This is in response to one member who has a lingering PSA, after a successful RP, and Scans that showed no disease. The RP was total with the removal of the Seminal Vesicles and clean margins all around with a Dozen Lymph Nodes taken, which were also clean. So our member was confused why his PSA had not reached undetectable. Later to report that in his Surgical report there was PN-Invasion.
So thus the title of this subject. An important determinant of Tumor Behavior is the ability to breach the basement membrane and spread outside the confines of the Prostate.
The classical knowledge of Tumor Metastasis is that of Tumor Spread via Blood Vessels and Lymphatic Fluid. However, Pca has long been recognized to show a propensity to invade and grow along Prostatic Nerves, which lead out of the Prostate to the Pelvic Nexus. This is known as Perineural Invasion. And this has been thought over the years to occur because Nerves provide cancer cells a low Resistance Path[ease of movement] out of the Prostate. Recent Studies of which there are few[or we would be having more discussions on this subject] suggest more Dynamic interaction. Even Pca cells adjacent/near the nerves show increased proliferation compared with those located further away. Thus the conclusion from Meta-Analysis with Pathology Biopsy and Scans show that the Perineural Nerve Space---which is large compared to the nerve itself may very well be a Microenvironment that provides cancer spread and growth and a source of later Metastasis. I have spoken out on the theory that depending on the aggressiveness of the Cancer, Pca might have already entered your bloodstream prior to your DX. I plan to prove that further with a later post. The same can be said for movement into the lymph Fluid. Where we have no scan, Bloodwork, or other tests that can prove this. And why would you even look if you had not been DX? Micro-Metastasis seems to always be in play.
In short, the insidiousness of the disease--->relates IMO to the ability of the cancer cells formed in the Prostate even with a PCA of under 2, in very early stages to enter the body, outside of the Prostate unbeknownst to anyone including the soon to become patient.
Nalakrats
Hmmm
Very interesting
My own PSA has stabilized at around 0.5.
This was after concurrent treatment with imrt, ADT, and seeds about 10 years ago.
It was explained to me that not all my non-cancerous prostate cells were killed. For lack of a better explanation, I just accepted that.
Not certain that understanding why helps inform what if anything to do about the situation. Lol
What was explained to you indeed does not make sense.
Nal
It does appear to be stable.
I'm not certain what to make of it.
There doesn't seem like there is much to do about it.
What do you make of it?
Closely watch it---remember my discussion about 2 men one 89 and one 90 who both had a major BCR, after being undetectable for 30 years, after an RP-->where was there cancer hiding?
Nal
Yep
Seems like that's the only practical option.
If it ever reaches 2.0, then maybe I get a scan.
The PSMA PET Scan is very sensitive .5 ng and up. 1 ng I think it's in the low 90% range. That's post RP. Not sure how that translates in the post IMRT setting. I'd look into Realtime MRI Guided Salvage SBRT if I were you.