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Thank you for this post, Sir Ed. It will no doubt be very helpful for some. For those who do no subscribe to the E-Letter, I did cover the issue of so called micrometastasis and systemic disease brifely in E-LETTER 9
Thanks for that reminder. It made me search "micrometastases" and see what the latest expert thinking suggests. There seems to be a lot of interest, research proposals but no conclusions as yet.
The term seems to be a generally recognised one now; I think we can drop the "so-called" tag. It also seems to be generally the case that these micromets have found their way to distant parts via the lymphatic system, leaving traces in the pelvic lymph nodes. Finding those traces is a good indicator that there are micromets.
What puzzles me is that my lymph nodes were clear. Can anyone reconcile that fact with, say, micromets in the pelvic girdle (which I suggest is the most likely lodging house for them)or other bones?
Alternatively, might my assumption that a PSA of 0.5 is explicable only by micromets be wrong? We know, after all, that the PSA is not prostate-specific. Anyone know how else a reading of this level might be generated when the prostate has been removed?
You ask What puzzles me is that my lymph nodes were clear. Can anyone reconcile that fact with, say, micromets in the pelvic girdle (which I suggest is the most likely lodging house for them) or other bones?
Some years ago one of the Internet doctors – from memory either Snuffy Myers or Stephen Strum explained that although the most common route for prostate cancer to progress was to lymph glands and from there to pelvic girdle and from there to other further destinations, the cells did not always stay in these spots. Or perhaps more accurately were not always FOUND in these spots. In another discussion Strum described how prostate cancer cells were found in the marrow of distant bones with no evidence of how they got there. Of course these are not scientific studies but the views of experienced practitioners, but I’d say that they reconcile the issues you raise, if they are correct.
Alternatively, might my assumption that a PSA of 0.5 is explicable only by micromets be wrong? Yes it could be.
Anyone know how else a reading of this level might be generated when the prostate has been removed? There was a long discussion on this forum in 2007 which you might find of interest Explanation for nondecrease in PSA despite prostatectomy? and there have been other discussions both on this Forum and others about what seems to be an increasing phenomenon of slowly increasing PSA after surgery (or maybe it has always been there but now that men exchange information on the Internet it has come to the surface). One of the views put forward, and supported as a reasonable thesis, is that the margins of the gland that may be left behind – perhaps as part of the nerve sparing aspect of surgery – start re-generating and it may be as part of this process that PSA is detected. That’s the optimistic theory. Alternatively, the pessimistic theory is that some prostate cancer cells were left behind and it is they that are generating the PSA. Yer pays yer money and takes yer choice.
Not much direct help I know, but food for thought.
Terry,
Another very helpful reply and I read through all the back posts you suggested. It seems to me that
1. Five weeks after prostate and bladder removal may be too soon for all of the PSA generated prior to surgery to have dissipated or for healing to have been completed. The next test in three months should be more meaningful (and based on what others have reported the number could be up, down or much the same without necessarily implying micromets).
2. As there are no rules to this disease, only time will tell whether a problem persists. There should be plenty of time!
3. A PSA 0.5 after surgery may turn out to be my "natural" level, but if it should rise there are loads of treatments available to keep it under control for years. My Urologist remarked that he felt sorry for those who have had to wait so long for abiraterone, because now there are so many better treatments available, off the shelf or on trial.
Aloha Sir Ed Netta,
I don't have any experience that may help you with your questions. One point I wish to make is about the bladder. My Sept/Oct 07, EBRT/IMRT caused so much damage to the bladder & the prostatic urethra that they (bladder/prostate) had to be removed in July this year. My radiation dose was quite high and MRI's taken before July did not show any PCa, but did show what was believed to be bone damage caused by the radiation. The pathology report on the bladder/prostate found no PCa. As usual, individual treatment experiences do vary a lot and my EBRT/IMRT obviously did more damage than planned, even though each treatment was proceeded by an ultra sound to verify positions of bladder and rectum. The rectum & anus were also damaged and are causing some minor problems.
Hang in there,
Joe
Joe,
I don't think the EBRT should cause bone damage. You might want to try and get your medical records and see what they did for your radiation treatment. The bones should get at most one-third of the radiation that is directed at the prostate. It is possible that with Gleason 9 they decided to give the whole area a very large dose of radiation. That may have been a good idea for improving life expecancy but not so good for your quality of life.
Sir Ed,
Dr Jelle Barantzs in Holland has done a lot of research into lymphnode PC and he was the doctor that developed the Combidex scanning for Lymphnode pc. He found in his research that small amounts cancer are very hard to detect in a lymphnode by a pathologist. There are also two different paths pc can take through the lymphatic system. The more common path is the one most commonly sampled, but the secondary path through the seminal vessicals is rarely sampled but is commonly seen when seminal vessical invasion is present. This research was conducted in Germany and Holland a few years ago in conjunction with the testing of Combidex's effectiveness and involved hundreds of patients that had their lymphnodes removed and subject to pathology after scanning. Lymphnodes that were found clear by pathologists were again closely reviewed if they were shown to be involved by the scan ,and in way to many cases the second pathology found the cancer the scan had identified. Lymphnode pathology is only accurate when the cancer in the node is fairly obvious, pathology has a difficult time identifying micromets.
