The Existence of the Oligometastatic State in Prostate Cancer (and other cancers)

[NPfisherman]

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

[ragnar2020]

Fisherman, Well stated my friend. Fortunately, Dr. Morgans is my MO, and she has been organizing my PCa care expertly. We both believe in metastatic directed therapy (MDT) and we have used the skills of Dr. Neta Vapiwala, my RO and her team of proton beam radiation staff at the Roberts PB Center at UPenn to keep any errand mets that they find under control. Thanks for supporting their findings.

[NPfisherman in reply to ragnar2020]

Visionary Ragnar,

Great to hear from you...Fabulous to hear that you believe, and in such knowledgeable hands

I don't know how Dr Morgans is able to do all the videocasts and see patients....Kudo's to her..(You go, Lady.... dang !!!) An oligo guy doing MDT (gasp)... It is amazing that people actually say on some forums that doing MDT is OK, they guess , but there is no benefit..

Oligometastatic patients--MDT is the bomb !!! Literally, a nuclear bomb for your mets...

Thanks for the reply...

[GreenStreet]

Don Pecsado

Thanks. A very useful summary of emerging thinking. My oncologists at the Royal Marsden have been happy to target my visible me with CyberKnife and 6 months ADT. It is not designed to be curative but may buy time and has been good so far from quality of life perspective. Bring on the scientific advances. I wish they would hurry up a bit.LOL

[NPfisherman in reply to GreenStreet]

Visionary GreenStreet,

I salute your belief, and the path that you are on... IADT with MDT/SBRT is a path that so many like us have chosen.... As you stated--the chance for improved QOL and time. In a study done, IADT was not inferior to CADT... The study we need is IADT with MDT/SBRT vs CADT, and see what the results say. Yeah , Science--Do that study !!!

"The Royal Marsden is not chopped liver, baby..." (In my Austin Powers voice)

May your path continue to be straightforward and smooth...

Always a pleasure, my friend.. Thanks for the reply...

[pakb]

My husband just finished his 2nd round of SBRT. His MO (Dr Geynisman at Foxchase) and RO (Dr J Wong) both say he is oligometestatic. He had great results from SBRT in 2022. Hoping for the same from the current SBRT he finished 2 weeks ago. He has no pain from his mets- they've been found on his annual scans.

"Oligometestatic" in RO notes

[NPfisherman]

Visionary pakb,

Thanks for your reply and information.... I salute your belief in the oligometastatic state and metastasis directed treatment (MDT). Sounds like he is in good hands, and so we hope that he will have more success with SBRT.

May your paths be straightforward and smooth...

[NPfisherman]

PLEASE NOTE READERS: I HAVE EDITED THE POST TO INCLUDE MY EQUATION, WHICH I WILL USE IN MY NEXT POST ON RESISTANCE....THANKS

[Scout4answers]

Positive message Don. Your thoughts on using Estradoil therapy in place of ADT. Currently it is my plan should my PSA start rising. DX was oligometastatic , did 30 months of ADT + abiraterone + prednisone + IRMT 20 sessions. Now 4 months into "vacation", PSA and T are undetectable.

[NPfisherman in reply to Scout4answers]

There is a guy Ron that has been using Estradiol for a while... I hope your T comes back... not unusual for first T and PSA to be undetectable... Estradiol is a choice that people can choose with a long history of working well in PCa... Everyone chooses their own path...

Good luck on your journey...