Cancer Survivors Network

YYYYYYeeeeeeeeeaaaaaaaaaa STUART!!!!! More Americans need to stop thinking doctors are gods. As you said "you must be your own advocate" Another opinion should be required part of medical diagnosis.

The horror story known will not be diverged but went through several doctors who cared absolutely nothing about me but wanted high paying insurance. Taking matters in my own hands things are very well after four years with PSA indictable.

Mark, I will be praying for you my wife and I. My story is just beginning though. In 2003 the VA did a blood test and I never learned about it until 2005 the psa was 8.9 so I went for another blood test and from 2003 8.9 to 2005 it went to 9.8 psa. I went for a byopsy and was told it was a smidge of prostate cancer. I am 61 and in good health otherwise so I am going to elect for the radical. Now get this while getting radiation counceling the Doctor order yet another blood test and the next night at home a VA surgeon calls me for any questions about radial option. Then he tells me that "hey you psa lab tests came in on my computer as we were talking and he says my psa is 2.0 or around there, like real low and normal. I am going to see him early in January 06 should I ask for another byopsy to find out if it is gone or what? I think he want to operate. Really confused and just don't know what to do. I am going to call my primary doctor to also enquire. Fitzner

Scheduled for radiation therapy- a 39 session treatment to the prostate. Told a likely side effect will be FATIGUE.
Had also scheduled to enter a sports competition which will occur on the 28th-29th day of treatment. Am trying to decide if the level of fatigue is such that I should cancel this event. Not getting idea of level of fatigue one experiences. Would appreciate any guidelines/personal experience you had....did it prevent you from active daily life?
PS- sport is veteran fencing- which requires short periods of intense physical activity- 3 to 9minutes long(bouts) spaced by brief rests until the next bout...and so on for some 6 to 10 bouts.
Event is distant from hospital so will have to stop treatment for 1 or 2 days- another question- should I wait until after event and start treatment dec 15
marcel

Here's my story for what it's worth. I had RP in December of 2000. It was caught very early and completely encapsulated. No Chemo or radiation recommended. 7 years later PSA still undetectable. In 2007 PSA 0.2. Early 2008 PSA 0.3. April 2009 PSA 0.3. Now Doctors recommend Radiation therapy. I guess I was naive about this thing and had begun to believed the waiting for the other shoe to drop was over. I'm sorry but I'm so angry. I see the look in my wife's eyes and can't stand to know I'm having to put her through this again. Especially knowing her father died of prostate cancer a year after we were married. I didn't mean to bring this thing to her. I'm so very sorry. I don't how to begin to make this up to her. Hell we're only 60 and recently retired. I just don't know what to do.

Sorry to hear about the slight rise in your PSA. I've been recently diagnosed and waiting for my surgery on August 12th. I would suggest openly talking to your wife about your fears and hers. The cancer is not something you brought on to yourself and I'm sure she knows that. I've been anry myself since I found out that I have Prostate Cancer. My Dad was diagnosed back in 1997 and still doing fine, but I'm 54 and not wanting to deal with all the possible side effects. Talking helps me tremendously.

Keep us updated on how you are doing.

Larry

Are you still online? I have some questions?

i just called my daddy to wish him a happy father's day and he "just mentioned" that his psa has risen to 3. he had a rp 10 years ago. he will be 81 on Wednesday. My husband is going tomorrow for biopsies, they take 12. His psa has risen from 1.5 in 2005 to 4.9 last month. His brother had rp last summer and his father died from colon cancer. I guess the waiting game begins. thanks for listening.

Please keep us posted on your dads and husbands progress! I'm waiting for my robotic surgery on August 12th age 54. My dad also had PC and was treated in 1996. Still doing OK but gets checked every year.

I had a radical surgery in Dec of 1993 and now my psa has risen from .01 after surgery to .89. Over the last year it has jumped from .04 tp its current level. Not sure what to do. Doctor is on vacation and will not be back till end of summer. Anyone have similar experience?

SINCE YOUR PSA DOUBLED IN A SHORT PERIOD OF TIME I WOULD BE HESITANT TO WAIT AND HAVE IT CHECKED OUT. A RAPID RISE IN PSA COULD MEAN AN AGRESSIVE CANCER LURKING SOMEWHERE. I WOULDN'T WAIT TILL THE END OF SUMMER TO SEEK ADVICE. GOOD LUCK !!

Arnie, I agree with Bronx that you ought to be looking at another doctor. I believe that most doctors now consider that a post-RP level that rises to greater than 0.2 ng/ml is indicative of a recurrence. Since it has been so long since your RP, you will want to know whether or not the cancer has recurred in the prostate bed or spread to some other area and what treatment options you have for it.

If your doctor does not have a colleague who handles his cases while on vacation, I would consider getting an opinion with another specialist. In any event, you will likely want to get two or three opinions beyond what your primary urologist says so you aren't really walking away from the existing relationship.

Since its almost the end of summer anyway, you probably don't have too long to wait for the doctor to return from wherever his is.

While I think you should move deliberately on this, I don't think you need to rush into anything.

Best of luck,

===================================

Age at Dx: 59. PSA at Dx: 4.3 PSA at Tx: 2.8 (after eliminating dairy)
1 of 12 cores positive with 15% involvement.
Gleason 3+3=6. DRE Normal. Stage T1c.
Treatment by CyberKnife radiation in June 2010. Side effects: Zero.

I second what Kongo said. Everything I've heard or read, greater than .2 is supposed to be the magic number. I had a radical prostatectomy in 2006. My GP has run PSA's and has reported scores of less than .01 (undetectable). However, my urologist has also run PSA's (the most recent was three weeks ago), and my scores from his office have been consistently less than .1 (undetectable). Psychologically, I feel better with the .01 than .1, but the doctors may use a different lab or have different reporting procedures. If I'm not mistaken, Dr. Walsh at Johns Hopkins considers everything below .1 as "undetectable". You can search the Internet to verify this through his writings.

what side effects did you have after the radation treatments. thanks griff

I don't mean to hijack this thread but just took a gut punch myself this morning.I'm 55 yrs I had robotic surgery last Sept lymph nodes clear negative margins Gleason 7 3+4. All PSA since 0 then this morning PSA .75 so I guess its radiation now. I had my surgery at MD Anderson Houston Tx and have a call into them for the next step; any idea's on what tests they may run and what I can expect from here?

Sorry to hear of rising PSA. I never got the chance to have a time of undetectable PSA so not sure how I'd feel if I was in your shoes. I too had negative margins although I was a T3B with seminal vesicle involvement. I'll let you know what I did. I met with a radiation oncologist and a medical oncologist and would encourage getting appointments with both. I talked extensively about the appropriateness of radiation with negative margins. I wanted some "magic test" to tell me that cancer cells would be in my prostate bed which is what is going to be radiated. Prostascint was discussed but I chose not to do that and it wasn't encouraged by either MD as they felt it would not give me useful information with a PSA of only .37. The biggest discussion was whether to do ADT concurrently with IMRT. Some indication that doing ADT for 2 months before, 2 months during and 2 months after radiation increases chances of staying undetectable for 5 years after. I really struggled with the decision but chose to do IMRT only. IMRT alone option for me was 35% chance of 5 year undetectable and 53% chance of 5 year undetectable with ADT andd IMRT concurrently. Two biggest reasons I choose IMRT only was I'm concerned about weight gain and impact on my diet & exercise controlled diabetes. Hate of survive prostate cancer and die from complications of diabetes. Also I was worried that I would not know if a post radiation undetectable PSA was due to radiation or ADT and that thought bothered me. I figured I can handle it if my PSA is still detectable after IMRT but not sure my "head" can handle not knowing if it is due to success of radiation or temporary undetectable due to ADT. I may have made a stupid decision not to do both ADT and IMRT but I'm okay with it and really feel like it time for me to get a decent break so I'm betting IMRT will work. Whatever the outcome is I will be okay with it because I made the informed decision. No one told me what I had to do. I haven't started IMRT yet so can't tell you if it was a good decision based on my outcome. I start within a week.

Prep for radiation is another one of those "experiences". Not that bad but I really get tired of "exposing myself" to so many different people. Keep thinking it would get better but ever time they tell me to remove "all your clothes and put on a gown" I cringe. Anyway, only uncomfortable part was they put contrast liquid into the ureathra and placed a plastic clamp on the penis to do a scan. Rest of prep was fine.

Good luck to you.

Thanks for the reply Ezra, hope your IMRT comes out ok. Its a strange thing for me looking like my future was long and now looking to making it another 5 years. But one day at a time I still have to get my appt and talk to the Dr and make a decision hope I'm as content after as you are.

Don't get concerned about the 5 year thing. I'm a couple years older then you. All my MD's kept throwing that 5 year failure rate term around. I finally stopped the medical oncologist and ask what he was saying "in plainer English". He said that he wasn't saying that I was looking at advancing metastatic disease in 5 years....just that I would had a 30-35% chance of non-detectable PSA in 5 years -so a 65-70% of detectable PSA. He said it's entirely possible that I would have a PSA low enough that I wouldn't need to start ADT for several years. He said that if my PSA approached 10 they would recommend ADT. He briefly talked to me about intermittent ADT and said he has had similar patients like me that have lived 20 or more years with out advancement. He said it's still highly likely that I would die WITH prostate cancer but not FROM prostate cancer. I am trying to do some things like avoid meat and dairy, exercise and living health lifestyle.

When I had my biopsy they told me there was about a 75% chance it was not cancer, and of course it was. Then after surgery they said I had better then an 80% chance of no return in the next 5 years and one year later its back. So I know they really don't know, as I said one day at a time I'll deal with it as it comes thanks.

My husband has been cancer free for 10 years after RP. April was .02. This month his PSA is 3.7

I am confused. His urologist, not the original, said he would re-do PSA in 3 months to make sure it isn't something from another gland that just pushed his PSA up.

All of you keep saying that when your PSA is above .30 you are having radiation already. My husband is off the charts compared to you and his doctor wants to wait 3 months.

did you wait 3 months and it show up again on the PSA test before they decided on radiation?

I am scared but my husband is comfortable waiting as he believes it to be a false positive.....

Thanks for any suggestions.

I feel for you - switching doctors is not my choice either. Just remember, different labs, different results. The follow up psa in 3 months should be at the same lab if at all possible. I've been having double tests for years - spring tests sent to Mayo in Minnesota and fall tests done in Nebraska. Results are very different. (detailed above.)

How old is your husband? Waiting 3 months really won't make much difference unless he is very young. My DH was 38 at diagnosis, so running against clock much more. Younger, more hormones, faster growing cancer.

Did you see comments above about reducing dairy and no sex to modify the psa test? Would be worth a try.

I'm praying for you.

He has his follow up with his urologist who he has had for the past 6 years in January.
He will also be following up with his VA doctor that also runs the test once a year.
That test is in December so I will be able to see how it differs from the urologist.
I was just so scared when it jumped from the 0.02 margin to 3.7 in just 6 months.
Thank you for your words of kindness and I pray for all those suffering from this disease.

Sorry that these test scores are causing you anxiety. More than a specific PSA reading, I believe the trend is what is most important. In your case, the PSA rise since August of 2008 has been pretty consistent and you may want to start considering options but I think the Mayo Clinic is giving you good advice about not worrying (easy to say, I know) about it till PSA goes above 0.1 ng/ml. Most definitions of recurrence are associated with a rising PSA that goes above 0.2 ng/ml.

One thing to keep in mind is that the standard deviation for the ultra-sensitive tests are often well within the the difference between your reading...in other words, it may just be a function of the lab procedure or equipment calibration.

Since you had a favorable biopsy at RP you have every reason to be optimistic and even if they should determine that there is a recurrence, the advances in just the past few years in salvage radiation therapy are very, very promising.

Please keep us up-to-date on your decison process.

Best

Thank you Kongo for your reply. I hope the test variances are because of calibration, but wish one of results had gone down, instead of up.

I just got off the phone with the Mayo clinic urology department. They would like us to get the tests as suggested by our local doctor. The tests can be performed here in Nebraska, and they will accept those results. Our RP doctor (Robert Myers) is no longer at mayo, so I havn't made an appointment with them yet. Surprisingly, they could get us in tomorrow, two weeks, and three weeks from now with another urologist.

Just trying to stop crying at work right now. At least we had 5 years with no worries.

I know how upsetting this is but if you research the background on recurrence you will see that about a third of the men who have RP experience a rising PSA within 10 years. Many times, if the PSA rise is very slow, no treatment at all is required. If the PSA doubling time is less than 2 years (which your numbers suggest)it may be an indication that the cancer is starting to grow along the margins which is very easily treated. There are several treatment options that provide excellent long term results. Typically treatment includes some form of hormone therapy or radiation treatment or a combination of both.

There could also have been a small amount of prostate material left behind at the time of surgery that could be causing the rise in PSA.

While the tests your local doctor is suggesting are prudent, given the readings you have described I would be astonished if they showed anything but I think what they want to do is rule something out. If the cancer had moved someplace else where it could be detected by those tests, I believe your husband's PSA score would be much, much higher.

As you did before when your husband was first diagnosed, you have to take this one step at a time and make sure you are getting second opinions and doing your homework.

This forum is an excellent place to get good information and many men who post here have dealt with similar circumstances and you will receive a lot of strong support.

Our local hospital will be doing the CT scan 9am Monday, and the Bone Scan at 1pm. My DH says I don't need to be there since I can't go in the testing room with him. I've been with him (well... in the closest waiting room) through all the tests and procedures with the RP 5 years ago, and want to be there for him now.

For you who have been on his end, should the wife push to try to be close, or is it really something you want to deal with alone? I remember him being very tired after first set of tests, but then that was with the fresh "C" diagnosis and facing unknowns at being diagnosed at age 38. We both are dealing with this episode much calmer.

We both work full time, and can take time away from work (sick days are available, so no pay loss)...

Our CT scan and Bone Scan came back with no signs of metastases. Now just waiting for 3 month psa follow up. I hope this time it doesn't continue to rise. Doubling time for his last 3 tests has been 14 months, so at least not going fast.

Darci, Glad to year all the recent tests came back negative. There are some interesting discussion threads in this forum recently about diet and its potential effect on PSA. Many of us have seen our PSA scores decline significantly when dairy is eliminated from our diet. You may want to poke around through past threads and see what folks have to say about it.

Best wishes for continued good news.

My husband had the RP in 2000. Over 10 years now. His PSA was always around 0.02
His last test in April was still at 0.2.

He just had his PSA done this month and it was 3.7!!!! I am really worried.
I met with his doctor who is not the original doctor. We moved in 2004.
He said not to be worried yet. He will retest his PSA in 3 months. Then he
will make a decision to do further testing if it does not go down.

When my husband had the cancer last time his PSA was 1.4, no outward signs,
and found by accident during a TURP procedure. I explained all this to the
doctor.

My husband is comfortable with the test being redone in January. He doesn't
really want to talk about it anymore. He was even hesitant when I wanted to
talk to the doctor myself. The doctor did say that, if I could not wait the
3 months, he could do a CT scan or MRI. I wish we still lived up north. His
original doctor was so much more concerned about these things.

Since it was at 0 in April, could this be just a bad PSA test. He has been cancer
free for 10 years, now this????????
My husband is only 64. He was 54 when he had the RP.

I had replied to your post above, and now see this one. Over 60.... waiting 3 months really won't hurt.

I personally just faced this same decision, and we chose to immediately have the ct and a nuclear bone scan, but since my DH is only 42 our hormones would make things move much faster.

This has to be scary since your husband's psa is higher now than with his initial diagnosis. We were up to a 7.2 and our doctor at Mayo clinic in Rochester Minnesota still waited a full month for RP surgery after biopsy (swelling/nerve sparing concerns.) Even with psa that high and only 38 years old, concerns of spreading within months was not a problem, with our gleason numbers.

I hope this makes you feel better. I totally feel for you. We just had the CT and Nuclear bone scan yesterday and are facing a 48 hour wait for results. We will also be repeating PSA in 3 months too.

Not a fun journey, but at least you are not alone!
Prayers from Nebraska-
Darci

Worriedwife:

Was the doctor who recommended waiting three months your family doctor or a urologist. Most urologists define recurrence in men who have had a RP as >0.2 and rising. Apparently, your husband was at that point last April. The latest PSA of 3.7 is highly significant and without any other information available, I would strongly suspect that this is an indication of recurrence.

More than a third of men who have RP see a recurrence within 10 years and there are several treatments available that have been shown to be highly effective in treating a return of PCa, including hormone treatment, radiation, or a combination of the two. From what I have read, the earlier your husband receives treatment when there is evidence of recurrence the more likely that he will have a positive outcome with very high long term survival rates.

Frankly, I don't understand the strategy of waiting another three months. What is he waiting for, some evidence of definite metastasis?

A CT scan or MRI is unlikely to show anything definite unless the cancer has spread to bones or other organs and created a tumor big enough to be detected by this equipment. Given the rise in PSAs you described, I doubt that this is what has occurred, although if it makes you feel better, I don't see any harm in it.

If this was your family doctor who is making this recommendation, I would make arrangement to consult with a urologist immediately. If it was your urologist who made this recommendation, I would seek a second opinion.

Best of luck to you and your husband.

It was his current urologist who he has been seeing the past 6 years. He has been having his PSA checked once a year. The test in April was with the VA doctor and last years PSA with the urologist both were under the 0.02 range.
Then this year with the urologist it came out 3.7 just out of the blue. He made an appt with the VA to double check in December and then depending on what that shows, he still has his 3 month follow up with the urologist. My concern is that his urologist does not seemed concerned at all. His original doctor was a Johnny on the spot doctor. When I asked why waiting, he said it could be a false read from another gland or recurrence, or a totally new cancer. Yes, that made me feel better. I asked what would happen if in 3 months his PSA was at 3.7 or above again. He said they do the ct or mri scan. He does not believe in the hormone therapy and said they would probably just do some radiation and that should bring his numbers down. It just did not seem like a real thought out process.

Thanks for helping with this and for so many to be so supportive of each other.

Kongo,

I just re-checked his April numbers and I misquoted them.

He was still at 0.002 not 0.02

The last test 6 months out was 3.7

He is having his blood test done at the VA in December so I can see the differences in the two lab tests. He still has his 3 month follow up with the urologist in January.

I guess that is why I got so scared. It went from 0.002 to 3.7 in just 6 months.

I really appreciate the information you have provided. If it is positive I will, as last time, ask for the best doctors to help him.

Thanks again

Having distanced myself from cancer for the last 10 years I find myself back on the internet and have come across this site which is very helpful, thank you for all the posts.

I had a RP 9 years ago at age 47. My annual PSA tests remained undetectable until 2008 when it registered .05, then 2009 it jumped to .09 and just last week it has come back as .18. My local GP had now recommended a bone scan and ultrasound. (He first recommended leaving it for 3 months and then getting another PSA test, it was only when I mentioned concern about levels between .1 and .2 that he changed his recommendation, not very reassuring!)

I just contacted my surgeon who has booked me an appointment next week for "seeing for biochemical failure", which I assume means seeing for recurrence of cancer. Do you think that radiation and or hormone therapy is likely, is there any way other than a recurrence, for the PSA to rise like this?

Thank you for your help

Bob,

Welcome to the forum and I'm so sorry that after several years you now find yourself dealing with all the issues again.

Most urologists today classify a biochemical recurrence (BCR) following a RP as 0.2 ng/ml and rising. You seem to be right there even though your latest score is technically less than 0.2. There are some nomograms available on the web where you can plug the date and the PSA value and it automatically calculates the doubling time. The quicker the doubling time the more worrisome the indications.

At the time of your RP there was undoubtedly a small amount of prostate tissue remaining from where the surgeon cut it away. Even though the margins may have seemed clear at the time, there could have been a very small amount of cancer left behind at the microscopic level. Since this is a slow growing cancer it took several years for it to generate enough PSA to be detectable. The other possibility is that the cancer had spread beyond the prostate before it was removed and these prostate cancer colonies at remote sites have now grown large enough to generate a detectable level of PSA. About a third of the men who have had their prostate removed eventually see a recurrence of PSA within 15 years. It seems that you have caught this pretty early on.

Prostate cancer is an inherently metastatic disease which means it will move to other parts of the body via the bloodstream or through the lymphatic system. However it got to where it is today, you now have to deal with it…or not. Older men with a slow growing recurrence may choose not to seek additional treatment. Given your relatively young age with a long life span in front of you I think you would want to seek some treatment.

Typically treatments for recurring prostate cancer include radiation, hormone therapy, or a combination of the two. If they can for sure localize the new tumors there may be some other options but my feeling given your relatively low PSA score is that a bone scan, MRI, and other tests are not likely to pinpoint exactly where the cancer is that is generating the PSA. I don’t think those tests really hurt; I just don’t think they’re going to give your medical team any useful information.

As you probably suspect, additional treatments carry a potential risk of side effects so when your doctors go over your options, make sure you understand the downside risk associated with them. Having said that, most studies show that early treatment of recurring cancer is extremely effective and has a long term prognosis.

There really isn’t any other reason for your rising PSA readings other than a biochemical recurrence. Of course there could have been some trauma to the remaining prostate tissue which caused the PSA to go up but it would most likely be a spike up and then down. Yours has been on an upward trend for a couple of years now. The other scenario is that the last two or three readings were errors…maybe the doctor changed labs or they’re using a different procedure or something. I would ask about it but it seems to me that’s a rather remote possibility.

I think you’re smart to start researching your options now and this is a great place to get advice from men who have experienced exactly what you’re going through now.

Best of luck and keep us informed.

Thank you so much for your reply. I went to the hospital today to get another blood test, even thought I just had one at my local GP's office, this one is at the hospital where had my RP. I fully expect it to be the same reading of .18 or thereabouts. My appointment with the surgeon in next Thursday, I will let you know how I get on and the recommendations. Thank you again for your help.

suggest that you contact your pharmacist and doctor, and google on the internet for possible side effects of zoloft antidepressants, and any other meds, both prescribed and over the counter...

I love your name! I checked webmd, and "abnormal liver function tests" is a side effect of zoloft. I will have to point that out to our doctor when we go in to have the other test results.

to deal with the Mayo Clinic, a center of excellence..find the best doc there...i'm not knowledgeable enough to know what specialty, maybe a medical oncologist who specializes in prostate cancer...........your local doc, my opinion...a doc should know the side effects of what is prescribed.

About going with your husband to get the tests, I think that it would be positive..but you need to respect his wishes...but I would definately go for the results with him.

It's going to work out

This is horrible to read, all these recurrances after surgery, I though with surgery they took the gland so the threat was very low, and that they wouldn't do surgery if cancer was outside the gland. Now I read this thread, does anyone think that maybe it's because of the biopsy, that it spread one tiny speck of cancer? What else could cause so many relapses?

I don't think that the biopsy causes the relapse. For many it comes down to two factors:

The Gleason score post surgery when they examine the complete speciman and if you have what is referred to as a positive margin post surgery.

The higher Gleasons 7, 8, 9 and 10 have more risk then a Gleason 6.

When the surgeon removes the prostate there is a very fine line between 'how much to cut'.
If you cut to little you may leave cancer behind and if you cut two much then you get into other problems. Or on examining the surgical speciman cancer is found at the very edge or 'positive margin'.

I'm Gleason 7 and a positive margin. Tomorrow morning I get my 14.5 month PSA result. I'm being monitored about every 4 months on blood work and will post in the morning.

Larry

Larry...wishing you the best and I hate this waiting game as much as but I am sure it will ease as more time passes on...God bless-B

there is a urban legend that the biopsy causes the cancer to spread, but this is not true.........tis has been dcoumented...one doc, Dr. Scholtz, in his book "Invasion of the Prostate Snachers" wrote about this.

Ira, while many doctors do not subscribe to the notion that biopsies or surgery contribute to the spread of cancer, there is a rather large body of evidence easily found on the web that suggests that indeed, biopsies can contribute to metastasis of many cancers, including prostate cancer. Even though the idea of cancer spreading as a result of a biopsy is not generally accepted (otherwise, why are they continuing to do biopsies?) there is enough out there that I would not classify it in the “urban legend category.” Instead, I would classify this as “maybe in some cases.” But in general, I don't think we yet know enough about this do be able to state definitively that it isn't a factor with any more conviction that when the "experts" dismissed Rachel Carson when she suggested that the chemicals we were putting into the environment was causing cancer.

The phenomena known as needle tracking where cancer is observed growing along the path of a prostate needle is fairly common in post RP pathologies, and other soft tumor cancers where surgery is involved following a biopsy. Women who have had a biopsy for breast cancer have a 50% higher risk of seeing their cancer spread than those women who have their tumors removed through a radical mastectomy or lumpectomy.

A recent study done at UCSD indicated that damage to the tumor during a needle biopsy may cause inflammation which is correlated to cancer metastasis. See http://ucsdnews.ucsd.edu/newsrel/health/03-07prostate.asp

Generally doctors will state that “there is no evidence that a biopsy can spread cancer” but it seems to me that that this is a plausible statement because they simply haven’t done any studies to determine if this is the case. Biopsies are such an integral part of the way cancer is diagnosed today that few physicians would ever challenge it. Without a biopsy they can’t give a definite diagnosis and none of the treatments that flow from that diagnosis could be undertaken. In the case of prostate cancer, 25% of needle biopsies show some level of prostate cancer and frequently these lead to follow on treatments that also make a great deal of money for the doctors. For all cancers, biopsies are not only a very large money making operation for doctors and pathologists, they lead to further treatments which also make a lot of money. Doctors have a vested interest in conducting biopsies.

Cancer can spread in many ways, such as through the lymphatic system called "embolization". The lymph system has its own channels that circulate throughout the body, similar to the veins and arteries of the bloodstream. These channels are very small and carry a tissue fluid called lymph throughout the body. Cancer also metastasizes when cells break off from the original tumor and travel through the blood stream to other parts of the body. Cancer can also spread directly to adjoining healthy cells such as occurs in skin cancer. For prostate cancer to metastasize to a distant organ such as the bone, lung, liver or whatever, it is probably traveling by the bloodstream. While cancer needs blood like any other cell, sometimes cells slough off and enter the bloodstream naturally and eventually find someplace that provides a home for a new colony.

My personal feeling is that when the tumor is pierced with a needle that some of the cancer cells also enter the bloodstream. Another way intervention can cause a spread is when surgery cuts across a margin where cancer is present and cells can then enter the bloodstream. The study I cited earlier suggests that the inflammation caused by a biopsy creates a chemical condition that accelerates the shedding of cancer cells that can spread through lymphatic action or by the bloodstream. The frequent manifestation of “needle tracking” suggests that SOMETHING abnormal is going on along the path that the needle takes during a biopsy. The needles in a biopsy gun that are used today (18 gauge) are much smaller than those used years ago, and may reduce the likelihood of cancer spreading as a result, but needle tracks still occur, and to in my opinion, the fairly frequent recurrence of cancer years after initial treatment when it was originally considered to be “contained within the prostate” makes sense if you consider that the original biopsy and treatment caused cancer cells to enter the bloodstream.

I wish there was a better, non-invasive way to determine prostate cancer without a biopsy and I am sure that our generation will see such a development given the pace of modern research. In the meantime we must take our chances as the only way to confirm a suspected cancer is to conduct a biopsy.

Actually, since I guess that I waved a red flag for you, I'm surprised that it took you so long to respond......

My view is that it is current establisted practice by the medical profession to do biopsies...it is up to nay sayers to provide concrete information to validate problems caused by biopsies, other than possible infections...I have not seen any information that does this....I believe that you are presenting a well thought out hypothesis, but the facts are lacking.....anyway my opinion.

I looked at the article that you referenced......as I read the article published in 2007, where mice were the subjects, it suggests...( I wonder if there has been any follow up in response to this study) more needs to be done to investigate the hyposthesis...(that's what I get from it, however others may see differently, so I pasted the article below.

You wrote "

"I wish there was a better, non-invasive way to determine prostate cancer without a biopsy and I am sure that our generation will see such a development given the pace of modern research. In the meantime we must take our chances as the only way to confirm a suspected cancer is to conduct a biopsy."

I agree, by the way a few weeks ago there was something on TV about colon cancer, and examining stools to determine cancer, I think looking at genes instead of a colonoscopy.So I'm thinking that a colonoscopy may go by the wayside

Anyway that's my take.

> News Releases > Health Sciences
Inflammation May Play Role
in Metastasis of Prostate Cancer

March 19,2007

By Debra Kain

Many would assume that “mounting an immune response” or “having your body fight the cancer” is a good thing. Now, research at the University of California, San Diego (UCSD) School of Medicine strongly suggests that inflammation associated with the progression of tumors actually plays a key role in the metastasis of prostate cancer.

The research, appearing online March 19 in advance of publication in the journal Nature, identifies a mechanism which triggers metastasis, which is the spread of cancer in late stages of prostate cancer development. The findings by Michael Karin, Ph.D., professor of pharmacology in UCSD’s Laboratory of Gene Regulation and Signal Transduction, and colleagues may help solve the puzzle of why it takes so long for cancer to metastasize, as well as what causes it to do so. Furthermore, this new work may lead to development of anti-metastatic therapies.

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A major hypothesis in cancer research has been that whether the cancer metastisizes or not is determined by genetic changes within the cancer cell itself. But this hypothesis didn’t explain why metastases appear many years after the initial tumor.

“Our findings suggest that promoting inflammation of the cancerous tissue – for instance, by performing prostate biopsies – may, ironically, hasten progression of metastasis,” said Karin. “We have shown that proteins produced by inflammatory cells are the ‘smoking gun’ behind prostate cancer metastasis. The next step is to completely indict one of them.”

More than 200,000 men are diagnosed with prostate cancer in the United States every year. As many as 25,000 men will probably die of prostate cancer in 2007, most as a result of metastatic disease.

Early tumors confined to the prostate can be treated, but no effective treatments are available for metastatic disease, according to Steven L. Gonias, M.D., Ph.D., professor and chair of the UCSD Department of Pathology, a study investigator.

“This study helps explain the paradox that, in certain types of malignancy, inflammation within a cancer may be counterproductive,” said Gonias.

In research using mouse models and confirmed in human tissue, the scientists observed that a protein kinase called IkB kinase α (IKKα) turns down the expression of a single gene called Maspin, which has well-established anti-metastatic activity in breast and prostate cancers. They found that the production of Maspin is repressed by a series of events triggered by tumor inflammatory cells, with the result that prostate cancer cells spread.

“An excellent inverse correlation between IKKα activation and Maspin production was detected, such that advanced prostate cancer cells contain high amounts of activated IKKα in their nuclei and express little or no Maspin,” said Karin. He noted that a perfect correlation between nuclear accumulation of activated IKKα and reduced maspin expression was also seen in human prostate cancer, and both correlated with the clinical stage of the disease.

Karin and his colleagues discovered a signaling pathway that increased metastases in a mouse model of prostate cancer. The pathway is activated by a ligand that binds to a Receptor that Activates Nuclear factor Kappa-B (RANK). RANK ligand has been shown in previous studies to be an important inflammatory protein (cytokine) that can lead to bone loss through activation of bone resorbing cells.

RANK ligand, produced by inflammatory cells that invade advanced prostate tumors, triggers a chain reaction in which IKKα is activated, allowing it to enter the nucleus of the cancer cell, repressing Maspin. IKKα is a key linchpin in the pathway that turns off the Maspin gene and activates the metastatic program. The new results also support the view that RANK ligand is a general promoter of prostate, and possibly breast, cancer metastasis.

“Maspin is a very potent inhibitor of metastasis; in a patient with metastasis, cells have found a way to turn off Maspin, which may depend on invasion of the tumor with RANK ligand-producing cells that activate IKKα,” said Karin.

Malignancies progress through stages. In early, non-metastatic tumors, a high level of Maspin is present, but it is turned off in late stages. Early tumors contain low amounts of active nuclear IKKα, whereas late-stage tumors contain the highest levels of active nuclear IKKα. The researchers also found a striking elevation in expression of RANK ligand in late tumors, but it was not expressed by the cancer cells. Instead, it is expressed by invading inflammatory cells. Interference with RANK ligand production or activation, as well as interference with IKKα activation, may offer new therapeutic strategies for prevention of metastatic disease.

The study was funded by the National Institutes of Health, the U.S. Army Medical Research and Material Command, the Prostate Cancer Foundation, the Aventis-UICC Translational Cancer Research Fellowship, the Lopiccola Fellowship of the UCSD Moores Cancer Center, and the Life Science Research Fellowship.

Additional contributors include first author Jun-Li Luo,Wei Tan and Olexandr Korchynskyi, UCSD Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology and Moores Cancer Center; David A. Cheresh and Jill M. Ricono, UCSD Department of Pathology and the Moores Cancer Center; and Ming Zhang, Baylor College of Medicine, Department of

Hey, Ira. No red flags. Obviously I don't have the "facts" on this issue other than the ones I referred to earlier. I just get very suspicious of one-liner dismissals about the potential impact of things relating to cancer. I don't think we know enough about too many things and in this case there is so much vested interest in continuing biopsies that I doubt we will ever see a costly study to examine it...who would sponsor it? Way too political.

I have recently read that dogs can be trained to sniff urine to determine if there is prostate cancer. Of course, dogs spend most of their lives sniffing urine so maybe they have a good nose for it. I would draw the line on a DRE though...wouldn't want a pit bull going there!

It seems to me that the hardest part about diagnosing cancer without a biopsy is determining the right Gleason equivilent without actually looking at the cell structure and the only way I can imagine doing that with technology today is via biopsy. But I do think some savvy researcher will find a way to do it in our lifetime.

Although given that we do know that cancer spreads via the bloodstream and lymph system and we do know that even a thin biopsy needle pierces these systems while drawing core samples, it makes sense to me that there is a very likely chance that there are some cancer cells that are going to get loose during the process. Studies or no, I will remain suspicious of the procedure and avoid it where I can.

A similar corollary is the amount of vitamins and supplements many men with cancer take without hard studies showing value. There is much we do (or don't do) that can't be absolutely supported by studies.

I am a young 70 recently diagnosed with PC, Gleason 3+3, three out of twelve hits on biopsy and a PSA of 7. I was going with AS until an MRI showed that the tumor was nestled up against the seminal vesicle. Bone scan normal and PSA actually went down to 6.7. The proximity to SV quickly put me in the same treatment maze that so many of you have been in. I am coming out of the maze looking strongly at radiation therapy and and am deciding between CyberKnife and TomoTherapy. I noticed from prior communications that Kongo chose CyberKnife after considering many options. I apologize for being off topic but this is my first post and I didn't know how to get in the conversation without just entering through this door. Does anyone have advice or information or anything else on TomoTherapy versus CyberKnife?

All of these posts I have read in the past have been very helpful to me generally and I appreciate the involvement and opinions of you fellow travelers.

Hi, Mike and welcome to the forum. When I was researching CyberKnife I also looked at TomoTherapy and asked a lot of questions about it from two different radiologists. I would encourage you to do the same so that you really understand the nuances between the two.

In many wasy there are very similar...both deliver very accurate dosages of radiation. TomoRadiation uses a process that modulates the intensity of the radiation beams to concentrate dosage in the exact area the radiologist wishes to target. As I recall, In TomoRadiation the equipment fuses at CT and MRI image in near real time and delivers radiation within about 1 mm accuracy. CyberKnife delivers < 1 mm accuracy and uses gold fiducials to track the prostate movement in real time via low level x-rays and adjusts equipment placement accordingly.

With IGRT (Which is what Tomo is...Image Guided RT) you lay in a tube and the radiating part of the machine spins about you. In CK you lay on a bed and the robot arm moves about you.

With CK you typically have 5 sessions, each about 40 minutes. With Tomo you have abut 40 session, each consisting of about 5 minutes of actual radiation. The biological equivilent dosage is about the same between both methods.

I chose CK over Tomo or straight IMRT because I felt that the real time tracking of prostate movement offered a slight clinical advantage and the treatment could be accomplished much quicker. I believe the side effects are pretty much the same for either method.

I would encourage you to meet with radiologists who specialize in both and get their opinions about which method might be best for your particular situation. In the end it may well come down to which doctor you prefer.

Good luck and keep us posted on what you learn and how things work out.

that there are side effects from everything....so as far as biopsies, I want to have less...less chance of infection, sexual problems, etc., and the same is true for vitamins...some of these vitamins , and also prescribed drugs have unknown negative effects.... ...there are people errors in what ever you do....

Frankly , at this time I also do not have the facts about biopsies spreading cancer, only input from various docs who I respect, who support biopsies and state that biopsies do not spread cancer.............however to be honest , many doctors used to support smoking, so who knows what we will come up with in the future, but for now, I believe that it is advisable to go along with current medical protocol, and not second guess....I for one am not qualified and do not know more that the vast majority of the personnel in the medical profesion, and I beleive that even you who I respect greatly are not qualifed.

I also believe that there will be improved diagnostic tests for PC... not needed for DRE's
.....airport security already does the best job.

After this past test being 3.7, I had the same question. The urologist explained that when the prostate is removed, there are small parts that remain. There are usually no problems if all the cancer is removed, but, if a very small amount of cancer remains, over the course of years, the PSA can rise and thus the recurrence. My husband had been at 0.02 for 10 years. I still am a bit befuddled. He also said other glands could cause the sudden rise and that is why they wait the 3 months to be sure it just wasn't from another gland out of whack. Either way, my husband and I would do it again. He has been cancer free for 10 years and that is alot of stress relieved. We will work it out again if that is what the results show this year. I was really scared a few weeks ago but just chatting on this site has actually eased a bit of my fears. Keep the faith.

Worried Wife:

I'm about confused about what your doctor relayed to you when he explained potential rises in your husband's PSA reading. I certainly agree with his discussion about prostate tissue left behind after an RP. That is always the case after surgery. What I do not understand is his discussion about another gland being "out of whack." I don't know what that means unless he is suggesting that prostate cancer has spread to another place, such as a lymph node or seminal vesicle, liver, lung, or bone but technically those aren't "glands." PSA comes from prostate cells. When a man has a prostate, non cancerous PSA elevations can be caused by a urinary tract infection, BPH, a biopsy, or other inflammation. Short term PSA elevations can come from ejaculation, a DRE examination, a hard stool, or even bicycle riding. Since your husband had his prostate removed more than 10 years ago, there really isn't another potential cause of the PSA elevation except for a return of prostate cancer where these cells (regardless of where they now are in the body) are generating PSA. The only possibility I can imagine that could be an alternate explanation is an error in the PSA reading due to equipment calibration, human error, or some accidental contamination of the blood sample. I would be fascinated to know what other glands he is talking about when he suggested to you that "... other glands could cause the sudden rise..."

I am certainly not trying to scare you or give you gloomy news but I think you and your husband deserve accurate and precise information about what is happening and why and what options you have to deal with it. Doctors should take pains to explain to you what is going on in exact terminology and make sure you understand it. Terms like "out of whack" only make sense if you understand the chemistry and biology of what is going on at the microscopic level. I do hope that your next reading comes back at the very low levels you have experienced for so long but you should also be prepared for what you should do if it comes back and shows another increase.

I was also surprised to see than in antother post on this thread that you indicated that your urologist doesn't believe in hormone therapy and would probably do radiation instead. Radiation is a common treatment for recurring prostate cancer but so is hormone therapy or a combination of both hormone therapy and radiation. Most studies show that there is a much higher long term prognosis with a combination of hormone therapy and radiation than with either treatment used alone.

As with any diagnosis of this serious nature, I would seek a second opinion on your doctor's recommendations.

Best of luck to both of you.

........basically he believes that it is a good idea to hold off hormone therapy; after other salvage treatment(radiation) because of the potential ill effects....(I did not ask for source information)...just mentioning here for possible discussion.

I agree that if things are not explained properly, I will seek another opinion. I replied above to correct myself in that my husbands PSA was at 0.002 not0.02 in April and then jumped to 3.7 6 months later.

I was not happy with his explanation and he seemed surprised that I met with him after he spoke with my husband and told him he would retest in 3 months. My husband had a brain injury last year and is almost back to his normal self with some residual minor issues. He had a great neuro surgeon. But, due to this issue, I have to get first hand information to understand what is going on. I also was not happy that he seemed so aloof about it all.

I am thinking of calling his original surgeon if it turns out it is cancer again. This urologist talked to us like it was no big deal. He said since it is 10 years out he doubts recurrence, rather it would be more likely a new cancer????? Yes, that made me feel good. Then as we were leaving he said if it is recurrence, they would just shoot radiation into that area and it would be all better. Then he said he was not a fan of hormone therapy.

Thank you for all your words of wisdom.

When I was first diagnosed 7 years ago this week I was told by my urologist that another gland also puts out small amounts of a tertosterone type chemical that makes the cancer grow faster. It may have been the throid but its been a long time and my memory is not that good. Anyway, he put me on some pill to discourage this from happening. I too am not a fan of hormone therapy and speak from experience. Side effects are not worth the time in my opinion.

Thank you for letting me know and I think in my stressful visit, he might have mentioned
the thyroid gland.

What kind of side effects have you had with the radiation and/or hormone therapy?

I am so glad there are people here to talk to and vent. I truly appreciate any and all input.

I understand the frustration you have with your urologist and in my opinion he should have taken more time to explain his thoughts. I also understand your anxiety from dealing with these new issues as your husband recovers from his brain surgery.

In your original post you mentioned that your husband’s original PSA was 1.4 and that some prostate cancer was discovered during a TURP procedure. I am assuming that the TURP was performed to alleviate some urinary discomfort from an enlarged prostate. Prostate cancer frequently begins to show itself at the same time as BPH (benign prostate hyperplasia). As you may know, very often incidental prostate cancer is found in men beyond the age of 50 without any other indications. Frequently this incidental cancer is indolent, very slow growing, and never poses a threat to the patient. Without knowing the details of the post RP biopsy this is just speculation but it’s certainly possible that the PSA you are seeing now is a result of a small amount of cancer left behind from the original surgery that has taken ten years to reach a stage where it is making enough PSA to show up. Remember that most forms of prostate cancer are very, very slow growing and these cancer cells only divide about every year and a half.

Prostate cancer spreads through the blood stream and the lymphatic system so it is possible that in the years since the original RP that prostate cancer has taken hold in a nearby lymph node or seminal vesicle (you will want to check the records from the prior surgery to see if they were removed or not). Outside the prostate, cancer grows faster than it does inside the prostate and PSA will tend to increase more quickly. Some scientists believe that the prostate produces protective tissue that acts to isolate the cancer but that outside the prostate this does not happen.

Given that your husband’s prostate was removed, it is difficult to imagine that this is a new prostate cancer distinct from the earlier form. Although since there was undoubtedly some prostate tissue left behind after his RP, I suppose it is possible but I have never heard of that happening. Most likely, it is a continuation of the previous cancer and recurrences after ten years or more while uncommon are not unheard of.

It’s entirely possible that if you do discover that prostate cancer has returned that it is a very slow growing, indolent type of cancer that does not pose a health threat. I would be prepared to calculate the PSA velocity which is a valuable tool in determining the severity of any recurring cancer. I also urge you to seek out second opinions, particularly if you’re second guessing whether or not your existing medical team is meeting your needs.