Increasing PCa aggressiveness

User

Posted 09 Nov 2017 at 00:54

I don't wish to add to the concern of men who have had treatment for PCa or are contemplating it. I am considering more RT if the cancer area(s) can be more definitively identified that is/are causing my PSA to rise.

Through our experiences and those of others, together with our research, we come to learn of potential advantages and downsides to treatment. However, are patients well informed about treatment and their options by consultants? The link Clare (Claret) posted of the study undertaken in The Netherlands shows we are not. Reasons why this might be the case have been posted on other threads but I also wonder whether the full extent of risks are not made known to patients because of further concern this may cause and perhaps even dissuade them from having treatment in some cases.

I was listening once again to a lecture by a well respected Dr who included a case of, one PCa patient he treated with RT, following which the cancer exploded throughout his body. I wondered whether this would have happened anyway or if it was brought about by the RT. (Although we hear frequently that RT can initiate other cancer many years later, I can't recall reading that RT can stimulate the cancer to become more aggressive and to spread more rapidly in the short term. There is not a great deal about this on the Internet but there is some support to confirm this possibility which is also said to apply to Chemo treatment. I will be looking further into this to try to see how high a risk this is. Meanwhile, if anybody has an appointment with an Onco soon, it would be interesting if he/she could provide more details and an idea of how many patients so treated could be worse off after it.

Barry

User

Posted 09 Nov 2017 at 01:27

There is some anecdotal evidence of surgery causing cancer to explode as well - particularly thinking here of horror stories relating to bowel cancer. And we have discussed on the forum the (limited) data on prostate biopsy needle tracking. Perhaps there are just some unfortunate people whose cancer reacts exceptionally aggressively to any form of attack?

Seeing Mr B in 3 weeks - will ask him.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 09 Nov 2017 at 00:54

Barry

User

Posted 10 Nov 2017 at 13:04

This is interesting, and a worry for some. But look at the bigger picture: Research consistently shows that survival rates are pretty similar for Surgery and Radiotherapy, although the statistics are inevitably out of date, as both fields will have progressed since the start date of the research.

The choice will always be a personal one, as concerns about the different side effect profiles will depend on individual lifestyles and concerns. Plus, the stage of disease will be a major factor.

The problem will always be that short of gaining a medical degree, we are never making a totally informed choice - at a time when we are still stunned at the diagnosis.

In my personal experience, the key problem areas were highlighted, and I was given ample opportunity to discuss anything further, either with the doctors or the Nurse Specialist, and, later, the radiotherapy team.

But ultimately, we're all unique, and the Best Doctor In The World cannot predict our personal outcomes - or our personal side effects experience. We either live with that reality or go mad.

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User

Posted 09 Nov 2017 at 01:27

Seeing Mr B in 3 weeks - will ask him.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 09 Nov 2017 at 19:20

Hi both.

What are we to do then? I don't think most people could live with the consequences of not doing anything.Surely some people have a happy outcome from treatment even if that means living with some side effects. Otherwise we are left feeling should we just cancel the op on 24/11/2017 and accept what comes.

Ann

User

Posted 09 Nov 2017 at 22:51

I shared this but it seems to have spent a long time in moderation

https://www.sciencedaily.com/releases/2017/09/170905093757.htm?platform=hootsuite

Surrey university study on the issue of increased aggressiveness ....

Interesting to me

User

Posted 10 Nov 2017 at 03:47

So we now also have RP and HT as possibly causing greater aggressiveness. However, whilst this remains a possibility, I think it probably applies in a minority of cases, perhaps with certain types of cancer but nevertheless should be known about as a possible risk. We know that there are potential downsides to all forms of treatment both in respect of outcomes and side effects. Following RP a very small proportion of men experience permanent urinary incontinence for example, so like this aspect, aggravated spread has to be accepted as a small risk, although it would be helpful to know the percentage of men who are affected in this way and the relative risks with various treatments.

Ann, when PCa reaches a stage where it is thought to be best treated, the potential downsides are considered by most men to be worth the associated risks of treatment. Treatment does not always provide a cure but can extend life beyond what would be the case without it. However, it is believed that quite a number of men rush into treatment where if left and just monitored it would not be a problem, particularly if diagnosed in elderly men. Some suitable patients therefore defer potential side effects by just being monitored and much research is under way to find a way to determine more patients who would benefit from delaying treatment.

Barry

User

Posted 10 Nov 2017 at 09:33

Yes a couple of really important discussion points

Doing nothing really is a valid option for some as shown by the ProtecT trial , especially for those with a solid diagnosis of Gleason 6.

The Gleason 6 doubling time being 475+/- 56 days means a small G6 tumour takes 40 years to grow 1 centremetre.

For many with a small G6 tumour overtreatment is a real thing ( looking forward to this years audit findings and hope it's improved). The cure could ibe worse than the cancer for small low risk diagnosis.

Re HT and aggressiveness ( albeit for a low number) what I don't understand is why this is a recognised problem in breast cancer treatment and already dealt with using PARP inhibitors but only just going to clinical trial for PCa?

Hmmm

User

Posted 10 Nov 2017 at 10:20

Originally Posted by: Online Community Member

Doing nothing really is a valid option for some as shown by the ProtecT trial , especially for those with a solid diagnosis of Gleason 6.

The Gleason 6 doubling time being 475+/- 56 days means a small G6 tumour takes 40 years to grow 1 centremetre.

Please remember Active Surveillance is not "Doing nothing", it a a clearly defined protocol designed to detect the advance of PCa in a timely way to allow appropriate treatment when required, whilst avoiding the possible side effects of early treatment.

I don't know where the figures for tumour growth have come from, I don't know what "Gleason 6 doubling time" is, and am concerned at the implication that action is not required as little is going to happen in the next 40 years.

Alan

User

Posted 10 Nov 2017 at 13:04

The choice will always be a personal one, as concerns about the different side effect profiles will depend on individual lifestyles and concerns. Plus, the stage of disease will be a major factor.

The problem will always be that short of gaining a medical degree, we are never making a totally informed choice - at a time when we are still stunned at the diagnosis.

But ultimately, we're all unique, and the Best Doctor In The World cannot predict our personal outcomes - or our personal side effects experience. We either live with that reality or go mad.

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