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Can invasive procedures spread prostate cancer?

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Posted 1/8/2015 4:17 PM (GMT 0)
A single case report (from UCSF) of cancer inoculation from an HDR brachy catheter led me to look into what is known and unknown on this subject. There have been case reports of spread from biopsies, surgeries, and seed placement too. The risk seems to be small, but it does raise a caution to choose a very experienced and careful surgeon if one is going that route.

Can invasive procedures spread prostate cancer?

- Allen

Post Edited (Tall Allen) : 1/8/2015 9:31:22 AM (GMT-7)

Posted 1/8/2015 4:25 PM (GMT 0)
Allen, I for one will be VERY interested in your findings.
Posted 1/8/2015 4:32 PM (GMT 0)
D'Oh! I forgot to add the link. I added it now above.
Posted 1/8/2015 4:35 PM (GMT 0)
I guess if you "cut through" there's always a chance of some cells breaking off. Experience should certainly be paramount in the selection of a surgeon.

Cheers, Doug
Posted 1/8/2015 4:53 PM (GMT 0)
Cause we don't have enough shxt to worry about!!
Posted 1/8/2015 5:20 PM (GMT 0)
so we should only do EBRT without a biopsy...
Posted 1/8/2015 7:18 PM (GMT 0)
Sheesh. Hard to imagine alternatives to biopsies, LDR/HDR, surgery.
Posted 1/9/2015 12:41 AM (GMT 0)
My surgeon, years ago, said on this subject, that in theory it could, but in reality, he had never heard of a genuine verified case in all his years of practice.
Posted 1/9/2015 1:45 AM (GMT 0)
After reading my pathology report that said there was a microscopic hole indicating capsular penetration, I couldn't help but wonder if it was related to the biopsy or the surgery and if there was any possibility that was responsible for possible spread of the cancer outside the Prostate. My guess is no surgeon would ever admit to it but it does make me wonder.
Posted 1/9/2015 1:57 AM (GMT 0)
tdnjam,

Was it near the rectum? Of course, your PSMs probably had more to do with it. I think we don't see what we don't look for. It's only recently that we've had the tools to possibly see it, and it's still very "iffy." Based on the Johns Hopkins study where they did look very closely at the pathology samples and compare them to the biopsy map, it is clearly a rare occurrence. Comparing risk to benefit, it's certainly not a reason to avoid a biopsy if one is indicated. However, it (and even more so, the growing incidence of biopsy-related sepsis) is a good reason to only have a biopsy when one is clearly called for.

- Allen
Posted 1/9/2015 2:15 AM (GMT 0)

tdnjam said...
After reading my pathology report that said there was a microscopic hole indicating capsular penetration, I couldn't help but wonder if it was related to the biopsy or the surgery and if there was any possibility that was responsible for possible spread of the cancer outside the Prostate. My guess is no surgeon would ever admit to it but it does make me wonder.

When the subject of Bx and possible surgery 1st came up, I was terrified of spread by either. Not that it means it is written in stone, my URO assured me that it was a fear with most cancers, but not with adenocarcinoma which is what PC is, or almost always is at least.

But I have never had a lot of confidence in that. If a cancer can eat through the capsule and then spread out from there, then how is it that poking holes into the capsule(or possibly even all the way through the capsule by accident?) then into the cancer and then dragging that needle back out, or even mishaps in the surgery itself(like incision of the prostate), can not dump those very same cells into the body from whence they can further spread? It has never made a whole lot of sense to me, but maybe there is something I am not understanding.

Plus, are there not occasionally men whose path report indicates all was contained and maybe only a 6 or at worse a 7G, for whom a cure is presumed, who then end up with rising PSAs and even mets?(EDIT: or does that never happen with a true G6?) Well if it was all contained in the capsule, how can that even happen(if it does)? Well one possibility that seems apparent is a needle being put into the Ca and then dragged back out through the tissue. But I hope I was always wrong to think in those terms. Considering I went right ahead and subjected myself to a BX followed by surgery.

Post Edited (BillyBob@388) : 1/8/2015 8:47:25 PM (GMT-7)

Posted 1/9/2015 3:16 AM (GMT 0)
Food for thought that's for sure.
Posted 1/9/2015 3:28 AM (GMT 0)
BillyBob,
As I wrote in the article, GS6 cannot live outside of the prostate. So since that's what most men with PC these days are biopsied with and given surgery for, those are not really a concern. More of a concern when grade 4 is dominant or there are grade 5s. However, once a cancer cell has made the epithelial-to-mesenchymal transition (EMT), it can live and move anywhere. So if it's a mesenchymal cell, it could have moved whether there was an invasive procedure or not. Fortunately, we all have immune systems that can detect stray cells, and if there aren't too many, and it's not an ongoing problem, they can be destroyed.

- Allen
Posted 1/9/2015 4:00 AM (GMT 0)
In his book "Dr. Walsh's Guide to Surviving Prostate Cancer", Walsh writes about the possibility of a biopsy spreading cancer:

…there is no evidence this has ever happened or that it could ever happen.

But then he writes with regard to biopsy:

But What If Some Cancer Cells Escape into My Bloodstream?

Well, they may. In fact, the more we learn about cancer in the prostate and elsewhere, the more we understand that the circulation of cancer cells in the blood is probably a fairly common event, even in cancers that are curable. And it's not unreasonable to assume that a few more cancer cells may find their way to the bloodstream when the tumor is manipulated, as it is during a biopsy. The key is the stage of your cancer. When cancer is confined to the prostate, even if a few cells escape into the blood, they won't survive. This is because they haven't yet gotten the hang of living outside the area where they developed. But over time, cancer cells change. They get more aggressive with age, and they become, in many ways "smarter." They not only move to distant sites but have the wherewithal to thrive in these new locations as well. So there are two different issues: one is the presence of cancer cells in the blood; the other is the survival of these cells in distant locations. Prostate cancer cells are simply unable to live outside their normal environment until they develop this ability, called metastatic capability.
Posted 1/9/2015 4:15 AM (GMT 0)

Tall Allen said...
BillyBob,
As I wrote in the article, GS6 cannot live outside of the prostate. So since that's what most men with PC these days are biopsied with and given surgery for, those are not really a concern. More of a concern when grade 4 is dominant or there are grade 5s. However, once a cancer cell has made the epithelial-to-mesenchymal transition (EMT), it can live and move anywhere. So if it's a mesenchymal cell, it could have moved whether there was an invasive procedure or not. Fortunately, we all have immune systems that can detect stray cells, and if there aren't too many, and it's not an ongoing problem, they can be destroyed.

- Allen

In the article linked to? Yes, I did see that. So that must mean that no one we know of had a G6, and was told it was all contained, and then had mets or later died of PC? If they can not live outside of the prostate, it would sure make me think twice about getting the prostate cut out.

But like you also said, that "does not preclude their eating into adjoining tissue, or possibly evolving to higher Gleason grade", though I was thinking that most thought G6s do not become G9s? Maybe that is incorrect.

Still, it also does not count 7s and 8s, and we don't ever know what is in there until Bx or really until post op path. So a 7 or higher might well be in there when the Bx needle goes in and then comes back out. Plus the accidental incision of the prostate and the problems with large(like mine) prostates and scopes/robots. And the problems with disconnecting the prostate/urethra .

Oh well, a lot of possible problems even if the % is low,eh? But, like you said, it really helps to have a strong immune system. Kind of like a guy I quoted elsewhere said(whether he was right or wrong) "by the time they are diagnosed and treated, they are all systemic". Maybe he is wrong about that, but then again he might not be all that wrong, considering possible spread by treatment. So, the immune system is maybe our best hope. Or at least really important.

Post Edited (BillyBob@388) : 1/8/2015 9:18:27 PM (GMT-7)

Posted 1/9/2015 5:03 AM (GMT 0)
So there you go, Walsh saying that gl 6 can morph into higher gl grades over time. I don't see how words "get more aggressive with age," can be interpreted any other way. They may not be able to survive outside the prostate, but they certainly can age in the prostate itself. Nice and cozy in there. what would be interesting to know is, under the scope, in multi grade path reports , are the different grades in separate focal points, {think multifocal} as in Pca is a multifocal disease. Or do they sometimes find different grades merged together in a single focal spot. My guess is the merge is common. Common sense would assume that, in time cancer will get more aggressive, any cancer... but then, Im just a caveman lawyer. One of Phil Hartmans, best SNL comedy skits, Sinatra was good as well.

since we are discussing rare scenarios, How about a sexual partner getting the disease from the sperm coming from a cancerous prostate. Possible?
Posted 1/9/2015 5:34 AM (GMT 0)

logoslidat said...
So there you go, Walsh saying that gl 6 can morph into higher gl grades over time. I don't see how words "get more aggressive with age," can be interpreted any other way. They may not be able to survive outside the prostate, but they certainly can age in the prostate itself. Nice and cozy in there. what would be interesting to know is, under the scope, in multi grade path reports , are the different grades in separate focal points, {think multifocal} as in Pca is a multifocal disease. Or do they sometimes find different grades merged together in a single focal spot. My guess is the merge is common. Common sense would assume that, in time cancer will get more aggressive, any cancer... but then, Im just a caveman lawyer. One of Phil Hartmans, best SNL comedy skits, Sinatra was good as well.

since we are discussing rare scenarios, How about a sexual partner getting the disease from the sperm coming from a cancerous prostate. Possible?

I admit I have had the same question, though I have never heard of it. Depending on the partner of course, the PC cell would be injected into a low testosterone environment, so that would not be in it's favor. Plus it would be outside the blood stream, normally.
Posted 1/9/2015 5:41 AM (GMT 0)
LOL! And how would the cancer cell get from the vagina, anus, or mouth into systemic circulation? A human cell is many orders of magnitude bigger than viruses or bacteria.Let alone all the biochemical defenses against pathogens, and the immune system.
Posted 1/9/2015 5:08 PM (GMT 0)
In addition to our plethora of statistical risks,
we have the Bone Scan, and that radioactive juice they inject into you for the Pet Scan.
Posted 1/9/2015 5:33 PM (GMT 0)
You can't spread prostate or any other cancer to another person.   It is specific to the host that developed it and can't live in a different host.
Posted 1/10/2015 12:15 AM (GMT 0)
Thanks, JNF, as Johnnie Carson used to say, with a quizzical look on his face and a index finger to his lips. " I did not know that "
I would thank you also Allen, but your answer was mean spirited, and I do not want to encourage that. I mean in capitals!!! Having said that I would have liked to seen your face as you said that but doubt that you would.{liked to have seen your face} Scolds are not mean spirited, they are meant to enlighten, not hurt. smilewinkgrin
Posted 1/13/2015 4:39 AM (GMT 0)
Hi All,
This is a very interesting subject and one that I have spent some significant amount of time worrying and researching. As an engineer, when we suspect that we have something bad in a container, the last thing we do is shoot 14 holes through it! In the MD world they call this needle tracking post biopsy.A careful job researching and interrogation of several doctors and two great surgeons, the word is this, it has never been documented (but is also difficult to prove). However, there is some body of knowledge that G6(3+3) and possibly higher Gleason score cancers have a hard time living away from the prostate. Some claim that G6 cells cannot metasticise at all.

So after looking over all the arguments, evidence and studies: needle tracking is theoretically possible with G8-9-10 cells, but is super low in probability.

One super interesting theory is that malignant tumors can and do send out many cancer cells that could result in metastasized daughter tumors, but that our immune system kills the vast majority of them.

Please note that I am not an MD or any other kind of a medically trained person, I am merely an engineer who reads a lot and has a long standing interest in medicine.

With Best Regards,
scientificlifestyle
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