The "mothership" and pca spread.

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User

Posted 03 Oct 2023 at 11:09

It is difficult to remove all the prostate cells in a prostatectomy. There will probably be some left in the case nerve sparing, hopefully not cancerous, and at the apex (bottom) of the prostate, it diffuses into the surrounding tissues and aggressive removal here (which is necessary if the cancer is in the apex) reduces the chances of being continent afterwards.

This means you are likely to be left with some prostate cells after a prostatectomy, but hopefully not cancerous ones.

In cases where you are in remission for 10+ years and it then recurs, I do wonder if that's a new cancer forming in some remaining cells. After all, prostate cancer is usually a multi-focal cancer (springing up in several places, and not just one.

As mentioned, if someone is suddenly discovered to be heavily metastatic 10+ years after a prostatectomy, that might be lack of monitoring. It may be that the cancer was a non-secreter (doesn't generate PSA), but in that case, monitoring is via scans, although I don't know how long those go on for - probably not 10 years.

Edited by member 03 Oct 2023 at 12:07 | Reason: Not specified

User

Posted 03 Oct 2023 at 13:35

The "residual cells in the apex" are what my Urologist says are the cause of my persistent PSA.

I have my fingers crossed whatever it is it will not have increased at my next test this month!

User

Posted 03 Oct 2023 at 14:28

'Ok I know somebody who had his prostrate removed and was fine for 11 years but just recently I spoke to him and cancer has come back and spread all over his body..'

I am not sure what is your point here? I are suggesting that that an evidence of the 'mothership' theory?

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

User

Posted 03 Oct 2023 at 14:45

Hi ok thr chap involved hsd his prostrate removed snd was fine gor 8 years,but for some un known reason it has come back an now he's having further treatment he told me it had spread to most organs in his body...but he fidnt say what caused it since his p gland had been removed...

Cheers tonyc01

User

Posted 05 Oct 2023 at 07:18

Originally Posted by: Online Community Member

Cheers tonyc01

This make me wonder, regardless of whether you do or don't still have a prostate, where is recurrence likely to occur after say 7-10 years?

Is it going to come from the prostate bed, the seminal vesicles, local nerves or does it perform a nightmare trick and turn up in bones or remote locations where it's going to be hard to treat? I ask because it relates to the dreaded micro-mets that have rated a few mentions in this topic.

Jules

User

Posted 05 Oct 2023 at 11:09

I don't know the answer to your question about where it's most likely to occur after a long time. Certainly, in the case of recurrence after a shorter time, it's most often in the prostate bed, although some research where PSMA PET scans were performed before the prostate bed treatment found that in 40% of cases, the results from the PSMA PET scan changed the pattern of salvage radiotherapy dose that would have been delivered without having had the scan first. For patients with recurrence after a long time, you'd probably have to split them into those who were still being monitored at least yearly, and those who weren't, as I might expect that to have a significant impact on extent and location of recurrence.

In the case where substantial spread has occurred, no one is going to go back and investigate how that happened, as it would be very difficult to do and it's of no clinical significance (i.e. it won't change how it's treated).

Nowadays, seminal vesicles are always removed with the prostate even if not thought to be involved in the cancer, but that hasn't always been the case, and might not have been the case in some people having recurrence ≥10 years later today. Actual spread to seminal vesicles (T3b) reduces the likelihood of a prostatectomy being curative, and most surgeons will not operate if this is the suspected staging before the surgery, and radiotherapy is available for the patient.

User

Posted 06 Oct 2023 at 08:22

Thanks Andy, plenty of food for thought as usual. The PSMA PET scan pops up again as a vital tool for locating cancer.

I was asking about micro-mets because in the understandable lack of information about something that is untraceable there's quite a lot of assumptions out there about where they are and what their role is. Best to stick with what we know and can measure for now I guess.

Jules

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