Prostate cancer patients on active surveillance may have metastasis. Metastasis is a term used to describe the spread of cancer to another part of the body. Prostate cancer, specifically, can spread to the bones as well as the liver or the lungs. Spreading to the brain, on the other hand, is rare for prostate cancer.
Even when prostate cancer spreads to other parts, for example, the bones, it does not become bone cancer – it is still considered as prostate cancer that metastasized.
Metastatic prostate cancer is an advanced form, and although there is no cure it can be treated and managed. The goals of treatment include managing symptoms, slowing the rate of cancer growth, and shrinking the tumor.
Sometimes, prostate cancer is locally advanced, meaning it has spread only to a nearby tissue. This is different from metastatic cancer, which is only when the cancer spreads to a different part of the body.
When prostate cancer metastasizes, the cancer cells break away from the original tumor, move through the blood or lymph nodes, and begin to circulate in the body. These cells then break through the blood vessels and latch onto tissue where they begin to multiply and grow.
The odds of developing metastatic prostate cancer is 50 percent for men diagnosed with local prostate cancer. A small percentage of men are not diagnosed with prostate cancer until it has turned into a metastatic cancer, which doctors can detect by sampling different tissues from various areas of the body. Metastatic cancer is found using X-rays, CT scans, MRI scans, and other tests.
More than three percent of prostate cancer patients on active surveillance may have metastasis. Prostate specific antigen (PSA) has helped boost early detection of prostate cancer, with nearly 40 percent of new cases being found this way.
Researcher Laurence Klotz form the University of Toronto said, “This is a detailed analysis of thirty patients initially treated with surveillance for what was thought to be favorable disease, but which eventually progressed to metastatic disease. We previously reported on five such patients. The current report represents a considerably larger group with longer follow-up, which presented an opportunity for risk analysis.”
Of the 980 patients, 211 were classified as intermediate risk, 109 had baseline PSA over 10 ng/ml, and 133 had Gleason 7 disease. Metastasis occurred in three percent of patients.
Michael O. Koch, chairman of the department of urology at Indiana University School of Medicine, commented, “The researchers may be overly optimistic about the safety of surveillance, particularly in patients with Gleason 7 disease. Since median follow-up was only 6.3 years, the number of patients with Gleason 7 disease in whom metastases develop will grow even further. As of now, active surveillance would appear to be ill-advised in this group of patients.”
Joel B. Nelson from the department of urology at Indiana University School of Medicine observed, “The reported rate of three percent is a best case scenario and it is likely that many more men have metastatic disease. Active surveillance is obviously safe in men who do not progress. The task now is to avoid misclassification of disease as indolent when it is not and detect progression before it is too late.”