Metastasis, a question of bones or organs

Just pondering a new thought.  In most of my personal research over the past 3 years, its seems like when there is metastasis with advance PC, it usually, but not always, heads straight for bones.  In a lot of cases, it starts out in the hip or femur areas, from examples I have seen.  Makes sense to some degree, as those bones are closest to the original source of the PC, the prostate.

I am wondering does if have to go to the bone first, then making its way to the nearest organs, in that order?  Or with micro-mets, new PC clusters could literally be anywhere in the body.  I have herd of PC being  on the liver, the lungs, and even the brain.

Not all will agree with this statement, but after gathering the opinions of 5 different doctors over time, PNI is a likely outlet for PC in the first place, allowing an open network of pathways allowing cancer cells to long escape the prostate glad itself, having taken place long before the patient's PC dx was ever made.

Wondering what other factors  play into the world of mets and micro-mets.  In my particular case, the doctor's thinking (he never stated it as a fact), was that with my rapid post SRT rise now, particularly the past 2 months, that more than likely that there are multiple sites they are adding up to the combined total PSA on my latest reading.

Feel like I am missing something here on the subject, open for input, or if there are any specifics published studies on the subject.

David in SC

Wow,
From my understanding:
The blood stream from the prostate and local tissues is the most common outlet for cancer. That's why the lymph nodes and seminal vesicles are a likely first location to find mets ~ not the bones. Then it's the bones but also anywhere the blood stream travels. I know many guys that have lesions outside the prostate but have clean bone scans. Thus why the staging system is set the way it is...

T3a outside but local Stage III
T3b Positive SVI signs the disease is metastatic. Stage III
T4 Mets to distant nodes or bones Stage IV
Any T with N>1 means stage IV
Any T with M>1 means stage IV

Tony

That was a good point, postop, about the small cell PC, I didn't consider that. Thanks for the link.

Alf,

Excellent article, thank you

Mets- Howard H. ended up with brain mets...but not until he did mega different protocols of drug therapies over alot of years..near the last couple years it ended up in his brain...he went 17 yrs. fighting this beast. Dr. Myers and others at a PCRI conference commented that a patient that has done so well in fighting PCa stopping it from his bones etc. (has a brain mets situation)..that it finally showed up in his brain. So, brain mets is rarer and not found very often. Even organs it is usually further down the road in treatments.

Mets-likes bone and the ones mentioned already are primary areas, it likes bone marrow and can hide there undetectable by scans ( Dr. Barken, et al and others have commented on in the past).

A few doctors were honestly telling patients about micro mets and unknowns, many years ago...when other docs were telling patients how perfect scanning methods were. That is an interesting history to note, shows who was on the right side of this historically and adds to their credibility.

There are some tests useful in finding out about mets, other than scans....good onco's do those tests to know asap and decide upon treatments. Anybody can prescribe a single drug, knowing when, what, how much and when to switch is a blanking art form.

Post Edited (zufus) : 4/9/2011 6:15:43 AM (GMT-6)

My amateur understanding is that PCa is not an easy cancer to spread. As witness the long lead time for the disease, in many cases. However, the most fertile growth medium in the body is bone marrow where blood cells are produced. Thus PCa, and some other cancers show in bones first. This is not unique to PCa. Lung cancer and other cancers of the central abdomen are also likely to spread to bones, at least as the earliest detected site after lymph nodes. As posters at this site can attest, even this still requires some years for further spread.
Notwithstanding, spread to the lymph and blood system means that systemic infiltration is assumed. Even if the cancer cells disseminate, they may not coalesce to form a palpable or imageable tumor mass throughout the body. They may not accumulate with enough vital energy to form new tumors, though the bone environment is most fertile.

Post Edited (tarhoosier) : 4/9/2011 8:05:49 AM (GMT-6)

David,
Tony is correct. It first goes to the lymphnodes then the lymphatic system takes it to the bones. While it is in the lymphnodes it doesn't cause any symptoms. The symptoms begin when it gets to the bones then to other organs. It's easy to see why many think that it goes to the bones first. It is more easily detectable on bone scans and that's when the pain starts, but you will find that anyone that has bone mets will also have lymphnode mets. Again, nothing in PC is 100%, but this is the common path the cancer growth takes.
JT

I agree with you all: John, Tony, and zufus. Makes sense.

My former medical oncologist, said that one million cancers cells would fit easily on the pointed end of a standard sewing pin. That's amazing, and even then, probably couldn't be picked up on any scan.

More research needs to be done on the subject of micro-mets, zufus you are dead on, knowing where they are clustered, and what they are up to, is a complete black hole at this point.

David

Since you asked...

Most cells are larger than the human red blood cell, but if you calculate the area of a 2mm diameter pinhead, about 64,000 red blood cells could fit.

Check out this very cool top-of-a-pinhead animation: http://evolutioncult.com/How%20Big%20is%20a%20Cell.htm
(either click the arrows below the image, or select one of the items from the list on the right)

about 70% go to bones first in the cases of PC with mets...