Prostate cancer can progress rapidly after diagnosis, but can also become undetectable after curative intent radiation or surgery, only to recur years or decades later. This capacity to lie dormant and recur long after a patient was thought to be cured, is relatively unique to prostate cancer, with estrogen receptor positive breast cancer being the other common and well-studied example. Most investigators agree that the bone marrow is an important site for dormant tumor cells, given the frequency of bone metastases and that multiple studies have reported disseminated tumor cells in patients with localized disease. However, while more difficult to study, lymph nodes and the prostate bed are likely to be important reservoirs as well. Dormant tumor cells may be truly quiescent and in the G0 phase of the cell cycle, which is commonly called cellular dormancy. However, tumor growth may also be held in check through a balance of proliferation and cell death (tumor mass dormancy). For induction of cellular dormancy, prostate cancer cells respond to signals from their microenvironment, including TGF-β2, BMP-7, GAS6, and Wnt-5a, which result in signals transduced in part through p38 MAPK and pluripotency associated transcription factors including SOX2 and NANOG, which likely affect the epi-genome through histone modification. Clinical use of adjuvant radiation or androgen deprivation has been modestly successful to prevent recurrence. With the rapid pace of discovery in this field, systemic adjuvant therapy is likely to continue to improve in the future.
Cancer letters. 2021 Oct 05 [Epub ahead of print]
Frank C Cackowski, Elisabeth I Heath
Written by
podsart
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Thanks podsart! Very true BC and Pc always come back. Look at Olivia Newton John . Hers Came back 22 yrs later … Maybe the good news if one pushes pc away for awhile otherthings like the heart can go first before the PCs return .
Lulu you know it doesn’t ‘always’ come back, though it surely does for many. You remind me of something though.
Let’s remember people like Olivia Newton-John who began treatment 10, 20 years ago and more were, if they were lucky, getting the best there was to offer then, which pales in comparison to what we have today.
The quality of treatments being very different now and new ones coming matters so much. More importantly, new TYPES of treatment on the way after so many years of mostly just improving on what we had.
To me this is the best part of the ‘good news’ you mention of pushing it away for as long as we can. More help is always on the way!
My PCa recurred 9 years after surgery (RRP). PSA slowly climbing. Last test it was .72. No other treatments to date. Not so sure I want to do anything right now, seeing the horrific QOL impacts of most current treatments either chemotherapeutic, immunotherapeutic, or hormonal.
Within a 1/2 year after my surgery (2010) it became clear that the curative goal of the surgery was not successful. At that critical decision point ( I didn’t have the benefit of the wise gurus on this site at that time) , my surgeon recommended dr Myers. As you may have read on this site, dr Myers had a patient tailored strategy, mostly oriented on multi med attack w/ supplements on the Pca .
For a long time I have been worried re resistance to treatment and the more recent understanding of how and why resistance forms, including the dreaded neuroendocrine forms. Also, including the key issue of dormancy.
I didn’t have the understanding of relatively new concepts of adaptive strategies. To date, I have been lucky to have good results with a current very low dose of Xtandi. I have no idea if being on such a Xtandi low dose has any mitigative effect on resistance and my onc says don’t rock this good boat as you don’t know if the beast can be recaptured. My response to Xtandi has included causing a steady supra T level. Of course supra T seems to have the downside of contributing to my elevated BP with an unclear possibility of helping re Pca.
This leads to a focus on this issue of dormancy. Much has been said about the Pca microenvironment and controlling inflammation. NSAIDs like Celebrex ( which spikes my BP) and the array of supplements that can help- including those recommended by Dr Myers before his retirement. Hopefully, Nalakrats and others will figure out a good path forward regarding microenvironment and dormancy.
It has taken years to get to 0.72. Slowly enough that I feel I can wait, that it may take years to rise to problematic, and don’t even know how to define that.
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