prostate biopsy

I have a theory that my prostate biopsy caused the spread of cancer around my prostate.
does it not seem reasonable that when you do a biopsy and that needle gun blasts your prostate and you bleed and bleed that the cancer cells will travel in the blood inside your pelvic area and cause the cancer to spread? it sure is strange that my psa was 5 when I had my biopsy then after my surgery it shot up like a skyrocket, I know there are other theory's on other possible causes for this effect, but it does make me wonder...


jack

jax,
There is no evidence to support your theory. This question has been looked at many times by researchers and no one has found that biopsies spread cancer. Given your own case unless you had surgery several years after your biopsy, there is no way in just a few months it could have spread to both the seminal vesicles and the lymph nodes. The fact that you had a positive margin indicates the tumor was large enough to pierce the capsule and spread on its own.

Post Edited (John T) : 9/20/2014 10:14:08 AM (GMT-6)

Not all pos margins are due to surgeon error. If the tumor has spread into the fat around the prostate, cutting into the fat will result in pos margin. The surgeon can only cut so far without risking cutting into the bladder or other adjacent vessels and nerves. That's what happened in my case and probably in yours since you had SVI and lymph node involvement indicating spread outside the capsule.

Not sure why they cannot tell exactly where the cancer is if you were to have a F18 sodium test.

There's probably some closer to Fontana CA in LA but I had very good experience with Dr Fabio Almeida at AZ Molecular Imaging in Phoenix.

If the F18 test shows anything suspicous but not conclusive you could follow up with a C11 Acetate but the latter is fairly pricey at $3,000 and not covered by insurance.

LupronJim

Jack,

I understand your conundrum. For now, while you're on Lupron, the cancer is mostly under control and I guess the side effects of the Lupron are more tolerable to you than what you imagine the side effects of salvage radiation to be. However, progression is inevitable with this strategy, and there are probably some castrate-resistant cells in there already.

There are some imaging techniques that can tell you where the cancer is, and more importantly, where it isn't. If it has metastasized to bone, there is little value in salvage RT for you. You can find that out from a bone scan. But to do that you'd have to come off Lupron and let your PSA rise to about 20, lower if it's rapidly rising. Letting it rise that much can be problematic.

Medicare and some insurance will cover a NaF18 PET scan sometimes. It is becoming more widely available - I know USC gives them. You can detect bone mets with a lower PSA, but at least 2, or rapidly rising. Check with insurance/Medicare to get pre-authorization.

With a C-11 Acetate PET scan, you can probably detect any mets with a PSA over 1.2, or rapidly rising, so you don't have to go off the Lupron for as long. But that lower detection limit will cost you. You can get a C-11 Acetate PET scan at UCLA for $2,400 out of pocket.

If the PET scan detects no bone mets, you have greater assurance that salvage radiation will be curative. And with your Gleason 7, they probably won't keep you on Lupron all that long. Since you are already continent, you have a good chance of staying that way. Since Lupron is already obliterating your sex drive, that doesn't seem to be your major concern about side effects. Which side effects of salvage radiation are you concerned about? I don't know anything about your age and co-morbidities.

- Allen

i wondered something similar. in 2008 my psa was 3.4 (negative biopsy) 1 yr later psa 19.8 (biopsy positive) I asked two doctors if the biopsy in 08 caused the rapid spread to the next year... Both said 'no' that it's not possible? But i still wonder.

jaxum said...
i am afraid of the bloody bowel problem, incontinence , further nerve damage

Those things can happen (except the nerve damage - radiation affects blood vessels rather than nerves), but usually are tolerable and transient if they do happen. The healing time you've had since surgery may help a lot too.

Memorial Sloan Kettering studied the rectal and urinary complications of men who had salvage IMRT radiation. A "Grade 2" complication is one that is resolved without surgical intervention or with meds; e.g., Flomax for urinary frequency or urgency. Grade 3 complications are ones that require some intervention; e.g., catheterization for urinary retention. Late complications are ones that occur several months to several years after treatment. They found:

• late Grade≥2 rectal complications: 2%, resolving on their own in 38% of those cases
• late Grade≥2 urinary complications: 17%, resolving on their own in 44% of those cases
• urinary incontinence: 14%
• erectile dysfunction: 26%

Improved Toxicity Profile Following High-Dose Postprostatectomy Salvage Radiation Therapy With Intensity-Modulated Radiation Therapy

- Allen