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Posted 2/10/2010 12:02 AM (GMT 0)
I have seen several contradictory references on this board to something that I've always wondered about -

All other things being equal, is it true that the longer it takes after surgery for biochemical recurrence to occur, the more likely it is that the recurrence is local?  Or the more likely it is that the recurrence is metastatic?

Thanks in advance.

Zen9 

Posted 2/10/2010 12:19 AM (GMT 0)
From a layman's point of view (and No, I dont play a Doctor on TV or anywhere else). It all depends on 1) if any cancer cells remained behind after surgery/rad, and 2) if they did and got into in the blood stream or found a place to reside near the origin. Either way it's metastatic and the biochemical recurrence will take the same amount of time, the only question being how much cell reproduction goes on before a measurable PSA is observed. In my case I hope the rad I had for a "close margin" took care of any lingering cells at the original site. If one got into my bloodstream and grows, oh well, those're the cards I was dealt.

Post Edited (zampilot) : 2/9/2010 6:56:39 PM (GMT-7)

Posted 2/10/2010 12:43 AM (GMT 0)
When I read the Partin table it depresses me, given my less than 2 year reoccurance, gleason score of 8. Not sure what my doubling time would be as my 3 month was .01 and then 6 month .4 and 6 1.2 moonth .5. Hope that I will beat the odds but will livestrong until told otherwise.
Michaeel
Posted 2/10/2010 3:28 AM (GMT 0)

Zen9, I haven't posted in quite a while, but I just saw your question wasn't really answered.  My understanding is that the longer it takes for biochemical recurrence after surgery, the more likely it is that it is a local recurrence.  It seems to me that a metastatic recurrence wouldn't necessarily have any timeframe relationship to surgery.  So, if you have metastatic disease present, and then you have surgery, your PSA would drop as a result of the removal of the prostate, but your metastatic cancer would continue to increase PSA and be evident soon after surgery.  On the other hand, if you didn't have metastatic disease, then after your prostate was removed, your PSA would drop significantly and any cancerous prostate tissue "left behind" would need time to grow to increase its PSA and become evident as a recurrence.  This could take years perhaps, however it would still be local.  I could be wrong about this, however, so if someone more knowledgeable chimes in, that would be good.

Posted 2/10/2010 4:05 AM (GMT 0)
MichGuy, you got it basically correct.

For this more detailed response, I refer to Dr Patrick Walsh's book, "Guide to Surviving Prostate Cancer", and specifically to the chapter "How Successful Is Treatment of Localized Prostate Cancer, and the sub-section on "What Should I Do If My PSA Comes Back After Surgery"...

Walsh references a study by Alan Partin which characterized men post-surgically prone to either local recurrence or distant metastases.  Keep in mind that these were simply characterizations and not definative.  The findings were:

Men prone to distant metastases generally have one or more of the following characteristics:

  • Gleason scores of 8 or higher,
  • cancer found in their seminal vesicles and lymph nodes during surgery, or
  • rise in PSA within a year after surgery.

Men more likely to have local recurrence of PC had one or more of the following:

  • Gleason scores of 7 or less,
  • no cancer found in seminal vesicles and lymph notes, or
  • increases in PSA several years after surgery.

--------------------------

I agree that the time-based element of MichGuy's response is basically correct; that is, the small amount of PC cells left behind locally may need some time to multiply enough times to produce measureable amounts of PSA in the bloodstream.

 

Posted 2/10/2010 5:48 AM (GMT 0)

Hey Michigan Guy:

Just curious-- where are you in Mi?

Mel (another Mich Guy)

Posted 2/10/2010 2:10 PM (GMT 0)
And that was my point in my earlier post, although I didnt express it very well. If you look at the Partin tables, you appear to have a very long life ahead of you and I wish you the best.
Michael
Posted 2/10/2010 2:29 PM (GMT 0)
It is hard to find any hard studies on this topic. There is a fair amount of anecdotal opinion, and theory.

Obviously I like Walsh's opinion, and I am cheering each low psa reading I get after surgery.

In my own case, I have reasoned that since my PSA dropped to zero after surgery, most all of the PC was local. However, that doesn't mean some cells haven't set up house somewhere else and are starting their little family. I am thinking that if I go a year or two with low PSA, and then it starts to climb, the little buggers have started in another location.

I am hoping they find a better diagnostic way of finding other concentrations of PC cells that can then be targeted. I know there is a technique they use with white cells, that they take from the body, treat them with an isotope, reinject them, and then scan for concentrations.
Posted 2/10/2010 2:55 PM (GMT 0)
Maybe I'm just slow this morning, but I think I am still getting contradictory answers: MichGuy and Casey59 (more likely local) vs. goodlife (more likely distant).

Maybe contradictory answers are appropriate because my question is too simplistic and there are too many variables to reach a consensus.

Anyway, I really appreciate everyone's answers.  If anyone else would like to weigh in, I would love to hear from you.  I don't get to post much any more because I am too busy trying to save my job.  I hate this Depression (let's call it what it is).

Zen9

Posted 2/10/2010 3:15 PM (GMT 0)
Zen, I'll reiterate that Walsh (actually, Partin) provided "characteristics", and these are not definitive. Different cases could either follow or not follow these characteristics. For example, distant mets might still be so small as to NOT immediately show up on post-surgery PSA testing; Partin's study found that generally they do show up.

I'm not sure I fully understand goodlife's technical description of his personal theory about how the "...the little buggers have started in another location."
Posted 2/10/2010 3:22 PM (GMT 0)
Off topic, but to answer Compiler's question above:  I'm in Ann Arbor, MI.
Posted 2/10/2010 3:38 PM (GMT 0)
Casey,

What I have been told is that it takes several million PC cells before enough PSA is produced to register above .01. If a few cells escape, and they learn how to live outside of the testosterone rich environment, it may take 1 , 2, who knows how many years until they get a large enough concentration to begin registering PSA. I reason that most likely, they are not in the proatate bed any more.

It's ok, you can laugh. I'm a troubleshooter kind of guy, and I have to visualize what the problem is before I can fix it. Works at least 50 % of the time.

As I said, I haven't found any hard studies on this topic.
Posted 2/10/2010 3:48 PM (GMT 0)
goodlife, I think you just repeated the atypical example I also provided. I wrote it this way in my most recent posting in this thread (with the word "DO" capitalized this time for emphasis): "For example, distant mets might still be so small as to NOT immediately show up on post-surgery PSA testing; Partin's study found that generally they DO show up."

For those looking for more detailed info, pubmed might be a good source...
Posted 2/10/2010 4:27 PM (GMT 0)
I was told by my uro that the first early psa test after surgery is to confirm no systemic disease (provided no lymph node or seminal invasion). If the psa comes back undetectable, then any subsequent rise will be local. If a positive margin is noted, then most certainly will be local. The caveat to all of this....if systemic disease is present, then normally the psa level will not drop below detectable limits after surgery.

So the short answer...if the psa comes back after being undetectable and there is no lymph node or seminal invasion, the disease can be considered local. This is the reason most surgeons want a psa test shortly after surgery, usually within 3 months.
Posted 2/10/2010 7:37 PM (GMT 0)

Zen,  I discussed this issue with my uro last month.  His thoughts were generally the same as Casey's.  But, he believes that men with high gleason scores are more difficult to diagnose.  He says that should I have a recurrence he will probably recommend a ProstaScint scan to try to locate the source.  The scans are controversial to some degree but only becauses it takes a very experienced person to read the scan.  With today's technology, it is very easy to send the electronic images to the most experienced doctors.  He believes he has access to the best in the world. (I'm starting to sound like James and Tony).  I'm with goodlife and his thinking with this.  If I do have a recurrence, I would really like to know where it is.  I would hate to have 2 months of SRT at my age and not be any better off.  This is a link to some info, www.prostate-cancer.org/pcricms/node/171.

Carlos

Posted 2/10/2010 7:44 PM (GMT 0)
Casey,

I certainly am not disagreeing with you. I think that some of this depends on the PSA plot from pre-surgery to the current point in time. And we know that PSA detection doesn't always follow set rules, I.E., some tumors apparently put out different amounts of PSA than others, or the PSA is encapuslated in the tumor.

The whole question still remains, where did the PC cells land if they escaped? If they landed in the prostate bed, we would call them local, altho I think technically they have gone systemic, in that they are no longer in the prostate. If they have travelled away for the bed, where SRT will not get them, then they are truly systemic, and therefore untreatable with today's treatment methods.
Posted 2/11/2010 1:38 AM (GMT 0)
I half to agree with Goodlife once cancer cells have gotten out they [dr's]have no clue where they are likey to go.i have had two. Prosticty scans isotons injected trying to find where the PC cells went .so it's just a roll of the dice as far as i'm concerned.bucky Ga.
Posted 2/11/2010 1:41 AM (GMT 0)
I half to agree with Goodlife once cancer cells have gotten out they [dr's]have no clue where they are likey to go.i have had two. Prostascint scans isotons injected trying to find where the PC cells went .so it's just a roll of the dice as far as i'm concerned.bucky Ga.
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