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← Return to Post RT 6 years after RP with Rising PSA now at .28.
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Post RT 6 years after RP with Rising PSA now at .28.
Prostate Cancer | Last Active: Oct 5 7:14pm | Replies (39)Comment receiving replies
We were advised that if we ever need (or want) salvage (or adjuvant) that 6 mos ADT is preferable. It seems that again every institution has it's own protocol. However as far as I read research papers show that having ADT gives better results as well as treating pelvic region + nodes. BUT, protocol is probably also adjusted to individuals age and health status in general. All studies usually have "average age of 65" and usually exclude patients over 70 not because they have different response but because they wish to follow patients for 15 years. At least that is my understanding.
It should not be surprising that healthy cells survive - if radiation caused all cells to die that would be devastating - than surrounding healthy tissues would die too , god forbid. This is how radiation works - it kills abnormal cells if it is done correctly (correct strength and correct amount). ADT theoretically makes abnormal cells even weaker.
Also, lets not forget that salivary glands can produce PSA as well as pancreas and breast tissue and that viral infection can increase PSA temporarily even after RP. That is why IMHO it is important to follow a trend of PSA rising and not concentrate on a single occasional blip on a radar.
Replies to "@heavyphil We were advised that if we ever need (or want) salvage (or adjuvant) that 6..."
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@surftohealth88 The part that always bugs me is the notion of ‘healthy prostate tissue’…why have an -ECTOMY if you ‘re gonna leave pieces inside that may become cancerous down the road??
Sure, ‘nerve sparing’ is the term used to imply that nerve bundles will be left intact and that protocol does necessarily leave tissue behind…it has to.
We all agree that PNI is not a gauge of aggressiveness but it is still a metric used to show the lateral spread of PCa cells…do we really want to do nerve sparing in these cases? Peri-Neural Invasion is just what it sounds like, right? Invasion of the area surrounding the nerve bundle to a greater or lesser degree.
I don’t believe a surgeon - even using the DaVinci robot and frozen sections - can painstakingly dissect away every last bit of malignant tissue and leave the nerves intact and unaffected in most cases. One cell left behind is all it takes for recurrence.
This is why I told my surgeon to spare nothing questionable, even at the expense of my virility; I wasn’t having surgery for the fun of it.
But ADT combined with radiation probably does kill/damage a certain amount of healthy cells even if that is not the goal. ADT is going to weaken healthy prostate cells as well, since they too rely on T. They will not replicate as fast. Weakening them, in turn, makes them more susceptible to having their DNA damaged by ionizing radiation.
Isn’t damage from radiation a HUGE factor in the initiation of cancer? So back to my rabbit hole conundrum: if ‘healthy’ prostate (not bladder, bowel, etc) cells are weakened by ADT and then blasted with radiation, can’t these cells become malignant and cause recurrence especially if they don’t die?
How would IMRT or SBRT ever be as statistically successful as it is if ONLY PCa cells died?? How can the beam know who is friend or foe?? Those ‘margins’ that we speak of are killing fields designed to eradicate anything in that area, so some healthy cells are killed as well just to be sure…
Other types of body cells are spared (mostly!) by the beam shaping capability afforded by the computer assist in the machines. But some secondary cancers DO occur down the line no matter how accurate or what type of particle is used.
Phil