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Gleason 3+4, 0.7 cm mass, but low PSA of 1.7

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Prostate Cancer
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Posted 7/14/2014 3:49 AM (GMT 0)
Hi all,

I'm new to the board and want to thank everyone in advance for being so generous with their time and knowledge.

Here's the story: My 50-year-old husband was recently diagnosed with PCa. His doctor felt a nodule during DRE--the same exam at which he found out that his PSA had gone from 1.2 to 1.7 in three months. Referred to urologist who also felt nodule and did a biopsy. One of 12 cores positive: 3+4 = 7 (50%). Staged at T2b.

I've been researching and reading but haven't found many cases of a Gleason 7 plus mass plus T2b and only a 1.7 PSA. Then I read parts of Dr. Walsh's book, specifically p. 185, and got really concerned: "Thus, if a man has a large, local cancer and a low PSA level, he should be evaluated for small-cell carcinoma."

How is one evaluated for small-cell carcinoma? Or does the fact that it is a Gleason 3+4 automatically rule out small-cell? Thanks for any info.

Melaine
Posted 7/14/2014 3:57 AM (GMT 0)
I don't really know but we have heard of guys with low PSA and PC. It might be a good thing to find a medical oncologist who specializes in PC. This is an unusual type of PC and it would be good to find a doctor who's dealt with it before.
Andrew

Post Edited (InTheShop) : 7/14/2014 12:05:52 PM (GMT-6)

Posted 7/14/2014 5:19 AM (GMT 0)
PCa is just weird, and you discovered why PSA is such a poor diagnostic test for an original diagnosis. Is your husband African- American? Their PCa sometimes exhibits that low PSA behavior.It's a good idea to have the biopsy re-read by Epstein or Bostwick. A pathologist can see small cell on the slides (the cells are small).

- Allen
Posted 7/14/2014 7:35 PM (GMT 0)
Hi Melaine, - You must remember that relatively few men have Prostate Cancer (PCa) diagnosed at the age of 50. As a result, much of the available statistical information is heavily influenced by older men who tend to have higher PSA readings due to more benign tissue as they age (BPH). 1.9 is NOT a low PSA for a 50 year old man, as the median range for a man in his 50's is 0.9 ng/ml, so anything over 1 ng/ml is considered elevated.

Small cell PCa is extremely rare and even more so as an initial diagnosis and about 85% are Gleason 8 or above when diagnosed, so I would suggest that your concern is substantially out of proportion to the actual risk involved. The odds are all in his favor, although nothing can be guaranteed. - Good luck and continue to monitor PSA on a regular basis. Good luck and I hope this helps. - [email protected] (aka) az4peaks
Posted 7/14/2014 9:46 PM (GMT 0)
Thanks for your responses everyone. We're going to try to move forward believing that it's run-of-the-mill cancer that we caught early--and hope for the best. That being said, we are leaning toward having some imaging done (3 Tesla MRI) to be safe. We don't want to find out too late that he's one in a thousand--or whatever the number is.

I appreciate your quick and thoughtful responses.
Posted 7/14/2014 11:41 PM (GMT 0)
Just to be clear, I don't mean to make light of any kind of cancer. I just don't know how to spell the other kind that my husband probably has.
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