There’s a mouthful for you.
I had seen the term bantered about in one of the online support groups that I participate in, and one of the members posted a link to a video [below] put together by the Prostate Cancer Research Institute featuring Dr. Eugene Kwon from the Mayo Clinic. While this may be old news to some, it was new to me, and it was definitely worth the 29 minutes to watch—I learned a lot.
First, oligo means scant or few, and when cancer metastasizes, it doesn’t metastasize throughout your entire body all at once. It’s not like throwing the switch on the national Christmas tree so your whole body lights up in a scan. It starts small and spreads from there. The hypothesis is that, if you treat those early oligometastatic locations, you are much more likely to have a successful outcome. As Dr. Kwon says, it’s a lot easier to kill something small than it is to kill multiple resistant larger tumors.
Second, imaging technology has now advanced to the point where those oligometastatic sites can be identified for treatment. Interestingly, in Dr. Kwon’s experience, only 30% of the cancer that comes back is found locally in the prostate bed. To me, that is hugely important. (For the remaining cancer, 54% is distant metastases and, in 16% of the cases, the metastases are both distant and local.)
The current standard of care is to start salvage radiation therapy (SRT) without the benefit of advanced imaging, zapping the crap out of the prostate bed, with an apparent seven in ten chance that it won’t be effective. And, as an added bonus, you get those potential life-long side effects from the radiation.
Of course, after (or in conjunction with) SRT is androgen deprivation therapy (ADT). It’s palliative in nature and only prolongs life with even more side effects.
Dr. Kwon asserts that, if you go after those early oligometastatic sites—surgically removing “hot” lymph nodes or spot-radiating affected bones—those treatments can be more curative in nature. Curative is certainly better than palliative.
You can rest assured that I’ll be investigating more of this in the future and discussing it with my doctor in April.
Dan's Journey through Prostate Cancer 
I believe this is the physician that my Ex has at Mayo. He has now had prostrate cancer for 20 Years. Currently his psa is zero. He had some of the lymph nodes removed a few years back. He highly recommends this dr.
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Thanks for the insights, Daniece!
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Hi Dan, thanks for sharing the info. Cheers, Phil
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Gladly, Phil. I find it interesting and a bit intimidating that there’s so much to learn about this disease out there, but the best part is being able to learn from each other. Dan
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This is the path I first chose when I was diagnosed stage IV with three small spots on my spine. My oncologist wanted me to wait, but I wanted to get rid of it. I was irradiated for six weeks. The radiation greatly irritated my stomach and or intestines. I had horrible nausea. It turned out to be one of the worst experiences of my life. My PSA dropped precipitously, but within 2-4 months climbed right back up to where it was. I was so crest fallen. Looking back on it, I wouldn’t do it again.
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Sorry to hear that, Jim. Did the radiation kill the spots on the spine and did they find the source of the PSA elsewhere, or did the spots just continue to grow after radiation?
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We didn’t do a subsequent scan, because he was sure it got the spots on my spine. The oncologist just thought it was from cancer in my bloodstream.
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Interesting. Thanks for sharing. It’s maddening, isn’t it? (But I don’t need to tell you that.)
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Dan, my husband is 48 and dx with stage 4 with high vol mets to bones and lymph nodes at dx in july 2017. He just finished chemo 2 weeks ago and next week we go back for the anxiety stricken scans. I called Dr Kwon to see if we can get a consultation (trying to be proactive vs reactive) and I was told that since he is under treatment (HT) he cannot be seen. Um, Im sorry he is stage 4 of course he is going to be on some treatment! Well her response is when he is finished with that contact us again….. umm Im sorry Hes stage 4 with mets to bones and lymph nodes he going to be on HT I want to be ahead of the game so that time will not be against us if it becomes resistant… This cancer is horrible! I am prepared to continue fighting with my husband. He too is fighting as he has been training for an IRONMAN.
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