"Prostate cancer lives as it is born" question (Radiation resistance)

[GeorgeGlass]

After reading this article years ago, I always wondered about my situation. My gleason is/way 4+3 (95% - 4) so basically gleason 8. My psa started to elevate in 2015 a a faster rate, when my PSA was at 10, I had IMRT and high dose brachytherapy. Two months later my PSA was down to 5, then I felt really sick for about three days, then went back to feeling normal but after that my PSA tests started showing increasing numbers. A doubling time of 3 weeks. I spew a lot of PSA in relation to the amount of cancer. At a PSA level of 38 in 2016, the CT scan showed no cancer (although the PSMA PET did show 3 hot spots).

My question is: Do you think this rapid psa increase would have occurred like this if I had done the prostatectomy or was this rapid increase caused by the radiation - maybe the cancer is radiation resistant or maybe the radiation escaped into my body (outside the prostate capsule) from the brachytherapy and caused me to feel that very unusual sick feeling in December, that coincided with when the PSA started to rise again?

The doctors don't have a clue. I suppose they don't think about this level of detail/cause. My concern is that it might be radiation resistant cancer, which the NIH doctor said, does happen to some, If it is radiation resistant then I might cause it to spread or mutate faster if I do spot radiation now. I suppose there is no way to know. I just wanted to see if any of you have any knowledge on this niche topic? It's just odd that I got really sick from either the cancer attaching to lymph nodes or it was from escaping radiation, and I wonder how that informs what kind of treatments to use going forward. So far, the Lupron only treatment has been effective and part of me wants to be aggressive and do radiation and add a 2nd line treatment and the other part of me says, maybe you should not mess with the success you've had so far.

This is an excerpt from the "prostate cancer lives as it was born" article:

health.harvard.edu/blog/pro...

"Over the study period, fewer and fewer men were diagnosed with advanced, late-stage prostate cancers that had spread beyond the prostate gland. This reflected the growing use of prostate-specific antigen (PSA) testing to diagnose prostate cancers earlier and earlier. In contrast, the proportion of high-grade cancers, as measured by the Gleason score, remained relatively stable rather than gradually becoming more aggressive. Previous studies have seen a similar pattern.

“It’s a very interesting study that confirms what previous studies have found,” says Dr. Marc B. Garnick, a prostate cancer specialist at Harvard-affiliated Beth Israel Deaconess Medical Center who was not involved in the study. “There may be rare exceptions, but in the vast majority the cancer is born with a particular Gleason score.”"

George

[depotdoug]

I too had IMRT 42 radiation hits of my prostate gland bed way back in Oct/Dec 2005. Now i am wondering if that radiation did not, Not get all my PCs cancer malignant cells killed. But that was 15 yrs ago, probably not as accurate as todays Rad zaps.

Now young got me wondering if my Adv PCa St4/mets was not radiation resistant. Hope i’m making some sense.

Thxs GeorgeGlass for posting this.

Doug

[GeorgeGlass in reply to depotdoug]

I wouldn't be too concerned if I was you. You had the treatment 15 years ago. My doubling time is 3 weeks. Yours seems to be steady and low. Are you on ADT?

[depotdoug in reply to GeorgeGlass]

Yes. ADT Lupron now Eligard Re-start was Sept 2019 with Abiraterone only 250mg + Pred 5mg 2x/day. Doing 2nd ADT for 18 months now.

1st ADT rounds were 2008-2012 4 yrs. Lupron/bicalutamide. Stopped 1st ADT sequences after my SCA which put me in CICU 12 long days.

Yes i’m being re-treated because my 68Ga-PSMA-11 PET Scan found many Avid hot spots on prostate, pelvic lymph nodes and some abdominal lymph.

So i am considered Bio-Chemically resistance PCa failure. Yes with Mets/S4.

[GeorgeGlass in reply to depotdoug]

what is this: my SCA which put me in CICU 12 long days.?

are your PSA doubling time and gleason scores relatively mild?

[depotdoug in reply to GeorgeGlass]

Sorry about the Acronymns. SCA means i had a Sudden Cardiac Arrest in my local hospital ER May 2011. CICU means cardiac intensive care unit.

That was 3 yrs into my 1st ADT treatments.

My cardiac arrest was not primarily due to my ADT. No it was not. But probably contributed to that life changing heart event.

My original Gleason Score was 3 + 4 (7)

Original PSA = 7.6 that was Sept 2005.

No my Cardiac arrest (non sustained ventricular tachycardia was probably not contributing to my 1st round of ADT.

But it surely caused my AFIB atrial fibrillation episodes from 2013-May 2020...

My PSA’s started doubling upward in 2018. Up to 20 something, i’d have to look up exact readings. Hope this helps clarify

[GeorgeGlass in reply to depotdoug]

Did you do any ADT from 2012-2019? What did they do to treat you for your heart, after the cardiac arrest?

[depotdoug in reply to GeorgeGlass]

I stopped ADT in late 2012 with my 2nd Urologist. That was consesus. May 17th five days post Cardiac Arrest i got an ICD/pacemaker device implanted.

My cardiac heart health was such a mess, my cardiologist and electrophysiologist kept me monitored closely... Yes, i had lots of BP med changes. AFIB Started 2013 and went through different med’s and Cardioversions and an Cryo-ablation

to try and stop my AFIB episodes.

Cardiac health took 1st place 2013-2018.

And my PSA did not start to increase/ double till late 2018-2019.

AFIB episodes continued till I had an RF catheter ablation May6th 2020. 5.0 hr procedure finally took me from persistent, constant AFIB to NSR( normal sinus rhytm). To date i have been in NSR ever since May 2020 286 days. One more thing: i had a new ICD/pacemaker implanted Jan 2019 which has been pacing me and also an insurance against NSVT( non-sustained Ventricular Tachycardia) which was was my orginal SCA cause.

I am very careful about my cardiac/ advanced prostate ADT meds with my newest Cardiologists and my 3rd Electrophysiologist on my team.

Doug

[Tall_Allen]

If the cancer were radiation-resistant, you would have seen cancer in the prostate when you did the PSMA PET scan - did you?

[GeorgeGlass in reply to Tall_Allen]

good point. I asked that question a couple times and they said they didnt see any, although the type of radiation (IMRT) done around my prostate may have had a different affect than the type of radiation inserted into the prostate. I dont know if that would make a difference, or if the cancer treats all radiation types the same.

[Tall_Allen in reply to GeorgeGlass]

Then your cancer was not radioresistant. Brachytherapy is used inside of the prostate to give a heftier dose there. It is all X-rays.

[GeorgeGlass in reply to Tall_Allen]

OK, good to know. I appreciate it.

[Garbonzeaux in reply to Tall_Allen]

And gamma rays. Don't get those with external.

[Tall_Allen in reply to Garbonzeaux]

There are no treatments with gamma rays, but they are sometimes used for detection.

[Tall_Allen]

Radiation doesn't cause it to spread or mutate faster. Sublethal killing slows it down.

BTW- I assume you also had 18 months of Lupron with your brachy boost therapy

[GeorgeGlass in reply to Tall_Allen]

Don't even get me started thinking about this. It is one of many stupid things that the doctors at Walter Reed screwed up. They should have done this but they didnt advise it because they said, "ADT is horrible, you dont want to be on that" Turns out that it isnt nearly as bad for me as they say, and after their failed treatment, I have to be on it the rest of my life instead of just 18 months. 😪

[maley2711 in reply to GeorgeGlass]

In slight defense of your Reed Docs, we cannot be certain that your outcome with radiation would have been significantly different than if you had also had concurrent ADT with the radiation. At the time of your treatment, had it been absolutely established that the ADT with radiation raises the likelihood of "cure" ?

[GeorgeGlass in reply to maley2711]

i dont think it was established at the time. I think the data I read indicated a very marginal improvement for those using ADT but very small improvement in cure likelihood and the radiologist was under the impression for some reason that ADT was horrendous so he did not recommend it.

[maley2711 in reply to GeorgeGlass]

Well, as you know, many men do report horrendous consequences...seems impossible to predict a given patient's reaction?

[Stevecavill]

You need more info on the "hot spots". It seems they are metastases that are driving the PSA increase.

[GeorgeGlass in reply to Stevecavill]

I'm pretty sure that's what it is but when they are small 5-6 mm they cant get much more detail other than were they are (not in the pelvis and not in a location where radiation is an option - I just got these scan results yesterday on Axumin scan machine. I posted a seperate question post today.

[rscic]

Many authorities feel one of the main ways Prostate Cancer (PCa) gets beyond the pelvic soft tissues is migration to the Seminal Vesicles (SV). The Seminal Vesicles are quite vascular and it is thought this is a possible site where PCa can get into the blood stream. If your PCa had migrated to the SV it might have already migrated to the rest of the body at the original time of treatment. If this were the case, radiation treatment of the Prostate would address the PCa in the Prostate & Pelvis but not the PCa in the remainder of the body. The rapid increase in your PSA could be due to metastatic disease already in place at the original time of treatment but undetected due to its small size. I do not have the full sequence of your PCa event history but given what I know this is certainly possible. If so, the radiation therapy would have nothing to do with your rapid PSA increase.

[GeorgeGlass in reply to rscic]

that seems logical and I've thought of that as well. I posted more details in a seperate post today, due to getting axumin scan results yesterday. I am having some trouble understanding what the result language means, including the part about the prostate gland. Maybe you can look at that post and tell me what you think. I posted it about 5 hours ago. thanks,

George

[MateoBeach]

Did your PSMA Scan show the absence of any cancer in the prostate gland and only the two mets? If so then the IMRT + HDR brachy eliminated cancer in the PG just as effectively as am RP so it appears. It is normal to have systemic symptoms when undergoing even very localized RT. That is the body’s response to the stress and the dying cancer cells. It is not radiation escaping the treatment field.

Still your cancer is aggressive wherever it remains and requires aggressive systemic treatment.

[GeorgeGlass in reply to MateoBeach]

The psma pet scan was not conclusive about cancer in the prostate gland, maybe because it's hardened from the radiation. I got new results yesterday from axumin scan and posted them in a separate post about five hours ago. Maybe you can read that post and tell me your thoughts. thanks.

[MateoBeach]

Cannot find the Auximen scan report. Can you send report to me? Only question is whether there is cancer outside of the prostate and pelvis.

[GeorgeGlass in reply to MateoBeach]

It's in my post here: healthunlocked.com/advanced...