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Why Can't They Remove the Tumor and Leave the Prostate?

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Posted 12/21/2015 8:08 PM (GMT -5)
I know that surgeons do extremely delicate surgeries, like operating on fetuses within a mothers womb, for example. Why can't they remove a small tumor from a prostate without removing the whole darn thing?

My Uro has even wondered if by some strange chance, the biopsy removed my "cancer".

Anyway, I've not seen this subject talked about and I wonder if maybe I'm missing something.

.
Posted 12/21/2015 9:28 PM (GMT -5)
Might be possible, but it's likely they'd miss some microscopic bits of PC. That's why they do, "radical prostatectomy." Just nuke the whole thing and guaranty you got all the bad cells. That's the theory. It's an area of the body you want to do more than one surgery on if you can avoid it so they just cut wide.

It's kind of like that time on mythbusters when the burnt the haystack to find the needle. Crude, but they got the needle...

We are starting to see more information on "focal" treatments where just the tumor is.

Wouldn't be surprised to see more of this in the future.

Andrew
Posted 12/21/2015 9:55 PM (GMT -5)
Pca usually has clusters of tumors in different places. Also Whats to prevent the cancer,as it found a fertile field, to just start up again. Lumpectomys are done with breast cancer, but I have no idea of the success rate vs recurrence.
Posted 12/22/2015 12:09 AM (GMT -5)
While I heard surgeons say that post-prostatectomy analysis often finds multiple sites, there is also the opinion that focal ablation of the primary index lesion will remove the current threat, as the other lesions are usually small G6 items that can be watched with AS.

Who knows? Both approaches sound reasonable, and it is now up to the advocates of focal therapies to make their case. I hope that they can, as the side effects of focal ablation appear to be far less than RP or RT.
Posted 12/22/2015 12:18 AM (GMT -5)
Fewer than 1 in 5 guys have prostate cancer that is unifocal; there are microscopic bits of tumor throughout the prostate in the vast majority of cases. There is a theory that one of the tumors - the largest, highest grade one - called the "index tumor"- is responsible for spawning all the others. Focal ablation works off of the "index tumor" theory - too early to tell if it works.There's also a theory that small amounts of progenitor cells that could be anywhere are the culprits. There are lots of theories and lots of individual differences. There also may be problems cutting through cancer cells and releasing them systemically if they're high grade.

- Allen
Posted 12/22/2015 4:37 PM (GMT -5)
You know an awful lot about this monster Allen. Hats off.
Posted 12/23/2015 9:32 AM (GMT -5)

GeetarMan said...
I know that surgeons do extremely delicate surgeries, like operating on fetuses within a mothers womb, for example. Why can't they remove a small tumor from a prostate without removing the whole darn thing?

My Uro has even wondered if by some strange chance, the biopsy removed my "cancer".

Anyway, I've not seen this subject talked about and I wonder if maybe I'm missing something.

.


I'm living proof it can and has been done. For me it was 7+ years ago and wasn't surgically but frozen off. My last PSA was .22 (3/2015) and I do have a working prostate.
Posted 12/23/2015 10:36 AM (GMT -5)
A breast is on the outside and bigger and thus easier to both examine, test and operate on.
Breast lumpectomies are also usually accompanied by RT as well and often chemo too.
Given PCa grows too slowly for Chemo to work that's a difficulty and if you are going to need to have RT anyway there could then be an argument for saying why not have RT up front and forget about surgery all together.

I think the way forward for PCa (and other cancers) is going to be a treatment that involves an agent (like a modified virus) that targets the cancer cells specifically and destroys them or disables them and thus gets rid of the tumours regardless of what size they are and how many there are.

I think in the future we may find we look back on the current time when it is all about refining surgical techniques in the same way that you might look back on shipping companies wasting time and effort trting to improve the turbines et al of transatlantic liners when the way forward was actually to travel by jet.

Alf
Posted 12/23/2015 11:07 AM (GMT -5)

GeetarMan, you said...
Why can't they remove a small tumor from a prostate without removing the whole darn thing?

The short answer is that they can remove the tumor but the evidence is thin on the ground that it does any good.

Actually, there are lots of "focal" treatments that can go after a tumor and leave the rest of the prostate intact. HIFU (ultrasound) can do it, proton beams would work, radio-frequency needle ablation might be a good choice, or cryotherapy, or half a dozen other technologies. But none of them have impressive success rates in real world use.

To some extent they may be bottled up waiting for imaging technology to get better so we can know, for sure, where all the cancer is located so none gets missed. Or it may be that, as Alf suggested, they will develop self-targeting drugs that can be administered systemically, or at least to wide areas, but only affect the cancerous tissues, which would make your question more or less moot.
Posted 12/23/2015 2:18 PM (GMT -5)
Allen

I still find things confusing. Trying to jibe the 7's maybe spawning the 6's, and that many do not think 6's develop into 7's, and maybe that the 6's themselves are not overly threatening and may not require treatment. And that 7's may spawn 6's, but there are a lot of guys out there who are only diagnosed as 6's, which implies their 6's were not spawned by 7's (at least not any that could be detected).
Posted 12/23/2015 9:13 PM (GMT 0)
Maybe I can deconstruct all that.

This much is true: If there are metastases, then there was a grade higher than 3 (or 3+3) involved in the prostate.

However, that is not the same thing as saying:

(1) A GS 6 tumor will never progress to a higher score (which may later metastasize).
(2) If there are no metastases, then there was no GS 6 in the prostate.
(3) If there are GS≥7, they will always metastasize.
(4) A biopsy-detected GS 6 is not, in fact, a higher score.

It also doesn't speak to whether a cancer progenitor cell can spawn both GS 6 and higher score tumors (which happens at least sometimes). And it doesn't include cases where a higher grade index tumor spawns lower grade daughter cells (which happens at least sometimes). There seems to be a lot of variability in the natural history of progression.

We do know that in 20 years of active surveillance, about half the men with GS6 at initial biopsy never progress to a higher score on subsequent biopsies.
Posted 12/24/2015 12:50 PM (GMT -5)
Thanks for the explanation, Allen. Helpful as always.
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