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A subject I have often wondered about is this risk of cancer spreading. I know there is a concern about cancer cells "escaping" during the RP procedure and going to other parts of the body. This makes me wonder if one left behind cancer cell isn't just as dangerous as having a full blown tumor. Is one "seed" of cancer just as dangerous as a whole "crop" as far as danger from spreading and growing? Could that mean a low PSA is potentially just as dangerous as a high PSA? It is a terrible idea to worry about and I wish I wouldn't be thinking about it but can't help it. Jon.
From what I have read, lower pre-surgery PSA is an indicator of better overall results. That fact also seems to hold for the outcome of secondary treatment after biochemical relapse.
It seems that there is a chance, not sure of probability, that cancer cells can escape the capsule during surgery.
My surgeon told me my prostate was really beat up from the biopsy 2 months prior to surgery. Not sure he did a great job as he left multiple positive surgical margins. The presence of positive surgical margins are supposed to have a reverse correlation to the skill and experience of the surgeon.
Too bad they haven't come up with a way to treat the surrounding area after they have finished operating with some sort of cancer killing agent before they "close". (Sort of like weeding a garden and then spraying for good measure after you have physically removed all the weeds.) That is kind of what they are trying to do with salvage radiation but why not do something like that when they are physically "in there" removing the prostate and the area is so accessible. Jon.
I've read that a lot of this has to do with the color vision of the surgeon (and experience); the variation between subtle pastel shades of tan and yellow seem to be important when trimming prostate margins that are suspicious.
As for Weed-b-Gone for the prostate, lol, that sure would be nice. But if they had that available, wouldn't they be using it instead of surgery? More like a vaccine or similar preventative therapy?
Still not quite sure I understand the logic that some surgeons will do mastectomies prior to diagnosis, but not a prostatectomy. I asked my first uro doc about this, and he just chuckled. Years later I realize I should have taken his complacency for what it was.
I wonder how many would actually remove the prostate as a preventative measure to keep from getting cancer - like some women have done for breast cancer. I guess there might be some but I would think very few informed men would opt for that. They can rebuild breasts fairly well but not so with prostates. Once gone, you are SOL. Even with perfect nerve sparing and success in every phase, it would still not be what it was before. (Many of us went through that being circumcised as an infant but never had the chance to experience what "before" was like.) Jon.
Apparently from what I read a few lower grade cancer cells ( gleason 5 or 6 )left over after surgery will have trouble taking hold anywhere and shouldn't pose a problem down the road. Higher grade cancer cells that are spilled are unfortunately more apt to start a new settlement and cause trouble at some point after surgery. That is why the most important thing if considering surgery is to use a surgeon who possesses great skill. One could extrapolate perhaps that 'watchful waiters' could be potentially at increased risk post surgery ( compared to when they were diagnosed ) if cancer cells are spilled as their cancers may become more aggressive as they wait. Delicate balancing act of risk vs reward.
At this point, I have no Gleason; just a high PSA and negative biopsy of a large prostate. That is a good thing for me, I guess. One upside is that NIH studies show men with higher prostate size generally see better LUTS results with drugs like finasteride. I'll get around to filling that script once the swelling has diminished. 10 days later still recovering from the needles (blood & very mild incontinence); pretty sure I don't envy you guys that have had real surgery.
My docs are flummoxed. While they agree BPH can cause high PSA, I'm way out there statistically. None want to say "yes" unless the pathology agrees, but I can tell in their faces they believe differently.
I've been around since my PSA jumped from 2 to 18+ in 2009... but with declining health I'd normally expect only with a cancer. Pretty sure BPH doesn't have that side effect, so I'm not going to chase my PSA any more. I need to stop worrying if only to keep what's left of my sanity.
If you have a G6 there is no reason to worry as G6 cancers rarely matastize. A higher grade cancer will mastastize and is highly dependent on tumor volume.
A cancer takes 44 doublings from inception to death. It can be detected at around 30 doublings when it is the size of a pin head. It stands to reason the more cancer cells you have the faster the tumor will double in size, so it stands to reason that smaller tumors are less likely to matastize than large tumors. Reducing the volume of a tumor through surgery or radiation will extend life expectancy unless the cancer has already matastized to other parts of the body.
There has been some really informative responses to this question! The more I learn about this disease, the more confused and full of questions I seem to get. Cancer is called a disease and yet it is something you don't "catch". It originates in your own body from a malfunction in (DNA?) as I understand it. Once "mutated" cells are allowed to move to another part of the body and establish themselves even though they are not the type of cells that belong there. Just doesn't seem right that they can do that and be allowed to survive. It is just a train wreck! After thirty times doubling, I just read, the tumor is only the size of a pin head! Does that mean this thing starts at a very early age and takes many years to become significant - if at all? Maybe this is why doctors are so hard to get answers out of. Are we just better off being blissfully unaware of details? The more we learn, the more we wonder about. Kind of a fruitless endeavor I guess. Best to all! Jon R.