So, our next question is in the advanced category as well, and this is something that I know
patients hear and get very confused by. So, they don't really know what "oligo," so "few
mets." Oligo means few, and so "few metastatic" so "oligometastatic cancer," and that can
kind of sound scary. It sounds like some weird alien disease. "What do you mean I have oligometastatic
cancer?" So, can you kind of explain what is oligometastatic cancer? I know it's kind
of that transitional phase, so explain the transitional phase of why it's more important
to pay attention to.
Well, it has become important because of advances in technology. Historically, with relatively
inaccurate scans and ineffective treatments, the advent of any metastatic disease was sort
of like saying it's getting to be mortal. It's about time to write your will and it's
very life-threatening, and that belief was pervasive because the scans would only pick
up big chunks of cancer and the doctors had learned through experience that if you tried
to treat those big chunks of cancer that other smaller spots would then surface that were
flying below the radar that weren't seen on these older scans. So, if you tried to treat
metastatic lesions, it was kind of like a game of whack-a-mole. You hit one and then
one would come up, and it wasn't a very useful treatment to go chasing after therapies directed
right at the metastatic lesions. But, things have changed. Two things: one is that the
scans now, when they're detecting metastatic disease, it is at a much much earlier stage,
and therefore there's a possibility that what is being seen on the scan is the only cancer
that has metastasized and that if you could administer an effective treatment at those
metastatic lesions, like surgery or radiation, that maybe some of those people could even
be cured even though they had early metastatic disease. And if they're not cured, possibly
put into an extended remission. So, the other thing that has come along is that the—especially
radiation treatments—are not much more focused and powerful. So, when they direct the radiation
at these metastatic lesions, it can be done non-toxically and it can almost certainly
sterilize the cancer that's in that field. It can cure those spots. So, thinking on how
to treat oligometastatic disease has evolved radically in the last 3-5 years. In the old
days, because radiation was sort of unfocused—kind of like, you know, with a spray can—and
their radiation was getting all over everything, it would make people sick, it would suppress
their immune systems, and everyone would want to avoid it like the plague unless someone
had really bad pain that needed to be controlled. So, in a relatively short period of time,
the thinking is completely reversed and the attitude now is, use the state-of-the-art
PET scan to find cancer at the earliest possible stage and then go aggressively with both medicines
that circulate in the blood stream plus radiation treatments that can zap those metastatic spots
and get people into extended remissions.
And the reason for the bloodstream is for micrometastatic activities? So to kill anything
that could possibly be traveling somwhere else?
Yes, so our modern scans are great, but they still can't detect things below two or three
millimeters across, so there's always the possibility of small spots that are out there
and those tiny spots are susceptible to eradication with medicines—more powerful hormonal agents,
more powerful chemotherapy treatments—and so the combination of treating the visible
spots plus getting systemic therapy to control any invisible spots is a powerful way to put
these cancers into remission.
And earlier you mentioned the word "cure" and I know that a lot of people kind of have
different definitions, but I would like to hear your definition of cured from a medical
oncologist because a lot of people think it'll never come back, and is that really what it
means? The word "cure" for this type of disease?
Well, cured means to have a stable low PSA for five years with a recovered testosterone
level. That's what a cure would mean, although there may be a small percentage of people
who would relapse after five years. Most people that are in remission for five years with
a recovered testosterone will remain in remission for the rest of their lives which is the same
thing as being cured. So, it seems counterintuitive, but we've definitely seen patients that have
gone into complete remissions for more than five years, have been able to get their testosterone
back, and their cancers haven't recurred even though they had proven metastatic disease
when they were initially treated.
So, when it comes to this transitional stage of oligometastatic, I know that kind of the
thinking is if you've been on Lupron or you've been on another drug and it's been working
for quite some time that you have time, but when it goes to a metastatic state, especially
oligometastatic, and you have these new scans that can see it, is there a new sense of urgency
that the patient should be paying attention to, that the type of prostate cancer that
they have, there's a new aggression to it?
Yeah, so there's oligometastatic disease in men that have been on Lupron and the Lupron
stops working—that's a more serious situation—and then there's men that have oligometastatic
disease that have never even been exposed to hormonal treatment, and those people have
a better outlook.
I know that a lot people can kind of—I've talked to guys on the Helpline and they don't
realize the Lupron stopped working and they're in a serious situation. "Well, it's metastatic,
you know, the Lupron has worked forever, I mean how bad could this be? It's only a couple
of mets." No, it's a different type of cancer. Let's pay attention. And it's not to freak
them out, but it is to address the issue very quickly so that they obviously don't have
further spread.
Thank you so much for watching this video; we really appreciate it. If you have questions
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