Biopsy causing mets?

[yehsch]

Hi, I'd like to find information about the risks of mets spreading because of biopsy.

[Tall_Allen]

Here ya go:

prostatecancer.news/2016/08...

It's very rare, and impossible while the cancer is unable to survive outside the prostate environment.

[yehsch in reply to Tall_Allen]

Thank you !

[j-o-h-n in reply to yehsch]

Greetings yehsch,

Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/04/2021 10:10 PM EST

[LeeLiam in reply to Tall_Allen]

TA, the only spot showing on my rhPSMA scan was on the pedicle of the T8 vertebra. They want to do a biopsy of the pedicle. If positive, then hit it with radiation. Since this lesion is outside the prostate environment to start with, is there a greater chance of it spreading due to the biopsy?

[Tall_Allen in reply to LeeLiam]

It is "the only spot showing," but there is much more where that came from that you cannot yet see. Your prostate cancer is already systemic, as you know when you wrote, "since this lesion is outside the prostate environment to start with." There are millions of prostate cancer cells in your blood, lymph, nerves, and in various tissue reservoirs. Whatever a biopsy adds is a drop in the bucket. ADT is your best shot at controling the cancer, and will counter any spread from the biopsy. If you want to zap the met on top of that, why not?

[Patrick-Turner in reply to Tall_Allen]

That was an interesting read. In 2009 I had 9 biopsy samples taken using a special gadget inserted into rectum which fired a needle at high speed through rectum wall and into adjoining prostate gland, PG. I was not under any anesthetic, and it was one of The Most painful procedures I ever had. I was promised anesthetic, but there was none. It all took about 7 minutes. I have no evidence that Pca cells from a Gleason 9 tumor spread to anywhere the needles went, but I am probably now fighting mets from PG which spread widely to lymph nodes and bones and which were undetectable until my first PsMa Ga68 scan in 2016. 2 lymph nodes had mets 2mm dia.

But rectum is free of Pca.

The early 2010 attempt to remove PG had to be aborted because Pca surrounded PG so it was resting against rectum and bladder walls but did not cross over to invade.

But in 2016, when ADT failed, I went to get salvation RT by new RT machine with Calypso method that allows beams to avoid previous EBRT pathways and be better focused by inserting "radio-opaque" pellets to PG which had been given 70Grey in late 2010.

The PG is full of blood vessels and when radiated these all become fragile and are slow to heal up when cut in any way. But that didn't stop doctors doing the salvation RT and insertion of 3 beacons in just the right position to allow RT machine to accurately fire X-ray beams.

Of course these beams flare out in the body so being accurate +/-1mm is not real necessary. But to get beacons to wanted position using ultrasound, doc might have stabbed applicator needle in many times before depositing a beacon.

When done, I awoke OK but had to stay overnight at hospital because I was alone. But by 2am next morning, I had not pissed, and I needed a catheter to drain blood from bladder which had not formed a clot or coagulated because it was mixed with urine. I was furious that the docs never considered this was bound to happen, but it was their first attempt to do this procedure in Australia.

I stayed 2 nights in hospital, but bleeding to bladder didn't fully stop until 10 days later. But I also assumed it highly likely that blood full of Pca cells went into space around organs within perineal sac. I had thought these supposed expert doctors at urology in a leading Melbourne private hospital knew better, but I experienced what is commonly called a "cock up".

They were legally untouchable, impossible to sue, etc, So I did not lodge a complaint.

It is possible I am now also fighting Pca mets released by attempts to insert pellets to PG full of Pca and RT damaged to guide the fancy-pancy RT machine.

I searched online to see where this procedure was first done and a Dr Shultz in USA did a lot back in 2011 and reported his results in AJCM where he said 47 patients got remission. Really? Out of a total of how many patients? Nobody knows.

I was told such salvation RT would "definitely kill all Pca in PG" but all 9 PsMa scans since then still show I have an active spot of Pca in PG. And I had 6 doses Lu177, so it seems that little active Pca spot in my PG didn't attract Lu177, so it has survived every attempt to kill it. It WILL be a problem in future, and I do not know if its spreading Pca that's untreatable. I may need more RT to PG. Time will tell my current docs if there is more spread from PG to soft tissues, but so far, nothing has been found.

I hope the targeted Ra223 will kill all Pca in bones because it has no reliance on PsMa expression. The idea result is that all bone mets die, and all I have left to do is get local RT to PG. This is highly optimistic.

Without optimism, we may find ourselves bogged in the mud of despair.

Well, at least for 10 minutes, before a man might say, "right, time to die, fetch the morphine"

Patrick Turner.

[MateoBeach in reply to Patrick-Turner]

Sorry Patrick, that very much sucks. With you man.

[treedown in reply to Patrick-Turner]

Your biopsy sounds like mine, horrible and w/o anesthetic. Of course I got a small preview with the very thorough DRE I had the week before. From my 1st PSA test results on 6/28/19 to my formal diagnose on 7/15/19 of Stage 4 PCa was a bit of a whirlwind. I still remember that phone call well, he used the words aggressive but at the end of a call I asked what my Gleason score was 7 (3+4) so that was my first bit of luck though he clearly did not think so. That was the worst of it for the invasive shit so far, I am happy to say. I have recently thought about people with relatively low PSA's and unclear biopsy's and how that must be harder with all the uncertainty going on months or years as opposed to knowing w/o doubt where I was in like 2 weeks. More luck? If so I hope it keeps coming, as it seems to be what we all need most.

[Patrick-Turner in reply to treedown]

There are 2 things a man can do to avoid the long fight with Pca with certainty.Both need doing before Psa reaches 3.0, which is about 3 times average Psa of a man of 60 who is never going to have any trouble with his PG. I have a cousin 75, he has a bit of BPH and takes ages to pee, but no Pca, and Psa has hovered at 1.1 for years. But I can't tell him to take Tamulosin to shorten the time he wastes in the toilet.

So, before Psa gets to 3.0 :-

1. Without having any symptom of BPH or Pca, have PG removed.

Its a pre-emptive strike form of medical insurance. So if a man is 50, he should wave goodbye to his PG, but he needs a really good surgeon to do that while sparing all nerves, so he's continent, and function of Rodger will remain adequate.

The good surgeon won't leave any PG material behind that might become cancerous in future. One surgeon I heard about who did complete nerve sparing charged $30,000, 4 times more than our local uro surgeon here who had fairly poor rate of Pca recurrence after RP.

2. Be more drastic. Have a good surgeon remove bladder, cut off penile urethra low as possible, remove seminal vesicles, then join ureters from kidneys together and to a stoma on lower side of abdomen and wear a plastic bag for pee for rest of life. The man then gets a decent sleep, no get ups to pee, and can go a long time between pees because a bag may contain a litre. But ED is instant, but then in many marriages I have seen, there no talk at all to anyone else that sex stopped when the couple found it embarrassing and absurd to try to mount each other, let alone give each other oral sex, because desire vanishes, and the dear ladies pause from men at about 45-55.

No 1 is a cheapest option to save about $200,000 of long fight expense.

No 2 is more expensive but more thorough option to avoid $200,000 expense, and I met a man who had this done successfully, and he had a very good life. About 50,000 Australians wear a pee bag, and quite a few wear a poo bag on the other side.

Its 0.2% of the population and I suspect numbers are similar in many western developed countries where advanced health fixes are available.

Many women will get a lump in breast and have it removed, then muck about with prosthesis to look good. But Angelina Jollie thought she would get Brca and had both breasts off, and because she is rich and famous the docs gave her a boob job that looked better than natural. My sister got a breast lump, and immediately had both breasts off, but at 65, she didn't mind being flat chested. But she can't really fully handle "losing herself" She survived Brca diagnosis, no recurrences after 8 years+ now.

Men should be more prepared to wave goodbye to bits that are useless.

ADT and RT have totally exterminated any sexual capacity I had, and I really could not care less, I enjoy riding a bicycle more than riding a woman, and I just don't need to jerk off.

But I love all the women I see around. They often seem more beautiful than ever.

None of the above options or considerations appear in any publications about Pca that are put out by Govt medical authorities.

Here, PGs are not examined until Psa > 5.0. This allowed me to get a Gleason 9 despite "doing the right thing" by getting yearly Psa test above 50yo.

If threshold of PG exam was 3.0, I would have been found to have Pca in about 2004, but Gleason might have been 4. As soon as ONE Pca cell is found in a PG, you could be classified to have a Gleason score, which would be low, but rather than "Watchful Waiting" as it was called, ie, doing SFA, its better to act early IMHO. VERY early.

With a Gleason 9 that was found to be inoperable, both above options were not any option. Just the long fight because the Medical System failed to prevent me getting Pca. If they gave me an RP at Psa 3.0, taxpayers might have saved $190,000 better spent on sick children etc, and saved my pocket about $130,000, if I complete the coming treatment with Ra223. ( Many have spent a lot more trying to beat their cancer ).

See my full experience with Pca at

turneraudio.com.au/Patrick-...

Meanwhile, its raining very well here, and the drought ravaged and bushfire burnt eastern part of Oz is looking very green, and this is very uplifting to all our spirits, and our Covid 19 virus has almost been eliminated by intelligent lock-downs where necessary, and I won't mind getting a vaccine shot soon. With luck, I'll be able to travel 300km From Canberra where I live to Sydney to get Ra223 without interruption by travel restrictions.

After diagnosis that was too late in 2009, I had to adjust to living with Pca as an expensive chronic disease, which is most likely to kill me.

Patrick Turner.

[pjoshea13]

Swedish study [1]:

"The extent of epithelial cellular material (ECM) occurring in venous blood samples after diagnostic core needle biopsy (CNB) was studied in 23 patients with CNB diagnosed prostate cancer without provable metastases and 15 patients without cancer. The data show a significant increase of ECM in the peripheral blood sampled 20 seconds or 30 minutes after the last of 10 CNB procedures compared to the number of ECM detectable in the blood samples taken before the performance of CNB. The data indicate that diagnostic CNB of prostate cancer causes an extensive tissue trauma with a potential risk of cancer cell dissemination."

More recent [2]:

"Using the standardized CellSearch® system that allows for the detection of single epithelial cell adhesion molecule-positive circulating tumor cells (CTCs) in blood, we investigated whether prostate biopsy is associated with release of prostatic tumor cells into the circulation. Peripheral blood was obtained before and within 30 min after performing prostate biopsy from 115 men with increased serum prostate-specific antigen.

"RESULTS

"The number of CTCs significantly increased after biopsy in men with histologically confirmed prostate cancer (odds ratio, 7.8; 95% CI, 4.8–12.8), whereas no biopsy-related changes could be detected in men without confirmed prostate cancer. Multivariable analysis showed that biopsy-related increase of CTCs was significantly correlated with a worse progression-free survival (hazard ratio, 12.4; 95% CI, 3.2–48.6) within the median follow-up of 41 months.

"CONCLUSIONS

"Prostate biopsies may lead to a tumor-associated release of CTCs into the blood circulation. Larger confirmatory trials with longer follow-up periods are required before any change in clinical practice can be recommended."

See also editoreal [3].

-Patrick

[1] ncbi.nlm.nih.gov/pmc/articl...

[2] academic.oup.com/clinchem/a...

[3] academic.oup.com/clinchem/a...

[treedown in reply to pjoshea13]

Whats the take? Too late for us but maybe a better way needs to be considered for the newbies down the road?

[bldn10 in reply to pjoshea13]

Holy crap! All I ever heard was NO, it doesn't happen, but these studies certainly fly in the face of that.

[Tall_Allen in reply to bldn10]

A CTC is not the same as a viable cancer cell. That's why they are saying "no."

[Fanger1 in reply to pjoshea13]

Thank you for the articles. In the future researches will hopefully go beyond using Cell Search to detect CTCs as now other platforms can detect CK- negative CTCs (Biocept and Epic).

[Stevecavill]

It doesn’t