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PSA and poorly differential

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Posted 9/4/2012 9:22 PM (GMT 0)
I thought your PSA would always tell you where you were at as far as cancer is concerned. My husband is a Gleason 9-10 with invasion in the seminal vesicles. He has had a Radical Prostatectomy. Stage T3b. His PSA was 0.01 for 18 months went to 0.03 now a month later 0.13. Now I here about poorly differential where the cancer might not even show up on the PSA. Why do we have to dig for this information? Our doctor didn't say anything about it!
I am so #@##***. confused.
Any advise?
Di
Posted 9/4/2012 9:34 PM (GMT 0)
Sorry for your distress.
If only a few cancer cells survive in the body they can eventually multiple and become observable.
If the PSA is going up without a prostate, that would suggest recurrence of the cancer. (The cancer seems to be causing the rise in PSA.)
Am guessing your husband is looking at hormone therapy / androgen deprivation therapy to control the condition for some time. Could work for 1 year or 8 years, it varies with hormone therapy. There are also a lot of good therapies coming (some very expensive.) Good luck to you both.
Posted 9/4/2012 9:41 PM (GMT 0)
Thank you so much. I would do whatever it takes, he is my life. We will be home next week and he has an appt. with his oncologist. He is all for hormone therapy and radiation. If we would have known the PSA might not be what the number is we would have taken another course. Now we will do so much more reading and listening to people like you.
Thanks
Di
Posted 9/4/2012 9:58 PM (GMT 0)
Di,

PSA is just one indicator. Before primary treatment, the value and the speed with which it changes can be an important indicator. At the same time, you can have a serious PCa and a very low PSA. That is why there is so much controversy about screening with PSA tests.

After treatment, when the sources of PSA should largely be eliminated, an increase means simply that there is some PCa remaining. With the SV involvement, that would be very likely. They may suggest Salvage Radiation and/or Hormone Therapy if the PSA continues to rise. The point at which that should start is also a strong point of discussion.

I don't remember his exact post-op Gleason (if you've posted it), but a higher Gleason carries higher risk. A 4+5 and 5+4 are quite different.

My first (and only pre-op) PSA was 7 at age 56. Much too high for my age, but it did not correctly predict my G4+4 in 9 of 12 cores.

Have a good, detailed conversation with the oncologist, and record it if allowed, so you can revisit it with calm.

Posted 9/4/2012 10:08 PM (GMT 0)
Post op was 4+5-9 and 5+4-=9 . Core 12 of 12 positive . Thank you so much. The oncologist is also a friend. He has nothing to do with the Clinic that did the surgery. I trust him with everything I have. Just wish I could have found this information sooner. :( So sad!
Posted 9/4/2012 10:26 PM (GMT 0)
Does the PSA really matter? What I have read about Gleason 9-10 the PSA might not matter because the cells are poorly differentiated and look different so the test doesn't see it. You might have a low score and a lot of cancer! WHT
Posted 9/4/2012 10:46 PM (GMT 0)
There should be only one Post-op Gleason score, covering what the pathologist determined was the predominate value. It sounds like you are using the biopsy Gleasons.

Once the prostate has been removed, the PSA test is the only real indicator that PCa is still present, until there is enough to detect by other scans. That gap of time will vary for each of us. During that time, they treat by the PSA.

Posted 9/4/2012 10:53 PM (GMT 0)
Di, so sorry to hear about your distress. I'm surprised that the doctor didn't recommend immediate follow-up treatment with a Gleason 9 and stage t3b regardless of what your husband's PSA was. The PSA test measures the amount of prostate specific antigen in the blood. Some prostate cancers make very little PSA and are called low-PSA producing cancers. Often, these are men with high Gleason scores indicating more aggressive cancers. Low-PSA producing cancers can be advanced and fool doctors. The PSA doesn't "see" the cancer cells...it detects the amount of PSA generated by both healthy and cancerous cells. A cancerous cell can generate up to 100 times more PSA than a healthy cell except in the case of high Gleason scores (9 or 10). In these instances, the PSA velocity (how quickly it rises) can be of more value to the doctor than the actual PSA number.
Posted 9/4/2012 11:18 PM (GMT 0)
OMG ,Thank you so much. From what I have read that is where we were at but I felt so alone because mostly relying on the PSA but my darl'in is not in the normal. Mayo wanted to wait to see if the surgery worked even though we had another Doctor saying we had to be more aggressive. I feel like I have not done enough! I just didn't know that the PSA could be more then what it was. We will let you know next week! Thank you again!
Posted 9/5/2012 12:30 AM (GMT 0)
Gleason 9 + Stage T3b would seem to argue for very aggressive treatment, regardless of the still relatively low PSA score.  Options at this point are usually some combination of, or standing alone:

radiation to the prostate bed (usually 40 sessions);

radiation to pelvic lymph at same time as radiation to the bed;

hormone therapy (HT) 

Sometimes all three are done together.  I am a Gleason 8.  I chose to do all three in part because my medical oncologist commented  "A Gleason 8 is a Gleason 8."  I thought you should know about these options before working out a treatment plan.  Best wishes to both of you!

Newspaper Lover

Age 68

DaVinci surgery 11/09. Clean margins, clean seminal vessels.

Rising PSA noted 06/11

Gleason 8

Time to recurrrence 18 months

Three month doubling time (summer 2011).

PSA rose from .07 on 06/11 to .17 on 11/11.

MRIs and bone scans negative so far.

Started hormone therapy (Lupron/Casodex) 12/11

Began radiation (SRT) 02/20/12.

Finished SRT 04/16/12

Last Lupron shot 03/12

PSA and testostorone "undetectable"  07/12

Next PSA and testostorone test early January

 

Posted 9/5/2012 12:35 AM (GMT 0)
The "poorly differentiated" refers to the appearance of the cells under microscopic inspection. It refers to how changed in appearance the tumour cells are compared to normal cells which are "well differentiated". All grade 4 and 5 cells are "poorly differentiated" in appearance with very obvious changes in the cell structure. Their PSA output is a different kettle of fish ----- as a general rule grade 3 cells will leak 4 ng of PSA per CC of tumour, while grade 4 will leak 2ng per CC and grade 5 leaking 1ng/CC of tumour. However, some of the rarer tumours can leak very little PSA in relation to their size. I believe it is thought this is related to what is known as the DNA Ploidy makeup of the cells.
(Gleason score is made up from the Gleason grade of the two most prominent groups of cells present ---- in your case either 5+4 or 5+5.
As for the doctor withholding information ------ most people are not really interested in the detail of whatever disease they have, leaving everything to their doc. As a result I think most docs don't give their patients a lot of intricate information believing they (the patients) would not understand it anyway. I believe most the members on Healingwell have a different approach.
Bill

Post Edited (BillyMac) : 9/4/2012 6:43:14 PM (GMT-6)

Posted 9/5/2012 1:58 PM (GMT 0)
Thank you all. It really helps me to understand what we are dealing with. So grateful for all the input.
Di
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