Metastasis - Event or Process?

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

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 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

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.