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Gleason 3+3, PSA of 6.7 and serious bone pain - Bone Metastasis?

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Posted 9/7/2015 11:23 AM (GMT 0)
Sorry Guys, your help is appreciated once more.

I seem unable to wait for my next consultation in four days time. In particular, since speaking with my GP.

I was diagnosed with fibromyalgia many years ago with the main symptoms being skeletal pain (arms, hands and legs, feet and more recently very bad on hip joints). In view of my cancer diagnosis last week and reconsidering the other symptoms, my GP is inclined to fear that this is more akin to bone metastasis rather than fibromyalgia and is urging me to have a bone scan.

Have you heard of any guys suffering from bone metastasis with the low level Gleason score and low PSA of 6.7?

As this pain has been present for many years, I find it hard to believe it is linked to cancer. Although it is getting progressively worse.

Would the prostate MRI not have shown a spread of cancer cells?

Did you also experience that it is difficult to concentrate on your profession when being diagnosed. I am considering taking a few days sick leave but fear that I may be having to take more sick leave in future for more important reasons.

Thanks
Posted 9/7/2015 11:53 AM (GMT 0)
I also had similar stats to yours and suffered some joint pain. Both my family doctor and urologist told me the chances of the pain being due to the prostate cancer metastasis with Gleason 6 is extremely low. They've also informed me that prostate cancer bone metastasis almost never starts at the extremities such as the shoulders, knees, arms, hands or feet.

It is worth a discussion with your doctors but I suspect unless you've been under-diagnosed regarding the prostate cancer that you have nothing to worry about regarding bone metastasis.
Posted 9/7/2015 11:57 AM (GMT 0)
I'm thinking your urologist isn't very educated on prostate cancer in general. With a G6 , a relatively low PSA, and your history of Fibromyalgia, he should not have jumped to that conclusion, let alone share that with you before consulting with a urologist
Posted 9/7/2015 12:18 PM (GMT 0)
balingtwine, from what I've read, it would be very unusual to have bone mets at a G6 and low PSA. I recall that you're in the UK. It does sound to me that you need to get into a major medical center that has lots of specialists in multiple disciplines to figure out what's going on.
Posted 9/7/2015 12:47 PM (GMT 0)

halbert said...
...major medical center that has lots of specialists...

Yes, thanks. Good advice. I am rather disappointed about how this has been handled.

The only competent person I have met so far has been the radiologist carrying out the biopsy. We spent some time just discussing the MRI scans, which none of the other specialists had considered worthwhile sharing with the patient.

This was rather interesting in itself as it clearly shows the bladder fault and other stuff. My GP is only part-time as he is on paternity leave. However, I cannot change at present as all other GPs are over-subscribed.

Gosh, this sucks. Three separate health issues and now I have to worry about losing my job.
Posted 9/7/2015 2:28 PM (GMT 0)
Bone scanning could be performed in symptomatic patients, independent of PSA level, Gleason
score or clinical stage. But a positiv finding is extremely low in low-risk patients like you. If you had PSA in the level of 20 - 50 is would be a risk.
Posted 9/7/2015 2:42 PM (GMT 0)

Pratoman said...
I'm thinking your urologist isn't very educated on prostate cancer in general. With a G6 , a relatively low PSA, and your history of Fibromyalgia, he should not have jumped to that conclusion, let alone share that with you before consulting with a urologist

I Agree. But, it was his GP that said it might be mets, right?

Anyway, assuming that your diagnostic work so far is correct, fairly low PSA and G6, chance of mets is close to zero. With your bone/muscle pain history, chance of it being related to that is quite high, IMO.

I went through something similar about 6 months after my RP. Despite my 1st PSAs post op showing < .01, my left hip pain, which had been with me for quite a while before diagnosis, just kept getting steadily worse. And it was on the left side where the largest part of my tumor was. I called my URO about that and he ordered immediate repeats of PSA and bone scan, both of which were still fine, scan showing arthritic deterioration in that left hip. So until proven otherwise, I would suspect your bone pain is not related to PC.
Posted 9/7/2015 3:04 PM (GMT 0)
"Might be" mets. Sure, anything is possible, although without a bone scan, and still having a prostate to account for your PSA level, I would not put much value on that statement.

My first bone scan (Aug '09) was full of spots that were related to arthritis and broken / bruised bones over the years of Scout trips and rough play with the neighbor kids. It was a baseline, and nothing was PCa. It was done as a part of the initial diagnosis.

I've suffered bone pain for many years. A combination of arthritis and gout. On my Sept. '13 bone scan, they did find spots, but a year's worth of Lupron later, the Sept. '14 scan came back "suspicious". But I did not have any "recognized" until long after surgery and ART.

I honestly did not have time to worry. My job was so busy at the time of my diagnosis that I had to squeeze in time for the docs. I went to pre-surgery tests right off an airplane flight.

I have changed job descriptions in my work, but am still effectively doing the same thing. PCa did not cost me my job, but it changed how I do it dramatically.
Posted 9/7/2015 3:19 PM (GMT 0)
Here's an "official" view on whether G6 cancer can metastasize (and the answer is it is very unlikely).

It's a medical article (linked below) based on the study of BCR in a group of post-open-RP patients, with attention to those who had been Dx'd prior to surgery as G6's.

The article states that "… our findings support the conclusion that Gleason 6 disease exhibits a very low capacity for metastatic spread."

While this study was limited to RP, it is a technical study and does support the general view that G6 cancers really don't metastasize.

The article:

www.ncbi.nlm.nih.gov/pubmed/23706588

There are a number of other studies on the web that also support this conclusion.
Posted 9/7/2015 5:21 PM (GMT 0)

81GyGuy said...
Here's an "official" view on whether G6 cancer can metastasize (and the answer is it is very unlikely).

It's a medical article (linked below) based on the study of BCR in a group of post-open-RP patients, with attention to those who had been Dx'd prior to surgery as G6's.

The article states that "… our findings support the conclusion that Gleason 6 disease exhibits a very low capacity for metastatic spread."

While this study was limited to RP, it is a technical study and does support the general view that G6 cancers really don't metastasize.

The article:

www.ncbi.nlm.nih.gov/pubmed/23706588

There are a number of other studies on the web that also support this conclusion.

linked study said...
RESULTS:

Eight hundred fifty-seven of men (48.1%) undergoing open RP had a pathologic diagnosis of Gleason 6. Twenty-three of 857 of these men (2.7%) developed BCR, 7 were designated as iBCR (mean PSADT 81 months, range 36 to 100), 16 were sBCR (mean PSADT 8 months, range 1.5-20 months). There was a 10-fold difference in PSADT between the sBCR and iBCR groups (P <.001). All men with sBCR underwent salvage radiation therapy (SRT) and all demonstrated a subsequent PSA decline to ≤0.1 ng/mL, suggesting all men had local recurrence. Two men (0.23%) developed a BCR after salvage radiation therapy, both of whom were found to have Gleason 7 disease after pathologic re-review.


So 16 out of 857(about 2%) G6s developed a significant BCR, which of course is not the same thing as met.

All of those had SRT with great results suggesting local recurrence.

2 men(.23%) developed BCR after SRT, and both of these turned out to be G7s on pathologic review.

As far as I can tell(does it say?), bottom line: none of these men had mets, including the G7s . And it seems almost certain that 0% of the true G6s developed mets, since only 2% of them even progressed to a significant BCR, and since response to SRT suggested "all men had local recurrence"..
Posted 9/7/2015 5:55 PM (GMT 0)
Thanks for the references. There seems to be a fair amount of scaremongering out there (outside of this forum), which makes this forum a more important source for us, as the opinions found here seem very much more researched and based upon a more critical approach. Again, many thanks for the contributions.

Perhaps there is a little 'psychology' going on in my head, ie worry about rather harmless biopsy and PSA results leading to less sleep, with subsequent fibromyalgia flare up and serious pain instances that cannot be masked by increased Tramadol.

At least it helps me get some other health issues seen to before I possibly take up cancer treatment, e.g. getting the haemorrhoids sorted.

Easy come, easy go ...
Posted 9/7/2015 7:48 PM (GMT 0)
Getting the 'rhoids fixed first, and giving them time to heal, is a good move, as any PCa treatment involving surgery or RT would potentially cause issues (been there).
Posted 9/7/2015 9:25 PM (GMT 0)

142 said...
Getting the 'rhoids fixed first, and giving them time to heal, is a good move, as any PCa treatment involving surgery or RT would potentially cause issues (been there).

What he said for sure!
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