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Pca Pathways (Natural and un-Natural)

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Posted 4/28/2016 7:02 PM (GMT 0)
I have two questions.....

ONE: I was wondering about how PCa migrates out of the prostate itself. Must extracapsular extension be present for this to happen? What I mean, is organ confined disease, if "really" organ confined, enough to say that no cancer has migrated outside of it? OR, does PCa actually slither though the capsule and migrate without any clear pathway (i.e. EPE).

TWO:Can surgery actually cause PCa to spread? That is, can poor surgical techniques, cause the spread of PCa at a later time? I don't mean leaving anything behind, but basic sloppiness, kind of like cutting something then leaving it behind by accident to root and spread?

J
Posted 4/28/2016 7:42 PM (GMT 0)
If it is left behind surgery for any reason it can continue to grow and potentially spread. It doesn't have to be left behind by sloppiness or accident. The surgeon may see the tumor, but can not see the cells as they are microscopic. The term "we got it all" really means "we got everything we could actually see". There is always the possibility that there are cells remaining that have not yet colonized into visible tumors and get left behind. That is how initial treatments fail.

As I understand the more natural pathways include the blood circulation system, the lymphatic system and the local spread into adjoining tissues including nerve pathways. Bone mets basically come from the blood born cells. Organ mets come from the blood born and I imagine the lymphatic system.

I don't think it can ever be absolutely confirmed that it was organ confined as PCa is very blood born and micro mets can not be detected by scans or visually. Negative surgical margins and lack of penetration through the capsule do not guarantee that all the PCa is within the organ. Many men end up with failed surgery with those features indicating the PCa was not confined. Many doctors state that circulating cells can be found in the blood of most men after age 50. Few of these cells can take root outside the prostate area, but some do. I have a client that had a RP at age 55 and was PSA undetectable for 15 years. Sounds like it was organ confined. Then at age 71 his PSA started going up and treatment began. Obviously his was not organ confined. His situation is not the norm, but does happen. Read the studies that show that the incidence of long term recurrances are not uncommon.
Posted 4/29/2016 12:23 AM (GMT 0)
Jay, more or less what JNF said as well. Are you having second thoughts about choosing surgery?
Posted 4/29/2016 12:29 AM (GMT 0)
Jay, part of the procedure in taking out the prostate as I understand it, is they cut and then put the prostate in a plastic bag, before removing it, to lessen the chance of cells getting away from them. Obviously it's not foolproof

Post Edited (Pratoman) : 4/28/2016 6:37:19 PM (GMT-6)

Posted 4/29/2016 12:46 AM (GMT 0)
At some point, high grade cancer (pattern 4 or 5) in the prostate undergoes a genetic transition called epithelial-to-mesenchymal transition (EMT). Unlike the epithelial cancer cells within the prostate, which die quickly outside of the prostate, mesenchymal cells have the ability to exist outside of the prostatic environment. They can travel in blood, lymph and possibly along nerve pathways. They also have the ability to clump together to form tumors.

This is different from cancer that grows into surrounding tissue, bringing its environment along with it. That kind of invasive tumor can be any Gleason score from 6 to 10. But in tissue left behind, it can later progress as above.

Here's an article about spreading PC by invasive procedures:
Can invasive procedures spread prostate cancer?
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