Your question is extremely difficult to answer because it's impossible to predict how somebody will respond to chemo. I have met folks who had lymph node involvement (stage IV), had chemo and have gone on to get years of quality, cancer free time. Micromets are better than visible mets, that's for sure. There may be something to the concept of 'tumor load', meaning the smaller and less cancer the more likely you'll see long term survival if there is initial, continuing response to chemo.
I guess the truth is that some cancers are just more aggressive than others. Or so it seems...
As far as gold standards, the chemo(s) of choice are in a state of change, from the 4 drug cocktail MVAC to a 2 drug combo of Gemzar (gemcitabine) and a platinum drug, preferable cisplatin, second choice is carboplatin which is less toxic. This drugs are said to be just as effective as MVAC with less toxicty. Still, toxicity is also a relative thing, depending on the general health of the individual, though it's said that age should be a factor with this newer combo. Otherwise, if someone is not in good shape, Gemzar alone is sometimes used. This is a pretty new drug used with many cancers these days and is one of the least toxic chemos out there today.
My father was diagnosed for Grade III, invasive bladder cancer in Nov. 05. He underwent a neo-adjuvant chemotherapy (2 cycles - abnormally ended due to sharp fall in his platelets), followed by the operation in March (bladder, prostate & 6 lymph nodes removed). Biopsy revealed that chemo worked well with the tumor (muscle was clean), however the un-detectable micrometastases obviously reached 3 out of the 6 lymph nodes through the blood (they were found to be 0.3-0.5 cm). His oncologist wants to start 4 cycles of chemo, however he's lost lots of weight and he's still not in a shape for it.
Although I researched on the web a lot, I cannot get a clear picture of:
1. What are the odds for long term survival
2. What is the gold standard treatment for this case
I would more than appreciate if somebody can help me on this