Prostate cancer is very slow-growing, and cancer cells may be disseminated (usually to the bones) pretty early in the course of the disease, even before the primary tumor is clinically significant. They can lie dormant for years or even decades before ever (if ever) becoming "mets."
So cancer returns because it was never really gone. Some think of PC as an intrinsically systemic disease. Of course, for many/most men who are never diagnosed and die of other causes, the cancer cells that have moved to the bone just sit there and do no harm. These men may have had cancer cells in their bones, but they never "had cancer" -- at least not in a way that was clinically significant.
The recurrence rate depends, among other factors, on the Gleason score. If you have a Gleason 8 or 9, it is likely that it has already spread micromets when you are diagnosed. Not all of these micromets are located in the pelvis, in the area that is selected for radiation. Therefore they are not radiated and can cause the recurrence.
You cansider 94% being free of any sign of progression at 9 years as "high?" I suppose if you're one of the remaining 6%, any recurrence is "high."
Not even the most sensitive PSMA PET scan can detect pre-existing metastases down to the cellular level. In fact, their ability to detect metastases smaller than 5 mm is very poor. Plus, around 5% of metastases don't express PSMA. Cancer cells may hide in systemic circulation (blood, lymph, nerves) or in tissue reservoirs. Some recent evidence is that intensive hormone therapy may be able to kill of many of the remaining cells even in very high risk patients:
Not even the most sensitive PSMA PET scan can detect pre-existing metastases down to the cellular level. In fact, their ability to detect metastases smaller than 5 mm is very poor.
What do you think about nano-MRI? It detects mets up to 2 mm.
And what are your opinions for choosing:
High Dose Brachytherapy + External Beam VS SBRT (Cyberknife)
Combidex MRI (Radboud University) also claims detection down to 2 mm in lymph nodes. But you seem to miss the point - there isn't any kind of imaging that can detect micrometastases.
Brachy boost therapy has high rates of late-term urinary side effects, SBRT has less, if done right.
Thank you. Point well taken. Yes, I was referring to Radboud. I keep thinking of extra screening like that would somehow at least reduce % of there being mets (i know eradicating that chance is impossible).
Also.Do you know which study best shows the high rates of late-term urinary side effects versus SBRT? I'm referring to high dose brachy combined with EBRT as that is the treatment that is offered by the doctor.
It seems that Brachy+EBRT is most superior. But those are high risk patients. I'm intermediate unfavorable. So question is if that still applies to me or should I maybe choose only Brachy. Logistics wise the Cyberknife would be best as its closest to me, for Brachy+EBRT I would have to travel to neighbour country and have it done, stay there for 5 weeks.
The reoccurrence of the cancer has to do with the cancer stem cells or CIC’s. If you would like to see published studies as to the effects of epigenetics on the cancer stem cells, I can send them to you.
I am 74yo with PSA=13.7 μg/L & G(4+3=7) Grade 3 Intermediate Unfavorable Risk.I had VMAT-RT 3Gy X 20Fx = 60Gy and 6 months of ADT(Lupron Depot 45mg/24weeks) a year ago.
Latest PSA= 0.04 μg/L & Testosterone=6.4nmol/L from <0.2nmol/L per-ADT.
I'm at nine years out. Lupron, Xtandi and occasional ,Zometa. Gleason 9, M1, PSA 31 at diagnosis, 5 mo doubling, stage 4. I also have taken many herbs, which could be anecdotal crap. I had 3 bone Mets. They're all shrunk up. Last PSA .04, don't know what it all means. On Xtandi 6 or 7 years. I'm apprehensive waiting for the next shoe to drop. In a study at NIH. They say ,'all good'. Praying for a cure.
Always appreciate good news.Don't think about that other foot, go barefoot or something ha.
You said Zometa occasionally. That's interesting. Are you scanned/imaged frequently due to being in a study ?
I'm wondering if they pay more attention to your bone activity in the study and can actually stop the Zometa when they think you don't need it. Start again if you do. If so interesting.
Although bear with me as I am making up assumptions.
For the 2.5 years I was on Lupron, casodex for like 4 months to prevent flair, I took supplements and aspirin. NIH clinical trial said no more aspirin. I was there for the trial. They were comparing Lupron and Xtandi against Lupron Xtandi and prostvac. Prostvac was a fowl pox vaccine. I was in the Lupron Xtandi arm, no crossover. I did well in that and they've been giving it to me ever since. Up until the introduction of Xtandi, they started a yearly reclast, which is a generic Zometa. My oncologist was dragging his feet do they decided to give it to me. Up until Xtandi I took zyflamend. I also took a few months of noscapine, and mu something, ordered from Europe, an excercize supplement. I took motherwort, tumeric and antidepressants. One desipramine which I read slowed down the cancer. I still take the antidepressants. NIH told me more supplements for the trial, then they relaxed this. But this stuff gets expensive so I take a one a day now. NIH gave me cat scans, bone scans, pet scans, bone density scan every 12 weeks. They found a tree in bud in my rt lung but it turned out to be a hamertoma, which is benign. The side effects suck but I figured better than going into the long sleep.
Sorry I meant no more supplements for the trial and no more aspirin. I was taking the full amount of aspirin which could have given me a stroke. Stupid really, take a baby aspirin if your doc says ok. There is pain, probably bone pain so for that, Tylenol. Desipramine blocks pain so, so far no opiates. I think it was crazy to take so much aspirin, but I read positive things about reducing inflammation so I figured what the hell. In that 2.5 years before Xtandi my PSA started to rise. I then applied to NIH. They fly u back and forth for free after the first visit. During covid they mailed me Xtandi and directed my oncologists on blood tests. NIH stopped scanning me. That's all I got.
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