Vernon,

This strikes me as one of those theories that has some
evidence for it, but not enough to know whether it's really valid.

As I understand it, prostate cells do appear in the bloodstream
and cancer cells do too.  But I'm not aware of any scientific
evidence that those cancer cells always establish themselves
and survive away from the prostate.  Sometimes they do.  Do
they always do so?

Your theory appears to be that they always do, and whether
we get a recurrence of the cancer depends only on how quickly
they grow.

But some theorize 1) that they don't always survive outside
the prostate, 2) that hormones may help kill them off outside
the prostate (still hotly disputed), and 3) that we don't yet
know what causes them to survive in some men or some
conditions and not in others.

In your personal case, with a PSA of 11 after radiation therapy,
it looks like you have metastases and that chemotherapy has a
target to attack (though whether it's better than hormone
therapy is a separate question).  But in other cases, with no
rise in PSA, we don't know yet that there are any metastases
for the chemo to attack.

If chemotherapy were a benign treatment then it would make
sense to give it to everyone during or after any other treatments.
But the chemicals used today are pretty tough on the body.
Is it wise to use them in the absence of evidence of metastatic
disease?

Best of luck with your treatment.  Please keep us informed
as to how it's going.  You may be pioneering something of
interest to many more patients.

   Alan

Actually, no.  I assumed you were a survivor.  I have challenged suspicious
posters before, but I'm usually more up front about it.I was not questioning
your bonafides.

It was just that you are the first one in the three years that I've been
here that suggested chemotherapy as a fisrt line of defense / offense.  I
assumed from that (never assume) that you chose this course of action and I
was interested in your subsequent history.

You have posted before, haven't you?  I seem to recall the resume.

I assume HT was offered and rejected?

That is something I've suspected, but I don't recall reading it anywhere.

Very interesting conjecture.  I'm very glad you replied.

"There is solid scientific evidence that the prostate sheds cells into
the
bloodstream whether it is diseased or not, and apparently at all adult
ages.
If you have prostate cancer some of these circulating cells are most
likely going to be the seeds for future metastases of this cancer. RP
or radiation (brachytherapy with/without EBRT) can only remove/destroy
what is localized in the prostate bed.   The prostate cancer cells
that had previously been distributed throughout your body, via your
bloodstream, will not be affected by whatever medical procedure you
use to remove/destroy the diseased prostate.  These metastatic cells
will be alive and well."

It is my understanding that malignant mutations occur practically all
the time but that the immune system usually takes care of them before
they can gain a foothold. It may be that cancer appears in people when
the tumor volume simply overloads the immune system or the immune
system is somehow weakened. I am beginning to suspect that all but the
earliest cases of PCa are in fact metastatic and that, as we say - if
you live long enough, it will come back.

"Another interesting thing is that it seems that these metastatic
cells,
particularly of aggressive cancers, grow faster when the "parent"
cells (the
prostate) have been destroyed.   It is as if the primary focus (the
prostate) regulates the growth of the metastases via chemical
(hormonal)
signaling.   So removing. or destroying, the prostate also removes the
shackles from the metastasized cells, and they begin to grow much more
rapidly and out of control."

Vernon, don't you watch The Discovery Channel? :-) What you describe
is Dr. Judah Folkman's angiogenesis theory. Folkman is credited w/
discovering angiogenesis - the propagation of blood supply into
tissue. His signature experiment was the introduction of cancer cells
into the sclera of an animal eye - capillaries then miraculously began
to grow toward the cancer cells. Pretty resourceful, that cancer.
Anyway, his theory is that the primary tumor produces an angiogenesis
inhibitor that keeps all the little baby tumors in check so mama can
grow and multiply w/o competition. Once you remove mama - well, you
figured it out - no more angiogenesis inhibitor so the dormant
metastases crank up and the cancer flares up again. Folkman's work led
to the anti-cancer drugs Angiostatin and Endostatin. Thalidomide is
also an angiogenesis inhibitor and it is/has been tried w/ PCa.
Unfortunately these drugs have not panned out - at least not yet. They
are also contraindicated in people w/ cardiac problems becuase they
will shut down the formation of new blood vessels in the heart. Not a
good thing when your old ones are getting clogged up.

"It  is obvious that the body must regulate the growth of prostate
cells that are not in the prostate ...."

The body regulates the growth of all cells and it may be that cancer
causes an interuption in the body's programmed cell death, apoptosis,
and/or growth factors. Gleevec is a growth factor inhibitor that is
being tested for PCa now at John Hopkins and M.D. Anderson and perhaps
others. One protocol adds Emcyt/Taxotere, which which you might be
familiar.

"The common wisdom among urologists is to wait until the PSA begins to
rise
again, and then begin to attack the problem with hormone therapy.  
However,
the current chemotherapy data suggests that previous hormone therapy,
and
some steroids, makes it more difficult for chemotherapy to be
successful. So, shouldn't we really be doing chemotherapy, NOT hormone
therapy,immediately after the prostate has been treated?  Especially
for high Gleason survivors?"

Vernon, what has been your experience? What have you had and has it
been "succesful?" Chemo is not the first second-line treatment because
there has been no evidence that it works, so it is reserved for cases
for which there is nothing else.

I hope you will be active in this Group because we need someone who
understands the chemistry.

Bill Denton
RP 2/12/02
Memphis