@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