First post, I am a 70 yr old retired neuroradiologist, trained at MD Anderson, dx'd at age 50, Gleason 6 (graded twice), treated initially with Iridium 192 brachytherapy with adjuvant pelvic RDRx, and subsequently salvage prostatectomy (big mistake) with bone met showing up 8 months later, and subsequently treated with chemotherapy, achieving undetectable PSA. Over the first 10 years treated with hormone ablation, and 5 years ago received IMRT for 7 bone lesions, and cryotherapy for 3 bone lesions 1 year ago. Started Dynamo (Zytiga, prednisone, abiraterone) 30 months ago; PSA stable at 0.6 for last year. Taking about 25 other various misc medications and/or pills all of which have been shown to have some effect on PCA in various animals or humans. Treated at MDA for last 16 years, and quite satisfied with quality, aggressiveness of care and availability of clinical trials.
Of course I cannot prove it, but I am a strong believer that many patients with Gleason 5 or 6 who have delayed mets discovered months to a year after biopsy are related to the rather traumatic prostate biopsy, with prostate RNA in patient's blood after biopsy having been detected in several studies. The prostate is extremely vascular and loaded with lymphatic vessels, and when possible other tumors like such are often removed intact to prevent known tendency for metastasis. However, present standard of care is to prove prostate malignancy with multiple core needle biopsies, as all in this forum have undergone, and grade such prior to any treatment. It is considered malpractice at this time to do otherwise. However, on the horizon are various imaging techniques that might be reliable enough to make a diagnosis, with some sort of grading system. This would be ideal, and I believe for lower grade prostate malignancy we will see fewer cases of delayed metastasis, that presently are classified as "events occurring as a natural course of disease."
Biopsy related metastases are well documented to occur. I have personally biopsied thousands of various tumors with needles similar to those used in prostate biopsy, and have had proven 5-10 or so "tract metastasis" show up later in the soft tissues of the tract on the needle, clearly related to tumor being displaced at the time of biopsy and becoming viable.
I believe it is most unfortunate, but at this time required, that many patients are rendered with metastatic disease during the process of diagnosis and/or treatment. For instance, during brachytherapy, which I had, numerous needles are inserted into the prostate gland, for up to 18 hours, while therapy occurs. Any of these needles could easily result in release of a shower of micrometastasis only to show later on scans or PSA rise. When such occurs, and it almost certainly does, the patient's doctor informs the patient that the disease has spread. It certainly has, but not necessarily as a result of the disease but of the process of diagnosis and treatment. What a shame, and violation of Primum Non Nocere.
It is my sincere hope that men will soon not be treated with such lack of regard to possible silent complications of diagnosis. This disease is being attacked on many fronts, with some success, but until such time as this organ is left untouched by needles or knives, unless absolutely necessary, some men will continue to suffer life long consequences.