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[M59][EU] Why the recurrence rate% is so high even with brachytherapy+external beam for prostate can

User
Posted 28 Jul 2021 at 11:40

I can't understand what makes cancer return even when people use brachytherapy and combine it with external beam radiation.

 

The external beam for the pelvis area should take care of micro-mets, no?

 

Let's assume person does PSMA/PET scan, maybe even PSMA/PET combined with nano-MRI which is latest discovery in terms of MRI as of 2021.

 

If that is the case, why are there still cases where cancer returns? 

 

How does it form and what are the exact causes that make it return?

 

PS:

M59, Gleason4+3, PSA7.8, T2C.

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 28 Jul 2021 at 12:21

OK I guess this is sufficiently different to your other questions it deserves a thread of its own.

Three answers I can think of.

1. Micro mets far away from the prostate

2. Some cancer cells can be dormant whilst being blasted, they later wake up and continue their evil job. I believe RT is spread over several weeks to try and catch them all awake at some point.

3. Assuming all the cancer is cleared, you are sitting there with a healthy prostate just like it was when you were a healthy 20 year old. Well that 20 year old prostate turned bad in about thirty years. So expect the same from your squeaky clean new one (in fact it ain't squeaky clean, so perhaps expect brand new cancer within ten years, but don't worry you will be 70 by then, and it probably won't become life threatening until you are over 90, if you live that long)

If you're worried about option 3. get a prostatectomy, and worry about incontinence whilst you're still relatively young.

Cancer is **** but you've got it. 

Edited by member 28 Jul 2021 at 13:42  | Reason: Not specified

Dave

User
Posted 28 Jul 2021 at 12:58
There is no cure for cancer - many cancers return eventually if you live long enough.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jul 2021 at 17:26
They feed on testosterone; if you don't want hormone therapy, the alternative is orchiectomy. This is rarely done in the UK now but is still common in some countries, particularly for people who cannot afford the HT.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jul 2021 at 18:54

I don't really like the phrase "feed on testosterone". Testosterone does not provide the cell with any nutrient, it just acts as a trigger.

I don't know much about cell biology and hormones, but I'll give you my take on it anyway. Men and women are pretty much identical. Men do have a Y chromosome but it doesn't do much, for example all the details of making sex organs male or female are on various other chomosones. All the Y chromosone does is trigger testosterone in the fetus, that then tells some of the cells to start becoming male cells, like penis, testicle, prostate etc.The testicles then carry on making testosterone for life.

By stopping testosterone in an adult man some of those male cells suddenly think "what am I doing here? I'm in a woman! " hence they become dormant. If you then replace the testosterone they are triggered to carry on as normal.

So testosterone is just a signal not food. Pretty much like music and dancing is to me, give me music and I will dance, no music: no dancing. Music is just the signal. But dancing or not I need food. 

Sadly prostate cancer cells eventually evolve to divide even without testosterone.

The fact you are asking this question, suggests you are hoping to find the secret which will cure cancer. Well join the people in white coats they are all looking, but it is taking time.

I don't know how much money you have, if you are in the Bezos, Musk, Branson league you may make some progress. Mind you Steve Jobs wasn't short of a bob or two (sorry english idiom) and he went down the wrong route. 

Even if you do have enough money to set up your own research project, it is unlikely to yield fruit until after you die of cancer. So take what is on offer now to delay your death until a cure is found. 

 

Dave

User
Posted 28 Jul 2021 at 19:52
Just to add to the answers you have been given.

There are different types of PCa, a number of 27 has been suggested. Some types are more radio resistant than others. The DNA may not have been sufficiently damaged in some of the cancer cells so that these are able to recover or they might have been missed or beyond the reach of the administered radiation dose. The delivered dose is shaped to limit exposure to other organs, so this may account for some cancer cells being missed or not receiving a full dose, so in time a new tumour may form. Some cancer cells may have already have escaped but couldn't be identified. It cannot be predicted how quickly or over what period it can take to become a problem. In my case high quality scans (done on a regular basis as my treatment was within a trial), showed nothing for some two years after radiation treatment. My PSA started to increase slowly but persistently after that but an MRI showed a new tumour had grown. (In some men the cancer cells are more diffused, at least at such an early stage so may not be able to be identified by scans).

Hormone treatment can work together with RT to eradicate tumours or of itself control progression of the disease as it reduces the Testosterone on which the cancer cells feed. HT may work for months or years but eventually cancer cells learn how to get by without Testosterone so this treatment can of itself become ineffective.

Cells grow naturally in the body but in some cases something goes wrong, so instead of growing in a proper and controlled way, they grow in an irregular and uncontrolled way, You an see this where somebody grows a wort which may be triggered by a virus or infection causing abnormal new cells to grow (not that these are necessarily cancerous but to illustrate). Prostate cells can grow into cancer cells. The precise reason for this has not been identified as far as I am aware but it has been observed that the incidence of PCa in men of some Eastern countries is less than those in Western Countries. However, when men from these countries relocate to more developed Western countries, after a few years their risk increases to the level of the Western country. From this it is postulated that diet in the Eastern country plays at least a contributing part. Unfortunately, once you have been diagnosed there is no firm research establishing that if you change your diet it will assist in treating PCa, although some men believe it might. Of course it's good to avoid an unhealthy diet for other reasons.

If you can find out what stops PCa growing, (other than existing treatment after diagnosis), you could share with me and together we could make a lot of money as well as stopping a rotten disease!!

In all seriousness, if you want to get deeply into PCa there are many books on the subject and lectures by professionals on the net. Although collectively here we have a pretty good idea of the basics and our individual experiences, we are not doctors. PCa is a very variable disease which affects men in different ways and to which men can respond differently to treatment. You should always be guided by your consultant who will have your personal histology and scans and knowledge and back up to provide best informed advice, that is of course if you get to finding someone who meets your requirements!

Barry
User
Posted 28 Jul 2021 at 20:14

Originally Posted by: Online Community Member

OK. Some research papers use the word "drive" or "promote" which may be more accurate.
But if you're going to be picky, are you sure that cells can actually think? Particularly "male cells" 😂😂

Alex, the biggest lie in my post was when I claimed that I could dance 🕺(me doing Saturday Night Fever) . 

Dave

User
Posted 28 Jul 2021 at 20:18

Originally Posted by: Online Community Member

Thanks. Which are nutrients that feed the cancer? In theory if you block cancer from receiving those nutrients, you could stop progression?

That's an easy question. The answer is: the same nutrients as every other cell in your body. Indeed by stopping eating you really can starve the canver to death, but with the collateral damage of killing yourself. 

Dave

User
Posted 28 Jul 2021 at 22:08

Originally Posted by: Online Community Member

So you are saying there IS a chance!

Now just to find the fine line of starving the cancer, but taking enough necessary nutriments to not starve myself.

Is there any information where I can find out which cells in body take up nutriments first? Which organs?

Because if the nutriments are limited only to where vital organs receive enough to survive, while everything else perishes (including muscle) then maybe suffering collateral damage is worth it if it also kills cancer sells.

The big bummer would be to find out that cancer is first to eat up any nutriments you take in, but is that really the case?

Well if you look up angiogenesis you will see that cancer promotes growth of blood cells to feed the cancer. So it does get first dibs (English colloquialism) on the nutrients.

Now I really do not recommend you starve yourself to death. In fact I don't recommend you do anything without medical supervision.

For thousands of years humankind has fought cancer, we have tried the low hanging fruit: Strange diets, prayer, magic stones, massage, mushrooms, snake oil, music, witchcraft, sharp knives. The reason we are now building machines which cost millions of pounds is because all the cheaper options listed above fail. There is no easy solution to cancer. You are not going to find a solution better than what the doctors are offering you. 

Dave

User
Posted 28 Jul 2021 at 23:34

The sense of this is getting lost in description and semantics which I feel is misleading the OP. Why all this talk of nutrients? Let's simplify it. The hormone Testosterone, (among other things) is produced naturally in the Testicles and the Pituitary gland.  PCa aside, some people need injections of this to get it up to a satisfactory level. With PCa it is usual to try to lower the Testosterone to castrate level by either stopping the production or cutting it off. This is achieved by HT or removing testicles. The Testosterone (drives, feeds, grows, or however you want to call it) the cancer cells. Some patients have their Testosterone level checked so it can be established how well the injections or tablets are keeping the Testosterone level down. Conversely, in certain, mostly unusual circumstances, Testosterone supplement therapy is given to destabilize cancer cells. Check out this link https://www.hopkinsmedicine.org/news/articles/testosterone-as-a-drug

 

Edited by member 29 Jul 2021 at 06:06  | Reason: to highlight link

Barry
Show Most Thanked Posts
User
Posted 28 Jul 2021 at 12:21

OK I guess this is sufficiently different to your other questions it deserves a thread of its own.

Three answers I can think of.

1. Micro mets far away from the prostate

2. Some cancer cells can be dormant whilst being blasted, they later wake up and continue their evil job. I believe RT is spread over several weeks to try and catch them all awake at some point.

3. Assuming all the cancer is cleared, you are sitting there with a healthy prostate just like it was when you were a healthy 20 year old. Well that 20 year old prostate turned bad in about thirty years. So expect the same from your squeaky clean new one (in fact it ain't squeaky clean, so perhaps expect brand new cancer within ten years, but don't worry you will be 70 by then, and it probably won't become life threatening until you are over 90, if you live that long)

If you're worried about option 3. get a prostatectomy, and worry about incontinence whilst you're still relatively young.

Cancer is **** but you've got it. 

Edited by member 28 Jul 2021 at 13:42  | Reason: Not specified

Dave

User
Posted 28 Jul 2021 at 12:58
There is no cure for cancer - many cancers return eventually if you live long enough.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jul 2021 at 17:22

Ok, thank you so much guys.

 

Next question: 
What makes cancer GROW?

So we know those mets can grow into bigger cancers.

What is causing those cells to grow?

And what can be done to prevent them from growing?

From what I understand hormonal therapy and nuking testosterone is one way, but that ensures shitty life quality, so what else can be done to prevent those mets from evolving? What do they feed on?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 28 Jul 2021 at 17:26
They feed on testosterone; if you don't want hormone therapy, the alternative is orchiectomy. This is rarely done in the UK now but is still common in some countries, particularly for people who cannot afford the HT.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jul 2021 at 18:54

I don't really like the phrase "feed on testosterone". Testosterone does not provide the cell with any nutrient, it just acts as a trigger.

I don't know much about cell biology and hormones, but I'll give you my take on it anyway. Men and women are pretty much identical. Men do have a Y chromosome but it doesn't do much, for example all the details of making sex organs male or female are on various other chomosones. All the Y chromosone does is trigger testosterone in the fetus, that then tells some of the cells to start becoming male cells, like penis, testicle, prostate etc.The testicles then carry on making testosterone for life.

By stopping testosterone in an adult man some of those male cells suddenly think "what am I doing here? I'm in a woman! " hence they become dormant. If you then replace the testosterone they are triggered to carry on as normal.

So testosterone is just a signal not food. Pretty much like music and dancing is to me, give me music and I will dance, no music: no dancing. Music is just the signal. But dancing or not I need food. 

Sadly prostate cancer cells eventually evolve to divide even without testosterone.

The fact you are asking this question, suggests you are hoping to find the secret which will cure cancer. Well join the people in white coats they are all looking, but it is taking time.

I don't know how much money you have, if you are in the Bezos, Musk, Branson league you may make some progress. Mind you Steve Jobs wasn't short of a bob or two (sorry english idiom) and he went down the wrong route. 

Even if you do have enough money to set up your own research project, it is unlikely to yield fruit until after you die of cancer. So take what is on offer now to delay your death until a cure is found. 

 

Dave

User
Posted 28 Jul 2021 at 19:38

Originally Posted by: Online Community Member

I don't really like the phrase "feed on testosterone". Testosterone does not provide the cell with any nutrient, it just acts as a trigger.

OK. Some research papers use the word "drive" or "promote" which may be more accurate.
But if you're going to be picky, are you sure that cells can actually think? Particularly "male cells" 😂😂

Originally Posted by: Online Community Member

By stopping testosterone in an adult man some of those male cells suddenly think "what am I doing here? I'm in a woman! " hence they become dormant. If you then replace the testosterone they are triggered to carry on as normal.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 28 Jul 2021 at 19:41

Originally Posted by: Online Community Member

I don't really like the phrase "feed on testosterone". Testosterone does not provide the cell with any nutrient, it just acts as a trigger.

I don't know much about cell biology and hormones, but I'll give you my take on it anyway. Men and women are pretty much identical. Men do have a Y chromosome but it doesn't do much, for example all the details of making sex organs male or female are on various other chomosones. All the Y chromosone does is trigger testosterone in the fetus, that then tells some of the cells to start becoming male cells, like penis, testicle, prostate etc.The testicles then carry on making testosterone for life.

By stopping testosterone in an adult man some of those male cells suddenly think "what am I doing here? I'm in a woman! " hence they become dormant. If you then replace the testosterone they are triggered to carry on as normal.

So testosterone is just a signal not food. Pretty much like music and dancing is to me, give me music and I will dance, no music: no dancing. Music is just the signal. But dancing or not I need food. 

Sadly prostate cancer cells eventually evolve to divide even without testosterone.

The fact you are asking this question, suggests you are hoping to find the secret which will cure cancer. Well join the people in white coats they are all looking, but it is taking time.

I don't know how much money you have, if you are in the Bezos, Musk, Branson league you may make some progress. Mind you Steve Jobs wasn't short of a bob or two (sorry english idiom) and he went down the wrong route. 

Even if you do have enough money to set up your own research project, it is unlikely to yield fruit until after you die of cancer. So take what is on offer now to delay your death until a cure is found. 

 

Thanks. Which are nutrients that feed the cancer? In theory if you block cancer from receiving those nutrients, you could stop progression?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 28 Jul 2021 at 19:52
Just to add to the answers you have been given.

There are different types of PCa, a number of 27 has been suggested. Some types are more radio resistant than others. The DNA may not have been sufficiently damaged in some of the cancer cells so that these are able to recover or they might have been missed or beyond the reach of the administered radiation dose. The delivered dose is shaped to limit exposure to other organs, so this may account for some cancer cells being missed or not receiving a full dose, so in time a new tumour may form. Some cancer cells may have already have escaped but couldn't be identified. It cannot be predicted how quickly or over what period it can take to become a problem. In my case high quality scans (done on a regular basis as my treatment was within a trial), showed nothing for some two years after radiation treatment. My PSA started to increase slowly but persistently after that but an MRI showed a new tumour had grown. (In some men the cancer cells are more diffused, at least at such an early stage so may not be able to be identified by scans).

Hormone treatment can work together with RT to eradicate tumours or of itself control progression of the disease as it reduces the Testosterone on which the cancer cells feed. HT may work for months or years but eventually cancer cells learn how to get by without Testosterone so this treatment can of itself become ineffective.

Cells grow naturally in the body but in some cases something goes wrong, so instead of growing in a proper and controlled way, they grow in an irregular and uncontrolled way, You an see this where somebody grows a wort which may be triggered by a virus or infection causing abnormal new cells to grow (not that these are necessarily cancerous but to illustrate). Prostate cells can grow into cancer cells. The precise reason for this has not been identified as far as I am aware but it has been observed that the incidence of PCa in men of some Eastern countries is less than those in Western Countries. However, when men from these countries relocate to more developed Western countries, after a few years their risk increases to the level of the Western country. From this it is postulated that diet in the Eastern country plays at least a contributing part. Unfortunately, once you have been diagnosed there is no firm research establishing that if you change your diet it will assist in treating PCa, although some men believe it might. Of course it's good to avoid an unhealthy diet for other reasons.

If you can find out what stops PCa growing, (other than existing treatment after diagnosis), you could share with me and together we could make a lot of money as well as stopping a rotten disease!!

In all seriousness, if you want to get deeply into PCa there are many books on the subject and lectures by professionals on the net. Although collectively here we have a pretty good idea of the basics and our individual experiences, we are not doctors. PCa is a very variable disease which affects men in different ways and to which men can respond differently to treatment. You should always be guided by your consultant who will have your personal histology and scans and knowledge and back up to provide best informed advice, that is of course if you get to finding someone who meets your requirements!

Barry
User
Posted 28 Jul 2021 at 20:14

Originally Posted by: Online Community Member

OK. Some research papers use the word "drive" or "promote" which may be more accurate.
But if you're going to be picky, are you sure that cells can actually think? Particularly "male cells" 😂😂

Alex, the biggest lie in my post was when I claimed that I could dance 🕺(me doing Saturday Night Fever) . 

Dave

User
Posted 28 Jul 2021 at 20:18

Originally Posted by: Online Community Member

Thanks. Which are nutrients that feed the cancer? In theory if you block cancer from receiving those nutrients, you could stop progression?

That's an easy question. The answer is: the same nutrients as every other cell in your body. Indeed by stopping eating you really can starve the canver to death, but with the collateral damage of killing yourself. 

Dave

User
Posted 28 Jul 2021 at 21:10

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

Thanks. Which are nutrients that feed the cancer? In theory if you block cancer from receiving those nutrients, you could stop progression?

That's an easy question. The answer is: the same nutrients as every other cell in your body. Indeed by stopping eating you really can starve the canver to death, but with the collateral damage of killing yourself. 

So you are saying there IS a chance!

Now just to find the fine line of starving the cancer, but taking enough necessary nutriments to not starve myself.

Is there any information where I can find out which cells in body take up nutriments first? Which organs?

Because if the nutriments are limited only to where vital organs receive enough to survive, while everything else perishes (including muscle) then maybe suffering collateral damage is worth it if it also kills cancer sells.

The big bummer would be to find out that cancer is first to eat up any nutriments you take in, but is that really the case?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 28 Jul 2021 at 21:57

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

OK. Some research papers use the word "drive" or "promote" which may be more accurate.
But if you're going to be picky, are you sure that cells can actually think? Particularly "male cells" 😂😂

Alex, the biggest lie in my post was when I claimed that I could dance 🕺(me doing Saturday Night Fever) . 

😂😂😂I can't dance either

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 28 Jul 2021 at 22:08

Originally Posted by: Online Community Member

So you are saying there IS a chance!

Now just to find the fine line of starving the cancer, but taking enough necessary nutriments to not starve myself.

Is there any information where I can find out which cells in body take up nutriments first? Which organs?

Because if the nutriments are limited only to where vital organs receive enough to survive, while everything else perishes (including muscle) then maybe suffering collateral damage is worth it if it also kills cancer sells.

The big bummer would be to find out that cancer is first to eat up any nutriments you take in, but is that really the case?

Well if you look up angiogenesis you will see that cancer promotes growth of blood cells to feed the cancer. So it does get first dibs (English colloquialism) on the nutrients.

Now I really do not recommend you starve yourself to death. In fact I don't recommend you do anything without medical supervision.

For thousands of years humankind has fought cancer, we have tried the low hanging fruit: Strange diets, prayer, magic stones, massage, mushrooms, snake oil, music, witchcraft, sharp knives. The reason we are now building machines which cost millions of pounds is because all the cheaper options listed above fail. There is no easy solution to cancer. You are not going to find a solution better than what the doctors are offering you. 

Dave

User
Posted 28 Jul 2021 at 23:34

The sense of this is getting lost in description and semantics which I feel is misleading the OP. Why all this talk of nutrients? Let's simplify it. The hormone Testosterone, (among other things) is produced naturally in the Testicles and the Pituitary gland.  PCa aside, some people need injections of this to get it up to a satisfactory level. With PCa it is usual to try to lower the Testosterone to castrate level by either stopping the production or cutting it off. This is achieved by HT or removing testicles. The Testosterone (drives, feeds, grows, or however you want to call it) the cancer cells. Some patients have their Testosterone level checked so it can be established how well the injections or tablets are keeping the Testosterone level down. Conversely, in certain, mostly unusual circumstances, Testosterone supplement therapy is given to destabilize cancer cells. Check out this link https://www.hopkinsmedicine.org/news/articles/testosterone-as-a-drug

 

Edited by member 29 Jul 2021 at 06:06  | Reason: to highlight link

Barry
 
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