Metastasis, a question of bones or organs

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Purgatory
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   Posted 4/8/2011 9:05 PM (GMT -6)   
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

compiler
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Date Joined Nov 2009
Total Posts : 7205
   Posted 4/8/2011 9:09 PM (GMT -6)   
David:
 
My understanding is the same as yours, except I heard that the spine is the most likely next target.
 
Mel

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 4/8/2011 9:48 PM (GMT -6)   
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
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Postop
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Date Joined Feb 2010
Total Posts : 385
   Posted 4/8/2011 10:34 PM (GMT -6)   
I think that all bones at multiple sites, especially the spine (vertebral bodies) and pelvic bones, are by far the most common places. The main problems with these is pain in the bones, fractures, and compression of the spinal cord. Spread to internal organs is more of a sign of small cell prostate cancer.

See

emedicine.medscape.com/article/454114-overview#a1

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/8/2011 11:07 PM (GMT -6)   
That was a good point, postop, about the small cell PC, I didn't consider that. Thanks for the link.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

English Alf
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Date Joined Oct 2009
Total Posts : 2215
   Posted 4/8/2011 11:16 PM (GMT -6)   
David,
My understanding is that it is bones first, starting with the nearest ones eg pelvis hips lower spine. And I found this recent article suggesting a possible way it happens:

www.sciencedaily.com/releases/2011/03/110323140237.htm

Alf

Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 4/9/2011 12:39 AM (GMT -6)   
Alf,

Excellent article, thank you
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

keepingon
Regular Member


Date Joined Mar 2008
Total Posts : 30
   Posted 4/9/2011 1:41 AM (GMT -6)   
I'am T4N3 w/ malignat neoplasm. I'am on my second round of Lupron. I'am having hip, femur, spine, lower left leg pain. The same thing happend with the 1st round. My last bone scan shows bone masses but, no cancer.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 4/9/2011 6:12 AM (GMT -6)   
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)


Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 4/9/2011 7:52 AM (GMT -6)   
What is a definition of a "bone mas" then?

zufus, glad to see you posting again. Your version is more in like with my own prevailing thoughts, that it would more easily go to the bones first. I have only read of 2 cases that clearly mentioned PC being found in the brain. Lungs, however, show up more often in literature for some reason. Have read of a handful of cancers where it hit the liver.

for the record, my own uro/surgeon was the first to sit down and tell me about micro mets back in 2007, a full year before my dx.

keep on posting, buddy.

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 487
   Posted 4/9/2011 8:01 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)


Squirm
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Date Joined Sep 2008
Total Posts : 744
   Posted 4/9/2011 9:15 AM (GMT -6)   
My dad had trouble walking and had pain around his hip area. He also had some strange pains every now and then.

I was under the impression that PC is attracted to bone material.

John T
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Date Joined Nov 2008
Total Posts : 4229
   Posted 4/9/2011 10:22 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
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 4/9/2011 10:44 AM (GMT -6)   
Yeah Tony and John and others herein, we are all on the same page...yes it may be found prior to boney mets showing up on scans( bone mets=it showed up on scanning..thus known mets). In surgery you might find lymphnodes positive, especially closest to the gland area, and some scans like Combidex or USPIO might reveal PCa in the nodes or elsewhere. But, micro mets will go undetectable in nodes, and bone marrow or anywhere, until a large enough mass is populated to been seen. Might be like 1-billion cells together before the scans can 'see'them' (show them).

Spot radiations will eliminate pain in bones and may kill off the PCa cells at the site radiated....the problem is other sites can still go undetectable and even for years. This is the biggest mystery in PCa...where is it...and how can it be killed or eliminated? Well cannot subject our whole body to radiation as a real option.

This is my understanding and what I have seemed to gather.
 
NEWS-  Phase II trials happening right now for using Genistein  (Bonistein 500 mg capsules) in patients while doing radiations for mets...to quantify duration of pain relief, overall value in pain variables.  It is likely known to have some value in the area of pain and in another Journal article I read 1 year ago or so...found if it could be concentrated in to a high dose that could be utilized showed a measurable value against PCa fighting (already proven in lab mice and such). Genistein is within soy products (soy beans), is a plant estrogen in effect, estrogens help with bone issues, is known about. I suspect if these trials don't get the axe, value will be found in using Genistein...how much????
 

Post Edited (zufus) : 4/9/2011 11:13:10 AM (GMT-6)


Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 4/9/2011 2:48 PM (GMT -6)   
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
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5829
   Posted 4/10/2011 6:53 PM (GMT -6)   
I thought it was how many angels could fit on the head of a pin. lol, just don't get medieval on me.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 7:31 PM (GMT -6)   
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)

medved
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Date Joined Nov 2009
Total Posts : 1096
   Posted 4/10/2011 7:45 PM (GMT -6)   
My dad's prostate cancer showed up in his lungs, liver and spleen before there was ever any evidence of bone mets.  (Eventually it did spread to bone too).  So I guess the pattern is not always consistent. 

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 7:49 PM (GMT -6)   
about 70% go to bones first in the cases of PC with mets...

Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 4/10/2011 7:49 PM (GMT -6)   
good one, logo

casey, i don't know if my oncologist at the time 11 years back was being literal or not, just repeating what he told me

medved, i have read of cases in that direction too. just like men can have mets with low level PSA recurrance, its not always a question of waiting for the PSA to re-rise to 10-30 levels to show mets. Our dear brother Sonny here is a good first hand example of a case like that.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,
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