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.