Members of the FPC Forum:
I submit to you that either I am a Prophet/Visionary, or I am a Fool, but I state clearly... and emphatically...that the oligometastatic state exists in Prostate Cancer and other cancers as well..I believe that if we were to sum it up as an equation, that it would be something like this:
Cancer Disease State= Total Micrometastases + Total Metastases (the visible with the invisible so to speak) OR
CDS= m MT + MT
For those that missed my popular post on micrometastasis:
healthunlocked.com/fight-pr...
THE TAKE HOME MESSAGES FROM THAT POST:
1) The metastatic process by which cancer cells disseminate from the primary tumor, survive in the circulation, implant in distant tissues, survive and grow is multistage and complex.
2) In order to implant at distant sites, CPCs must survive in the circulation, it has been suggested that only 0. 01% of CTCs can produce a single bony metastasis [53, 54], and injected CPCs obtained from men with castrate resistant prostate cancer may fail to produce metastasis when injected in immune compromised mice [55].
3) It is not clearly understood how CTC's/micrometastases are kept in dormancy, nor a clear way that is needed for them to escape dormancy. That people can have CTCs for years and show no evidence of disease is a known fact...
4) That there is a mechanism of AR resistance that develops from exposure to AR drugs. Despite that fact, it has been shown that ADT can eliminate bone marrow micrometastasis in approximately 80% of patients.
Thus, we can see that micrometastasis exists, but only a very small number become metastases, and that the use of ADT plus ARPI drugs are used to eliminate the micrometastases in our equation, thus leaving us with Metastases, the visible part of our disease as shown by scans.Do not forget that ADT plus ARPI kills off metastases as well.. Thus, don't sweat the small stuff...
But how is there an area that is not considered fully metastatic, but yet not in the category of nonmetastatic ?? I have heard it discussed as a Venn diagram-- the intersection of metastatic and nonmetastatic, an area that offers an advantage in regards to tumor and tumor mutational burden, and thus, overall survival benefit in the vast majority of cases... the discussion by Dr Tran and Alicia Morgans of the ORIOLE trial and the oligometastatic state is below:
urotoday.com/video-lectures...
What did the ORIOLE trial show us:
SABR induced a systemic immune response (The Abscopal Effect), and baseline immune phenotype and tumor mutation status may predict the benefit from SABR in the oligometastatic state.
But what is the real number that is considered oligometastatic?? The jury is still out on that issue, but an answer is coming... SABR COMET 10... a trial of SBRT in patients with 4-10 lesions...
bmccancer.biomedcentral.com...
I like the initial statement they list in the paper:The oligometastatic state refers to a stage of disease where a cancer has spread beyond the site of the primary tumor, but is not yet widely metastatic [1]. In patients with a limited oligometastatic burden, emerging evidence suggests that treatment of all sites of disease with ablative therapies (such as surgery or stereotactic radiation) can improve patient outcomes, including overall- and progression-free survival.
Please note that this trial will use breast and lung cancer patients as well...
Well forum members, you can believe the science--MO's and ROs that are MDs and treat patients, or you can believe another poster, blogger, or Facebook friend... The choice is yours...
BTW--FEEL FREE TO INDICATE IF YOU BELIEVE--
As always, I welcome input/ lively discussions when I post...
Don Pecsado
Study Solves Testosterone’s Paradoxical Effects in Prostate Cancer, Duke Health, Published September 04, 2024 
