Metastasis - Event or Process?

UKMax · August 2020

Hi all

BY way of introduction my name is Max and I'm a long time reader of these impressive pages, though joined only today. I live and work in England, and am 58. I had Robotic Prostatectomy in 2016, and my PSA has remained undecetable since, for which, coupled with my complete physical recovery, I'm grateful beyond measure.

So I don't come asking personal advice about my own situation, but reading these boards and others have planted a question I can't seem to find an answer for. Many times we see the advice to 'take your time because PCa is a slow grower'. Whislt I understand this to be objectively true, surely it's always a bit of a gamble when offered as advice since we don't know at what stage the recipient of the advice is? At some point cancer can metastasise, and my question is, is that an event or a process?

Does a sufferrer go from being local to metastatic in one go? If so, what's the timescale? A day? A minute? Or is it a process over many weeks or months? If the latter, at what point does it become irreversible?

I expect there may not be a strict answer, but would love to invite the sort of expertise I see here brought to bear on the topic.

Thanks,

UKMax

Clevelandguy · August 2020

Timeframe?

Hi UKMax,

Welcome to the board, from what I have learned over the years I don't know if there is a clear answer to your question.

A lot of the people on this board that have posted about their cancer metastasizing shows a slow uptick in the PSA over months/years followed by some cancerous lesions being pick up by an MRI or PET type scan. That to me does not sound like an imediate undetectable to a large full blown tumor somewhere in your spine,hips, or ribs within a couple of weeks. One man on this board just reported that he has been cancer free for 28 years after his treatment but for others it has been a few years before the cancer has returned. Does not seem to be any definite pattern or predictive rate as to when the cancer will return if it ever does. If it does return there are always things like radiation in our case, more surgery, chemo or other type of testosterone reducing drugs to knock the cancer back down. In my case I had surgery in 2014 & have been undetectable evey since. Will I remain that way till I die? I hope so but there are no guarantees in life. I could get hit by a truck or struck by a lightning bolt or whatever. In my humble opinion I feel it depends on the serverity(gleason score) & location(close to the edge of your Prostate) of your cancer plus the quality of your doctor(s) & facility that performed your treatment. Hope that kinda answers your question, I hope other will chime in.....

Dave 3+4

hewhositsoncushions · August 2020

I would say it is a process

I would say it is a process but the act of detecting advanced cancer is an event.

VascodaGama · August 2020

Cells skills and instincts in action

UKMax,

Though cancer initiation is an event, metastasizing is a process. One can understand this fact by following the steps cancer do to develop, expand, travel and set home at a newer place (metastatic cancer).

It all starts with a blow disrupting the normal way cells multiply and divide, making these cancerous. The disruption is usually initiated with a sudden occurrence of something unwelcome; a stressful moment in life, Injury due to a radiation stroke, Exposure to agents and carcinogens as chemical events, etc.
In any case, cells are well prepared to survive blows and will resist any attempt to kill them. It is this surviving instinct (if we can call it like that) that make damaged cells to continue multiplying creating tumors and expanding in its environment (prostate gland). The growth is only stopped when these tumors reach the basal lamina made up of proteins and glycoproteins forming the shell of the gland.

This is here where the malignancy skills of the cancer is shown when it uses its weapons to cut through this lamina using a series of enzymes (matrix metalloproteases), moving forward. From there it spreads and infiltrates the blood vessels traveling to far places through the blood stream. These are metastasis that can set home at places away from the prime cancer becoming dangerous and threatening life.

However, it is not easy for the migrating cells to fix into a new place as these will be rejected by the local cells demanding an urgent attack by the immune system. The process takes time (years) to complete and reach a success. Many metastases do not die and live locally but do not succeed in developing at the newer environment causing problems to the patient. One knows that metastases in the lungs or liver lead to a shortening of the life of the patient (typically becoming irreversible).

Accordingly, one can judge advanced cases (not contained) via the data collected that identify the grade of cells (well or poorly differentiated), volume of cancer (number of positive cores), tumor location within the shell (PIN and SV positive), extraprostatic findings (LN invasion), bone lesions (image studies), etc. Surely the way to identify and locate cancer is still primitive (PET working at cellular level is the best at present) but the numerous of past cases serve as experience to provide a final conclusion with a high grade of validity.

I hope my lay opinion helps and answers your question.

Congratulations in your four years of remission.

Best wishes,

VGama

Georges Calvez · August 2020

Gleason Grade and metastasis

Hi there,

There is a big link between Gleason Grade and metastasis. Grade 3 cells seldom if ever establish distant metastases, what they will do is grow into the bladder or rectum if they are allowed to advance far enough. Grade four cancers tend to establish pelvic metastases and something like seventy per cent of metastases are of this type. Grade five tumours are capable of losing small balls of cells that set off around the body and they will often set up distant colonies while the tumour in the prostate is still quite small.
Prostate cancer is extremely variable in its nature with the great majority of cancers showing quite low rates of growth, this is what makes it a cancer that men die with rather than from.

Best wishes,

Georges

UKMax · August 2020

Thank you all so much for

Thank you all so much for your answers.

Vasco's characteristic thoroughness is very persuasive, I think. It seems quite a challenge for any rogue cells to become established, but the process described does in part explain the odd timescales we see in recurrence.

Everyone's input much appreciated.

Max

Max Former Hodgkins Stage 3 · August 2020

UKMax said:
Thank you all so much for
Thank you all so much for your answers.

Vasco's characteristic thoroughness is very persuasive, I think. It seems quite a challenge for any rogue cells to become established, but the process described does in part explain the odd timescales we see in recurrence.

Everyone's input much appreciated.

Max

A thought

UK,

It seems your question involves both etiology (cause of a cancer) and therapeutic/clinical responses to probabilities. But I will share a few thoughts that touch upon both.

As you have noted, recurrence (relapse for PCa, or any other cancer for that matter) can occur over virtually any time frame. My first cancer (a strain of Hodgkin's lymphoma) has a 15% liklihood of relapse, but this is often delayed for as long as 20 years or more. A question with blood cancers, which occures due to corruptions in the manufacture of stem cells in the bone marrow, is whether a new lymphoma or leukemia is in fact the previous one returning, or a wholly new cancer that was spawned through factors or defects in the genectics involved. I have a friend at the Lymphoma Board who has had 8 different lymphoma diagnoses, and as many treatments, involving now over 20 different chemotherapy drugs over 15 years. One would think that at least some of these are sui generis, of completely unrelated diseases.

With an organ cancer, the issue is a bit different, and I approach this as a logic problem, rather than a biochemical one. IF the prostate is the only source of Prostate cancer, then removal of the whole gland must logically require one of two outcomes: permanent cure, or eventual relapse from PCa cells that remained after the gland was taken out. Both of these of course happen with some regularity, but the former is much more common than the latter. If a man has had the gland removed, and has been undetectable for PSA for years, and then relapses for PCa, then there had to have been cells left behind, since this disease cannot emerge ex nihilo -- 'from nothing.'

This line of reasoning is why women with genetic liklihood for, say, ovarian cancer sometimes have their ovaries removed, or their breasts (BRCA1 or BRCA2): If there are no ovarian cells, then there is nothing there to cause ovarian cancer, and so forth. The so-called 'Angelina Jolie' surgery. A first cousin of mine tested positive for BRCA1 a few years ago, and her doctor recommened preventative ovary and breast removal, which she did, since she had alread had breast cancer once years before. (Testing positive for BRCA 1 or 2 yields an 86% LIKELIHOOD of developing AGGRESSIVE BCa. -- a horrible prognosis.)

Ergo, it seems like some cancers or series of cancers may trace back to a one-time event, while others may be wholly new processes taking place. Either way, a cancer diagnosis seldom leaves people mentally at ease for life.

UKMax · August 2020

Max Former Hodgkins Stage 3 said:
A thought
UK,

It seems your question involves both etiology (cause of a cancer) and therapeutic/clinical responses to probabilities. But I will share a few thoughts that touch upon both.

As you have noted, recurrence (relapse for PCa, or any other cancer for that matter) can occur over virtually any time frame. My first cancer (a strain of Hodgkin's lymphoma) has a 15% liklihood of relapse, but this is often delayed for as long as 20 years or more. A question with blood cancers, which occures due to corruptions in the manufacture of stem cells in the bone marrow, is whether a new lymphoma or leukemia is in fact the previous one returning, or a wholly new cancer that was spawned through factors or defects in the genectics involved. I have a friend at the Lymphoma Board who has had 8 different lymphoma diagnoses, and as many treatments, involving now over 20 different chemotherapy drugs over 15 years. One would think that at least some of these are sui generis, of completely unrelated diseases.

With an organ cancer, the issue is a bit different, and I approach this as a logic problem, rather than a biochemical one. IF the prostate is the only source of Prostate cancer, then removal of the whole gland must logically require one of two outcomes: permanent cure, or eventual relapse from PCa cells that remained after the gland was taken out. Both of these of course happen with some regularity, but the former is much more common than the latter. If a man has had the gland removed, and has been undetectable for PSA for years, and then relapses for PCa, then there had to have been cells left behind, since this disease cannot emerge ex nihilo -- 'from nothing.'

This line of reasoning is why women with genetic liklihood for, say, ovarian cancer sometimes have their ovaries removed, or their breasts (BRCA1 or BRCA2): If there are no ovarian cells, then there is nothing there to cause ovarian cancer, and so forth. The so-called 'Angelina Jolie' surgery. A first cousin of mine tested positive for BRCA1 a few years ago, and her doctor recommened preventative ovary and breast removal, which she did, since she had alread had breast cancer once years before. (Testing positive for BRCA 1 or 2 yields an 86% LIKELIHOOD of developing AGGRESSIVE BCa. -- a horrible prognosis.)

Ergo, it seems like some cancers or series of cancers may trace back to a one-time event, while others may be wholly new processes taking place. Either way, a cancer diagnosis seldom leaves people mentally at ease for life.

Thank you Max for your

Thank you Max for your thoughtful response. I like and agree with the exercise in logic applied to prostatectomy, but struggle a bit to apply the same rigidity to the process of metastasis.

Vasco's explanation, wherein he describes a colony of malignant cells struggling to establish themselves at some distant site, which may or may not succeed depending on a number of variables, probably best fits my own unsophisticated understanding, but you then rightly add the hugely complicating aspect of one's unique genetic make-up, and whatever developing clarity I had leaves me.

Thanks for taking the time to answer. I find the more thoughtful boards a huge boost, since my confidence that this disease will one day yield to science is renewed.

Metastasis - Event or Process?

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