Question - Prostate removal accelerate growth of metastasis?

To be honest, I've never heard of such a thing. My guess is that it is someone's "view".

My surgeon works under the premise that if mets have developed, that the value of removing the prostate may not be worth the side effects, since you then need to treat a systemic disease rather than a localized one. That makes a lot of sense. But to imply that mets are somehow worsened by removing the root of the cancer seems extremely far-fetched to me.

Thanks guys - that was my thought too, I had never heard of this but since it was on the yananow site, I didn't totally discount it.

My case seems weird to me - but I'm learning that this is such a "personal" disease and everyone is different, there really are no rules. Since I had one negative biopsy and I have only one core positive, I'm just banking on the hope that it's small - to me the only negative I have (other than having this at all) is that it's coming in at an 8 or 9. If it was a lower gleason, I'd probably go with active surveillance - I mean I literally have no symptoms and my PSA is still only going up by about .5 per year and has stayed that course for 3+ years.

Purgatory - I've read some of your info and given your gleason, you should have had a much easier time of it - my thoughts are with you!

Still heading towards surgery - that info on yananow just surprised me.

Gadget, I've heard about that with other cancers. The story I heard goes back many years and it was that some tumors secrete some as-yet-unidentified substance that inhibits the ability of metastases to take hold. Maybe it works directly, maybe it works by suppressing the growth of blood vessels that the tumor needs to feed itself and grow. (anti-angiogenesis). This was controversial; some surgeons cited anecdotal reports of patients presenting with large primary tumors but no metastatic tumors, and then as soon as the primary tumor was removed, mets popped up all over. But no one could come up with a mechanism for how this would work. So maybe it was just coincidence.

In any case, I've never heard this issue discussed with respect to prostate cancer. On the other hand, there seems to be an ongoing controversy as to whether removing a cancerous prostate after the cancer has already gotten out is helpful (the "debulking" theory) or whether it just piles on side effects without providing any clinical benefit in cancer control. That debate seems to come up fairly frequently these days, and there are smart docs on both sides of this one.

it's a good question for your doctor, assuming your doc has a lot of experience with prostate cancer specifically.

Going for brachy, that wasn't the question. I totally understand removal of the prostate after the cancer has metastasized will not remove all the mets. The article said removal would accelerate the growth of already existing mets, different issue.

And I am doing proper research before deciding.

Thanks for your note.

Thanks Jerry - great to hear from another "youngster" and someone else with a G9. Sorry to see yours came back, but your numbers are looking great! Good luck man.

Jerry, I went from 1.8 in late 2008 to 3.56 now. Last May, 2011 I was at 2.9, so in almost a year I'm up about .65. Again, right now at 3.56.

Seems low but I've been taking propecia for about 12 years so I know that lowered it. Even so, the velocity is pretty slow.

No problem, it's nice to have someone to bounce things off. My biopsy was March 16. One core out of 13 positive and depending on pathology report one says 15% and a second opinion says 40%.

I also had a biopsy in may of last year and it was negative. So I don't get the feeling it's all over my gland.

Thanks again!

Thanks again Jerry, sorry for the late reply - I finally put down the phone last night :)

So I had an MRI before I had the biopsy so the doctor would know where to aim when doing the biopsy. Since I'd already had one negative biopsy, he wanted to make sure he was targeting anything that looks suspicious. My DRE is totally normal too. Then I had the biopsy on March 16. The results from Northwestern said it was a 3+5=8 and involved 10% to 15% of one core out of 13. I sent my slide (I thought I was sending all of them, but NW only sent the one positive slide) to John's Hopkins. Hopkins said the slide is a 4+5=9 with 40% involved. I'm a bit nervous since NW is so different, what if they missed it in the other cores - although as someone did tell me, that would be grossly incompetent if they did, it's one thing to get the Gleason score a bit off, but to say a core is clear and benign when it's not is a whole other story.

Anyhow, after that I've had the obligatory CT and Bone Scan. The nurse told me both where fine and clear, but when I had her send them a few things looked off to me - I see the Doctor tomorrow for my consult, so I'll get all my questions answered, just hate the waiting.

The Bone Scan said:
"There is a focal area of decreased density with centrally increased density noted in the medial aspect of the left iliac bone, adjacent to the left mid-sacroiliac joint, on the concurrent CT study referenced above (series 2, image 51 and series 3b, image 90). However, this finding is not associated with an area of increased MDP uptake on the current study, making a skeletal metastasis in this location less likely. In addition, the appearance of the lesion on CT is not typical for a metastatic lesion from prostate carcinoma.

While there is no definite evidence of skeletal metastases, radiographic correlation and/or other further imaging is recommended for any clinically relevant sites, such as the focal finding in the left ilium described above, although as discussed above, this finding is not typical in appearance for a skeletal metastasis, and in addition, is not associated with increased tracer uptake. Correlation with the serum PSA level is also recommended. "

The CT scan also said:
"The liver is normal size. There is no intrahepatic mass. There is a tine low-density focus in the dome of the right lobe of the liver on image 8/2 which is too small to characterize"

Both of those notes make me nervous. I am totally planning on surgery and I think I'd go through with it even if it turns out to have spread, I do think there is something to getting the main source out and with being an 8 or 9, there is something to be said for giving it every treatment possible - one of them is bound to work or the combination is bound to knock it out. The note on the yananow site was off to me, I had never heard that or seen it discussed on any forum.

I really have no symptoms, which is what makes this almost more surreal - the only thing telling me something is wrong is the tests and the doctors.

Again - thanks for the feedback - and seeing how you were a 9 and doing well certainly gives me some hope :)

Gadget,

I've been thinking about this throughout the day.  Trust your doctor/radiologist.  They know how to read the scan results better than anybody.  If something was positive, it would be obvious.  My CT and BS showed the one spot I had very clearly.  I know this may be driving you crazy, but I would concentrate on what you do know - 1 core (btw-I had 8), small amount of cancer found, good DRE, and really no evidence of anything outside the prostate. 

You said: ..."and seeing how you were a 9 and doing well certainly gives me some hope"

 

Are you kidding me?  You have a lot more than hope.  You have facts.  The odds are in your favor to deal with this now and move on with your life.  Let's concentrate on preparing for surgery. 

Keep us updated and if you need anything, do not hesitate to email me.

Thanks,

Jerry

 

 

Never heard of the idea that removal promotes growth of mets.
Now I'm no expert, and have seen no evidence, studuies, research etc on which to base this suggestion I'm about to make, but after a little thought about this I was wondering if there might be a way to make the possibility make sense.

My hypothesis could/would I think apply to all cancers and not just PCa.
As far as I know what a cancer does or can do is in some way usually related to what the immune system does (or does not do)
Thus just suppose that at the point at which you have your primary treatment the cancer has already spread, but those mets are undetectable because they are only at the microscopic/cellular level.
Then the primary treatment in some way affects your immune system. For example due to antibiotics that you have to take after surgery, or stress, or changes to diet, exercise lifestyle, tiredness etc. (And if your primary treatment is Radiotherapy then that can definitely have an effect on your immune system.)

Thus after primary treatment the body might be (momentarily/temporarily) weakened and with the guard down the mets take advantage of it and get worse.

Does that sound possible? After all we all talk about making sure we are as fit and healthy as possible before having surgery RT etc, and many of us have mentioned how we have had to struggle with other health problems after treatment (eg even simple things like a cold making you feel sicker, or taking longer to go away.)

Alf