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I friend in Silver City, New Mexico, was diagnosed with PC 2008. PSA was 88.x biopsy showed most of prostate compromised. Radiological oncologist said 99% of prostate cancerous. Friend has taken Lupron for two years. PSA now 3.1. Bone scan in 2008 showed hot spot, now not so. RO said:
"The short version is that I'm back exactly where I started. The RO gave a very thorough discourse about why it would not be appropriate for me to have RT, including the fact that medical guidelines would not support it. He said I could probably find an RO who would do it, but most would not. That if he did it and something went wrong he'd be in trouble for doing non-standard procedures.
The medical niceties are that my prostate is about 99% PC; the prior pubic bone hot spot is not expected to show right now because I'm on Lupron; and I probably have other metastatic locales elsewhere. He said that even if he could zap all the PC cells in the prostrate, nothing would change in the long run. He said in my condition he would do RT only to relieve bone pain, which I don't have."
Question for today; since RO says no IMRT/IGRT nor surgery are suggested. When asked why wouldn't killing the PC completely despite the probability that there are other PC cells located in body elsewhere, be a good thing. RO said that killing PC might/would? signal other remote PC cells to start to grow more rapidly.
Anyone know what research that would support such a suggestion?
This is one of those issues (spontaneous regression is another – at the other end of the scale) that is virtually brushed under the carpet. I think this is because it cannot be scientifically proved, and that is always a significant problem for the scientific community.
If you speak to oncology nurses you will find that there is a substantial belief that the removal of the main tumour will often/usually/always result in the proliferation of distant metastasised tumours. Some doctors, like your friends RO will refer to this possibility, but usually more obliquely.
The views held by this people often concern the possibility of growth of distant cells being stimulated by the growth hormones generated by the body to heal the traumatic effects of a major surgery. There are some studies that seem to link major injuries with an increased probability of developing cancer years after the event. There are also studies that demonstrate a higher probability of cancers developing in people who have had radiotherapy, but those cases are considered to be because of collateral damage to cells from the radiation.
Dr Judah Folkman did an enormous amount of research on the issue of the growth of secondary cells, based on the premise that the main tumour had some sort of bio-chemical control over the cancer cells which did not form part of the main tumour, including those cells which may have lodged in remote parts of the body. Removal of this control could therefore result in the uncontrolled growth of the distant cells – unless the immune system swooped on the distant cells (which might now be unguarded as well as being uncontrolled).
His views were not those of the main body of medical opinion and belief and were therefore rejected, by and large. He battled on and ultimately his work resulted in a change in the basic acceptance of his views and the development of the anti-angiogenesis drugs that have demonstrated some value in controlling cancer cells.
As I say, a controversial issue, but hopefully this simplified summary may give you some insight into the issue and suggest lines of investigation you may care to pursue.
There was a study done with an internet link on it, from John Hopkins Hospital concerning using LHRH drugs like Lupron for longer useages, to supposedly help PCa morph into more viralent strains or aggression...was the message in that piece, they wrote. Sure makes everybody wonder about that. Similar talk has been said about using Avodart or proscar for longer terms. Plenty of controversy on PCa all over the place.
Dr. Barken coined the term micro mets years ago, it is PCa cells that cannot be detected by any scanning method available and could literally be in anyone with PCa. This explains recurrence or BCR failure in patients and especially guys who looked cured via surgery(or whatever) for 8-10 years and later found uncured because of such realities. Bottom line is they cannot disguish micro mets and there is no total definity in knowing if one has it, until plenty enough shows up for our less than perfect regular scanning methods. Some docs will openly admit this and plenty of them won't, of course they are selling a modality for ones possible cure. I still like total honesty and disclosures, even if it hurts to hear it.
You might want to google Bolla Abstracts Studies on PCa, it might be worth this patient to atleast know and analyze if he wishes to go that direction. I did with my case and had very lousy stats, so far approaching year 9 now without major problems...but could be on the cusp of the dragon. Some were thinking I had 2-3 years, glad that was wrong.
