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Rare forms of PCa / Low PSA output

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Posted 2/6/2017 2:52 AM (GMT 0)
We know that there are some rare forms of prostate cancer that metastasise without putting out much PSA.

Does anyone have such a cancer, or know more about it?

Would such a cancer be visible to a pathologist when they dissect a prostate after prostatectomy? Or could any cancer be or become such a cancer?

Thanks,

D
Posted 2/6/2017 3:23 AM (GMT 0)
Yes, they would be pretty obvious to a competent pathologist. Some types only are diagnosed after metastases are evident. Small cell may sometimes appear as a mixed type after metastases have progressed. Why do you ask?
Posted 2/6/2017 3:55 AM (GMT 0)
Thanks TA. I am asking in the general sense, as I am getting to know this complex disease. But as always there is some context that leads one to such a question.

My urologist has expressed concern about the disease burden / tumour size I had pre-operation, and the increased probability that has for metastatic disease. I had a total of 3.9 cc of tumour, in three areas in the prostate. Largest single one - 2.4 cc. Still confined - T2c. He said it was one of the five or so largest total tumours he had removed - more typically total tumour volume was 1-2 cc.

I then asked why my pre-op PSA was still relatively low - 3.9, a month before my operation. The train of thought being that large tumour = large disease burden should manifest in a high(er) PSA. That is when he mentioned the rare low PSA forms of the cancer. My next question - one I asked above, but not to my uro yet - is whether that then should not have been detectable in the specimen pathology post operation. It seems the answer is maybe, possibly. (That seems to be the answer to most PCa questions!)

Hopefully this makes sense.

D.
Posted 2/6/2017 4:11 AM (GMT 0)
Just to be clear, the answer I gave was not "maybe, possibly;" it was "yes."

With GS 6 at your focally positive margin, and your very low PSA, you seem to be in good shape so far. I don't think it does you any good to destroy your peace of mind imagining highly improbable events - as of now, you're fine. Take it as it comes.
Posted 2/6/2017 4:54 AM (GMT 0)
TA: Fair comment, your answer was yes.

Your general advice above is very good, I am sure, but I am finding this limbo-land hard to navigate. While my PSA is very low, as you say, it has lifted marginally. As you well know, there are no scans that will tell us anything meaningful at these PSA levels - to my knowledge. Decipher tests, again to my knowledge, are not available in Australia. So this means wait, while it feels to me that something is busy happening. And I am not a good 'waiter' - but that is my challenge and my problem. Thanks anyway!

D.
Posted 2/6/2017 1:37 PM (GMT 0)
Yes, there are forms of prostate cancer that do but raise your PSA. For example, small cell and Ductal. They did not find mine (Ductal) until it was already advanced (G8, T3N1). My PSA finally went over 4. After the digital exam (where they "squeeze" the prostate) I had a retest. In less than two weeks it went from 4.7 to over 11.

Both the biopsy and the pathology report showed that it was Ductal. Most of my cancer team never heard of Ductal. They are struggling on finding the best way to tract it. They stained a pathology slide and determined that 30% of the cancer did not give a positive PSA result. Some reports recommend bone and CT scans. The issue there is the danger of that much radiation. What they are hoping is that they can follow the cancer based on the 70% that does respond to PSA.
Posted 2/6/2017 4:22 PM (GMT 0)
From what I am learning is that low PSA + high risk G8-10 can be a sign of aggressive cancer. One of the direct reasons I'm doing chemo now. I'm in agreement with TA, you seem to be in good shape for now.
Mark
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