Cure or remission

[reconjj]

Hello All , from what I understand having oligometatastic ( 1 pelvic lymph-node ) and doing the SOC which Im on now . SBRT to the lymph-node and 25 fractions to the pelvic area , plus Eligard , Zytiga , prednisone that this may be curative after the 2 yr period of treatment . So if labs are all good , I would be in remission , not cured right ? Has anyone gone this same route and can call themselves cured ?

[Magnus1964]

Remission is goal. There is no cure.each treatment can give you a remission for a few months to several years.

[Hidden]

Depends on who you talk to. Some of the doctors are talking about it like it can be cured if it is in a lymph node only or seminal vesicle. I don't think anybody knows for sure.

[MateoBeach]

It is possible, if the cancer has not spread beyond the pelvic LN fields treated. Short term ADT with the radiation appears to make it more effective. But the longer term (2years) seems to be working to prolong time to recurrence (a good thing) but not a cure.The problem is that micro metastasis may well already exist. How to mop them up systemically after SBRT and pelvic LN IMRT?

For myself, being in a similar situation, opted for experimental Lu-PSMA-J591 treatment (Which is NOT the usual Pluvicto, Lu-PSMA-617) at GenesisCare/ Theranostics AU with Dr. Nat Lenzo in Perth. You can consult him via video Zoom.

The answer is that “only time will tell” as we do all that we can do. Paul

[Tall_Allen]

Your cancer is NOT considered to be oligometastatic, which is always M1. You are only N1 and potentially curable.

[reconjj in reply to Tall_Allen]

Allen on my report from V.A. it says Oligometatastic . I thought 4 tumors or less were considered oligo . V.A report says : Stage 4 , Oligometatastic prostate cancer to lymph node (BCR) measuring 5x6 located in the right lateral pelvis to the right hip and posterior to the femoral vein , SUV max24

[Tall_Allen in reply to reconjj]

Pelvic lymph node metastases (N1)are a different stage from distant metastases, which are M1.

[Scout4answers in reply to Tall_Allen]

Allen How can you say that reconjj is "potentially curable"? ( last time I believe you said "cured"), While maintaining that mine (Oligo, in two LNs) is "incurable prostate cancer". Seems like a very fine line that you are drawing.

[Tall_Allen in reply to Scout4answers]

He had radiation to his entire pelvic lymph node area. From your profile it doesn’t look like you did. The radiation is what probably cured him.

[Scout4answers in reply to Tall_Allen]

Thanks

I have that on tap

[Tall_Allen in reply to Scout4answers]

This is not something to wait on. I assumed you decided to go the hormone route - maintenance, not cure - that is your decision to make. But PCa will always find a way of escaping hormone therapy and seeding in places unreachable by radiation.

[Scout4answers in reply to Tall_Allen]

Getting fiducials installed next week at U of Chicago. I have thrived on a life of risk taking in the trading pits in Chicago. I am taking the short odds bet with IMRT for 10 year survival, despite the poor odds on side effects. Best of poor choices is sometimes all one can do.

[Scout4answers in reply to Scout4answers]

Per your suggestion rad to prostate and lymph bed. I thank you for educating me Allen, you have been an invaluable asset to me and others on here.

[Tall_Allen in reply to Scout4answers]

I'm not sure what you characterize as long odds or short odds. That's very individual. You might find getting up 3 x per night to pee for 2 months to be insufferable, whereas I might shrug it off.

[Scout4answers]

I think this post by Nal 4 years ago is as good an answer as we may get;

Where Did Our Cancer Go, Where is it Hiding

Nalakrats profile image

Nalakrats•

4 years ago•96 Replies

This post is for all Pca Patients, but more so for those that by whatever treatment modality, reached a nadir of Undetectable in terms of PSA. There are many hundreds of men on this site at some point during their Pca Journey reached an undetectable PSA. Many of us have known that at some point down the road there would be a recurrence. of PSA, or in other words the Pca is active again. Our Doctors told us it would eventually happen.

Well has anyone ever asked their Doctors what the odds of a cure, or never having your PSA come back with a number over 0.2. Some have suggested less than 5%. I had one Doc. tell me it was more like 2%. If you lived long enough!

Well as an ex researcher, I have a curious mind. If one is undetectable, {where did the cancer go to]. Since it is suppose to come back in 95% of the once undetectable patients. Where is it? Where is it Hiding? Why can we not find it? Did our bodies decide to create new Pca cells, after having blood tests that said none could be detected.

Now I have asked a few respected Doctors in the field of Urological Prostate Cancer, and Medical Oncologists that specialize in Pca. Those of us who have asked probably got the same kind of answers I did.

1] The Pca is asleep

2] The Pca is in Hibernation

3] It has found a place to hide

4] It is in a dormant equilibrium [now I can buy this somewhat]

5] It was so beat up, it cannot at this time give off any PSA, so we do not know it is there. But it is!

And there are other theories. But collectively think about this. When our PSA burden is so low---if all the cancer cells were lined up and if they are less than a half a centimeter, we cannot detect them by today's scans---One day we may get down so low to be able to count cells.

But the greater point here is where are they? I had a friend who we just buried--who went 12 years with Undetectable PSA's. In his last 3 years after he lost his undetectable PSA's he went thru hell--Xtandi, Zytiga, 2 types of Chemo, Radium 223, Radiation to Mets. And then one day--he said he had enough, and took the Morphine drip. I ask where the F*** did his cancer go for 12 years. Someone tell me!!!!!!!!!! How did it stay dead but was yet still alive.

Men on this site have quoted many years of Undetectable PSA's to only have a return, and to fight anew.

So what is it that is so unique to certain cancers, that you can go into remission, and the cancer will almost always return, if given enough time. As I have said before,"Cancer is not of the Earth".

Now how did I get to write this balderdash above? I was asked a question by someone who follows me. The Question Was----Nalakrats, if you are undetectable why are you maintaining all of your supplements and drugs outside of the stopping of Vantas[Lupron], and Casodex. It was a great question. And I had an answer. As I had been thinking about this subject, a long time. My conclusion is number 4] above---A Dormant Equilibrium.

It is my theory that when we get down to an undetectable PSA, what we have is a very low burden of Pca cells, that go back and forth between being productive and being dormant. The activity is so low we do not detect it by blood tests or scans. Now this equilibrium can last for a couple of months, or for 12 years like my friend Jerry. That something breaks the equilibrium, of going from live to dormancy to live to dormancy. What that is I can speculate a dozen things--none with proof as there is no proof to my hypothesis of Dormant Equilibrium. Logic says that dead is dead. But defining Hibernation, or Cellular Sleep is hard to do.

So if I am right, I keep myself loaded up with my supplemental/drug program---without ADT, while on vacation---so everything is there if I lose the Equilibrium Theory I put forth, to prevent Castrate Resistance, allowing me the ability to return to ADT therapy. I just cannot believe that living cells, even cancer ones can stay dormant for 12 years. Or hide for 12 years.

Anyone have a better answer--or heard from a medico---something more exacting. I would be interested in other theories.

Nalakrats

[reconjj in reply to Scout4answers]

Good read , where the hell is it , where did it go ? I guess we are all grasping for straws in one way or another .

[George71 in reply to Scout4answers]

My Dr. said that the cells die in 7 years. I guess if you could keep them all from replicating for 7 years you would be cancer free.

[Papillon2 in reply to Scout4answers]

👽

[Scout4answers]

I think remission is our goal for now, until the real cure comes along. Better to be vigilant for a recurrence, than be lulled to sleep with false hope.

[Justfor_ in reply to Scout4answers]

Youtube search: GUcast, Martini Klinik, (part 2). Check the second part on positron detector PSMA guided lymph node ectomy.

[Boywonder56 in reply to Scout4answers]

Thats what my onc said were gonna put it to sleep......how long ....who knows....

[john4803]

The goal is to die with Cancer but not because of it! It is kind of like weeds in your lawn. They are always there but we keep pouring the weed killer on to keep them from completely taking over and killing all of the grass. It's a chronic illness, that we die with at an old age, if we are lucky, or have when the Lord returns and then we can use the "C" word!

[CurrentSEO]

Our goal is to live without worrying about cancer. Cured means in remission till you die of something else (preferable in your sleep from old age) besides prostate cancer.. Remission means you are not on any serious meds/treatments and at the same time your tests/scans are negative prostate cancer wise.

That is my personal take on this issue.