Why is Metatastic Advanced Prostate Cancer incureable?

Basically, yes. Most cancers, PCa and others, will become incurable by current medical methods as the cancer continues to mutate and evolve methods of surviving the treatments. For many cancers their death comes only when the host dies. The problem with metastatic disease is that we really can't find all the cells to treat them and many systemic treatments do not kill all the cells. Treatments are toxic and the balance must be found to manage the cancer without killing the person.

An exception to this may be the Gleason 6 variety of prostate cancer. In and of itself, it can't live outside the prostate so it can not form tumors elsewhere. So it is a cancer that is more easily cured by either surgery or radiation. But, since it won't spread and do damage, it really doesn't need to be cured. It is a cancer we can live with, and many men both knowingly and un-knowingly do so. However, some G6 may become a G7 (or worse), or a G7 (or worse) may develop alongside the G6 and then must be treated and, hopefully, cured.

It is known that the vast majority of prostate cancers can be managed for a long enough time that they do not cause premature deaths. The really aggressive, untreatable PCa that causes premature deaths is, thankfully, not very common.

gleason 6 can as a gl6 spread and do damage...all cancers spread unless in remission...what is different is a gl6... is where it can spread...inside the prostate...into the bladder neck and bladder...and I believe also ...if enough has spread in the prostate itself... and goes out toward the rectum...caution this is an internet site and wrong information can spread easily...from every single one of us...

Sally,

One reason that prostate cancer -- and to some extent breast cancer as well -- is different from other cancers is that it occurs in tissues that grow in response to sex hormones. The presence of testosterone tends to make prostate tissues grow (even normal, non-cancerous tissues) and if you eliminate the testosterone the growth stops. This dependency on hormones remains, in varying degrees, in prostate tissue even after it becomes cancerous. If you eliminate testosterone then most prostate cancer cells will stop growing... most will, that is, not all. Over time those few cancer cells that don't need testosterone to grow will come to predominate in the tumor and growth will resume despite castrate levels of hormones. That's an over-simplified version of how resistance develops over time (usually a few years).

Hopefully your husband's cancer will respond well to the hormones and the chemo. As you said, his cancer is incurable, but there are a lot of new treatments in the pipeline and his current treatments will buy him time for new treatments to emerge.

Thank you everyone for all the info.

So does this mean that with a Gleason of 9 - made up of 4+5....
The cells that are 5 are unlikely to be responsive to hormone treatment (or even if they are they will be become resistant very quickly.)

Apologies for my basic queries - I'm just trying to learn as much as possible.

Let's hope so Akai

Sally-

It's not just prostate cancer, there are very few cancers that are curable after they have metastasized to distant sites. The hope is that they can be controlled for a long time.

Metastasis means that the cancer cells have evolved to live outside of the original tissue in which it formed. Such cells are in circulation everywhere - in the blood, lymph, and in tissues. Sometimes they clump together to form visible masses, but most are invisible. That's why treating visible metastases doesn't accomplish anything other than pain palliation - there's always more out there. The only therapy that helps is systemic therapy - like hormone therapy, chemo, nuclear medicine, immunotherapy, etc.

Gleason score only refers to prostate cancer cells within the prostate, not metastatic cells. (Metastatic cells don't have a Gleason score.) It refers to the breakdown of the tissue architecture as the cancer evolves. Actually, higher Gleason score tissue seems to be more responsive to hormone therapy, at least when combined with radiation. At some point in the cancer's evolution, it undergoes a genetic transition (called EMT), which enables it to live outside of the prostate and form masses. Metastatic PC cells continue to be responsive to hormone therapy for a long time. Eventually, they undergo another genetic change (called castration resistance), which enables them to thrive even with little or no androgens.

Because metastatic cancer cells have undergone genetic changes that enable them to replicate very quickly, they evolve at an accelerating rate. For every "cure" we try, some cells will have worked a way around that cure, and those cells quickly populate to replace any cells that have been destroyed. It's worse than this - they send out signals to non-evolved cells that "teach" them how to evolve to evade the therapy. They also "teach" healthy tissue, like bone, how to be a good host to cancer cells. It's what we call a "complex adaptive system" of interacting cells. On top of this, our adaptive immune system soon recognizes the PC cells as "self" and stops any attempt to attack them. I doubt that there will ever be a simple cure. Our best hope is to maintain the complex adaptive system in a state of dynamic equilibrium for increasingly longer time periods.

"really usefull" ain't it dat trute