my prostate removed. I had been on a trial of Enzalutamide 4 years ago, it failed after about 20 mths. (PSA 32).

From following this site, most men are getting through the radiation well, except for some constipation. I am well, 68 play golf and walk and have a reasonably good diet.

There was a study, a glass of red wine a day is beneficial in radiation!

[TheTopBanana]

prost8blog.com/2020/04/26/p...

This confused me!

”Second, what about treating a small number of prostate metastases (oligometastatic prostate cancer) in a patient who was treated years ago and now has a rising PSA? Ongoing investigations suggest this might delay the need for hormone therapy in such patients or potentially even cure some of them. ”

[Ausi in reply to TheTopBanana]

This is pretty much my experience, after having a prostatectomy, 10 years ago, then salvage radiation a year later and then ADT/ hormone treatment/ Zoladex about 2 years after, then Enzalutamide and then my first radiation for oligometastes (I had 2 bone mets) about 3 years ago and then 3 more treatments to bone mets again last year. This has, I believe “delayed the need for hormone therapy” or rather and more likely soon, chemo. Although I may choose Zytiga, abiraterone before chemo (sooner or later!).

I thought Tall_Allen had a link in his post to a blog he writes which gives a good explanation about radiation. He’s very knowledgeable and well respected on this site. He’s not a fan of radiation, “wacka mole” and may well be right about going straight to hormone therapy, ADT, to clean up all the micro cells.

Stay positive blue cat dog, your Dad’s cancer is probably not curative but there are some here that have gone 20 years with it, and keep in mind, cancer is complex, many respond well to different drugs and treatment and there are more coming off from trials.

[Ausi]

I’ve just read another of your posts bluey, your Dad’s depressed state of mind is common, for me, there was not a day that went by without thinking about when and how. This went on for about 5 years but you tend to accept the situation you are in sooner or later. I’ve avoided the “why me” thought as I know there are kids with cancer and the thought of that is very sad. Losing his wife, your mother, must also be very hard for him. You’re a wonderful loving daughter and he’d appreciate the help you’ve given.

For me, I’m lucky, my wife and I have enjoyed travel, hiking and I like my golf. I hope he can get some interests to take his mind off his situation, family around helps a lot.

All the best