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So where is it

User
Posted 19 May 2023 at 17:30

Diagnosed in 2015  T3b


RALP carried out in 2015 but PSA didn't drop to less than 0.1. Margins reported clear but PSA increasing.


33 sessions of Radiotherapy carried out in 2016 but PSA continued increasing.


HT started in 2017 and after 6mths PSA undetectable. Still on 3 monthly Prostap and 6monthly blood tests and PSA still undetectable. 


No metastases as far as I know, so where are the cancer cells that the HT is keeping in check ?


 

User
Posted 20 May 2023 at 16:00
Often after Prostatectomy some unseen cancer cells are left in the bed where the Prostate was removed and this together with some lymph nodes in the pelvic area are radiated with the hope that this will remove remaining cancer cells. The location chosen is what you might call an educated guess. Clearly there is a limit to the extent that RT can be directed. In your case the RT doesn't appear to have reached the cancer cells, even though RT does take months to work. So as no specific area could be found you have been put on HT which systemically puts the cancer cells to sleep wherever they are. While HT works, it makes it more difficult to identify where the offending cells are. That is why sometimes RT is not given until the cancer cells congregate to the extent that a tumour is identified to which RT can be directed. But if waiting longer there is a risk that the cells advance further and gain extra heterogeneity. In your case the cancer cells could be in a number of places, including bladder, liver, lung, bone or lymphatic system among them, perhaps too small or dispersed to be seen by scan until HT no longer constrains them. So at present it may not be possible to know where these errant cells are.
Barry
User
Posted 21 May 2023 at 23:50
PSMA scan may find them even if you are on HT.. I would push for that as your best chance of finding them.
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User
Posted 20 May 2023 at 16:00
Often after Prostatectomy some unseen cancer cells are left in the bed where the Prostate was removed and this together with some lymph nodes in the pelvic area are radiated with the hope that this will remove remaining cancer cells. The location chosen is what you might call an educated guess. Clearly there is a limit to the extent that RT can be directed. In your case the RT doesn't appear to have reached the cancer cells, even though RT does take months to work. So as no specific area could be found you have been put on HT which systemically puts the cancer cells to sleep wherever they are. While HT works, it makes it more difficult to identify where the offending cells are. That is why sometimes RT is not given until the cancer cells congregate to the extent that a tumour is identified to which RT can be directed. But if waiting longer there is a risk that the cells advance further and gain extra heterogeneity. In your case the cancer cells could be in a number of places, including bladder, liver, lung, bone or lymphatic system among them, perhaps too small or dispersed to be seen by scan until HT no longer constrains them. So at present it may not be possible to know where these errant cells are.
Barry
User
Posted 20 May 2023 at 20:25

Thanks Barry. I thought that this would be the likely answer so I guess that it's a question of remaining grateful that the HT is keeping a lid on things and forgetting about it.


 

User
Posted 21 May 2023 at 23:50
PSMA scan may find them even if you are on HT.. I would push for that as your best chance of finding them.
 
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