Gleason 9 (4+5) PSA 3.83

Doug,

Welcome to the forum -- the club that nobody ever wants to join. Sorry you find yourself here but glad you found us. You also apparently qualify for the Gleason 9 club. So welcome again.

I can't speak to the downward trend (change in medication, maybe, did you start Avodart?) but I can speak to your high Gleason/ Low PSA question. A Gleason 9 Tumor consists of two categories of cancer cells (Grades 4 and 5, with more 4 than 5). The higher grade makes for a more aggressive cancer so you are like me, a high-risk patient.

One of the changes that happens as cancers reach the higher grades is that the cells produce less PSA. Cancer cells that are only slightly messed up -- Grade 3 -- tend to complain vigorously about how hard they are working by cranking out lots of PSA per gram of cancer cells. Grade 4 cells produce much less and Grade 5 sometimes produce none at all.

So that part is bad. On the other hand a PSA in the range you mentioned is fairly low, even for a Gleason 9 and it sounds like there may be a good chance you caught it early. That is very likely what your doctors think since they have recommended surgery. (If they thought the cancer was more advanced they might go after it with radiation.)

For reference, I am also a Gleason 9(4+3) and my PSA was about 8 before surgery and I was on Avodart which tends to lower PSA readings. Currently my doctors are hopeful that they got it all and my PSA was about twice yours.

Do you know how many cores were positive for cancer in your biopsy? If so that would be useful information to add here.

You mentioned a language barrier to your research there in Sweden. Your English is very good (but your American is a bit spotty, eh?) so I assume you can read research written in English. Here are a couple of research papers I found that touch on your question:

Prostate specific antigen and gleason grade: an immunohistochemical study of prostate cancer.

Low PSA predicts poor prognosis in high-grade prostate cancer

The first study is twenty years old but seems to have held up nicely. The second study is more recent and will make you glad your PSA is as high as it is. They found that high-Gleason men with PSA less than 2.5 ng/mL did less well than men with higher PSAs.

Peter I'm Canadian hence the eh, eh! Language barrier is talking to the medical staff, not a good time for "misunderstandings" or "lost in translation. I'll check those papers out. Tks.
D.

Doug, let me add my welcome to the forum. I sure wish you didn't have to be here, but I'm also glad you found us. As you're aware, the G9 itself puts you into the high risk category.

Prostate cancer is a very diverse disease, from types that will never be trouble to types that will take you out. Everyone freaks out when they hear the cancer word, especially applied to one's personal self. Over time though, the concerns discussed here vary, from low risk and possibly fully cured people working out some side effects, to high risk and advanced stage people looking for advice on how to survive a life threatening diagnosis. You'll find a wide range of discussions here, so use the search function on the forum (even though it is a little clunky).

There are quite a few of us G9 folks here, so you'll find truly empathetic responses. I made a thread a while back to help concentrate the responses about G9 concerns, for more focused mutual support. Here's a link to that thread, and you may find it helpful to read through it. There's a list of us at the top (took the liberty of putting you on too), and an asterisk indicates if the person has made an entry somewhere down that thread.

www.healingwell.com/community/default.aspx?f=35&m=2863652

Hang in there Doug, it's a wild ride! We're here for you. Ask, vent, whine, probe, complain, whatever you need to do. You won't find anyplace with more people who fully understand!

Doug, I was diagnosed with Gleason 9 (4+5) and my PSA was 3.87. The pathology report after surgery was Gleason 8 (4+4). As you can see, you can have low PSA with high Gleason. One thing that helped in my case was the low volume of cancer in my prostate (10-15 %).

Much like you and Ed, I was diagnosed G9 (4+5) with a max PSA of 3.68.

What puzzles me is your PSA's downward slope. Had it not been for my PSA Doubling time from 1.6 to 2.62 to 3.68 every half year, I would not have had the biopsy or known that I have advanced prostate cancer.

Despite the low PSA, do get an Crologist was going to skip it since he was sue it would come back clean, but my second opinion urologist isnisted on it, and I am glad he did.

Per Redwing's post above, check out the thread on the G9 members.

LupronJim