Do Gleason 9s not make much PSA?

Interesting discussion about the subject...

prostrcision.com article said...

How much PSA is produced by prostate cancer?
Prostate cancer cells leak a lot more PSA into the blood stream. On average, one prostate cancer cell will produce 10 times more PSA than one normal prostate cell. Consequently, a man with prostate cancer will usually, but not always, have a PSA level above 4.0 ng/ml or 2.5 ng/ml for men age 60 or younger....

and

Does the PSA level always measure the amount of prostate cancer?
Unfortunately, no. 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. We discover low-PSA producing cancer based on digital rectal examination through palpation of a cancer. Additionally, these cancers can be discovered by measuring PSA velocity. Even though a man’s PSA may be within normal limits, if the PSA is progressively rising, for example 0.5 ng/ml to 1.0 ng/ml to 1.8 ng/ml in less than a year, this rise should alert doctors to the possibility of prostate cancer...

www.prostrcision.com/qa/evaluating-your-cancer

pasayten

Post Edited (pasayten) : 6/17/2013 4:05:07 PM (GMT-6)

Mine 7.4 G9 (5+4).

The PSA output per cm3 of cancer volume declines with increasing grade. In this study they stained pT2 tumors with an antibody dye that detects PSA. They found that "Nearly all acini in grade 1 and most in grade 2 stained positive (2 to 3+) for PSA; 87% were positive but with less intensity in grade 3. While many grade 4 (79%) and grade 5 (49%) cells were positive, the intensity of staining was weak. Serum PSA levels correlated with total tumor volume (r = 0.67) but serum PSA levels per cm.3 of cancer decreased with increasing grade (r = -0.24 and p < 0.02). These studies confirm the strong inverse correlation between Gleason grade and the PSA content of prostate cancer."

Prostate specific antigen and gleason grade

This speaks to PSA output of the cells. The effect in the serum may be moderated because higher grade cells are more likely to break free and release PSA into the serum.

My husband's PSA was 1.4 when diagnosed with Gleason 8 cancer. It was upgraded to Gleason 9 after surgery. Like EdC it was the velocity that caught the internist's attention. The PSA h doubled from . 7 the year before.

I am the poster child for this phenomenon.  PSA of 4 going into surgery, Gleason 9.  Bone met while still technically undetectable PSA after surgery and radiation.  I've only seen one or two cases like mine in the past 4 years.  Dr. Myers calls it PSA Negative disease.  I have other names for it.

So it is not uncommon for Gleason 9s to not make much PSA.  I have also seen many Gleason 9s make a lot of PSA with similar levels of PC. 

I am not convinced, however, that this stealthier Gleason 9 is any more or any less aggressive than all other Gleason 9s.  Like all things PC, it's the Twilight Zone (right, zufus?)

 

Jerry L- exactly......PaactNewsletter had an article by Dr. Chinn on Gleason 9's and basically says not all Gleason 9's are equal or comparable or as aggressive, they vary (2 patients with similar scenarios of Gleason 9 and having different control and aggessiveness).

Lots of reasons for possible variations among patients, like DNA ploidy analysis types, the worse the DNA chaos happening the worse it is for the patient as to controlling the cancer/psa. Bone mets with ultra low psa is rare to some degree, but not super bizzare (as Jerry demonstrated). The worst cases are guys with some of the rarer variant types of PCa, like small cell, signet ring, squamous cell and some others that are very aggressive and may not respond to normal HT therapies. It is possible to have happening within your PCa gland, different types of PCa (variants possible), different Gleason scores, way different volumes % per cores that are positive, and my conjecture maybe even different ploidy types of DNA happening (s.w.a.g. tea leaves guess).

The higher the Gleason, the less like the original prostate cell the cancer becomes, thus the less PSA is expressed per cc or tumor mass.

Benign prostate cells give off about .066 PSA per cubic centmeter of mass. Cancer gives off much more PSA per cc of mass and in declinig order. Gleason 6 gives about 4 PSA per cc, G7 is about 3 PSA per cc, G8 about 2 PSA per cc, G9 about 1 PSA per cc and G10 less than 1 PSA per cc. These are my roundings of the averages from Strum's work in his book.

In my case the conversions indicated I had about 15-20 cc of cancer volume. A Gleason 9 could have had the same volume with less than one-fourth the PSA. As an example, my brother's brother-in-law was dx Gleason 9 with PSA of 1. He was systemic from the start as he has had surgery, salvage radiation, and two courses of HT over the last 7 years. Thus he has a good amount of aggressive cancer throughout his body but it expresses very little PSA.

Psa leakage is roughly half with progression in Gleason grade (note this is grade ---- i.e. 3, 4 or 5 cells.) Grade 5 leaks half of grade 4 which in turn leaks half of grade 3 cells. It is explained here about half way down:

prostate-cancer.org/a-strategy-of-success-in-the-treatment-of-prostate-cancer-2/

Bill

I've appreciated all the responses to my post on this topic. After reading these, it does begin to make sense why there would be an inverse relationship to PSA and Gleason score. It also explains why when Dr Lam was staging my condition, my PSA score was only several factors he used--he was equally concerned about the PSA velocity.

This has been a very informative thread and I appreciate hearing from so many other Gleason 8s and 9s.

Michael