Low Gleason, not aggressive, mets to bone?

Tdoyle

PSA results ?????

Had my first 6 month checkup with my oncologist yesterday 8/30/18 ....let me back up a bit...2 and 1/2 months ago at my GP he did blood work and my psa was 3.01 and yesterday at the oncologist appointment the psa from his visit was 3.620   This is the first since deciding to go with AS   

Needless to say now I am worried once again...the oncologist said his practice is to go another 6 months amd check again..I asked about another biopsy and he said if it goes up next time then he would go that direction...

Is that increase in psa something to really worry about ?? I dont know 

VascodaGama

Expect different results from different assays

Different assays provide different results. The test done at your GP used a sensitive assay of two decimal digits while the one at the oncologist used a higher sensitive assay of three decimal digits. The time difference and the value in both assays is big when judging the PSA doubling. In any case, you still do not know if the lupron effect was masking the initial PSA result. As commented by Old Salt above you need a T test to check your hypogonadism status. Normal T can take longer to reach.

I think that waiting six months till the next meeting is OK. In any case, if worried, you can take again another PSA at the same laboratory to declassify errors. You should also be attentive to your life style the day before drawing blood for the test. Any massage of the prostate or sex or riding a bike, etc, can influence the level of the PSA greatly.

Best,

VG

 

G53

Bone mets?

A Gleason 6 will not cause bone mets. If there are bone mets, as the bone scan showed, the biopsies did not return the correct Gleason score. As VG said, the biopsies were done from the same area of the prostate. Therefore they missed the regions with the higher Gleason scores.

AS is not the right choice if there are bone mets. You should get surgery and this will determine Gleason 7 or 8.

G53

Tdoyle

G53 said:

Bone mets?

A Gleason 6 will not cause bone mets. If there are bone mets, as the bone scan showed, the biopsies did not return the correct Gleason score. As VG said, the biopsies were done from the same area of the prostate. Therefore they missed the regions with the higher Gleason scores.

AS is not the right choice if there are bone mets. You should get surgery and this will determine Gleason 7 or 8.

G53

test

G53, 

I have went for 2nd opinion since the first diagnosis of mets and with further testing and a bone biopsy the mets have been ruled out...i have had a 12 core and a 24 core biopsy done... I have posted all test results and have chosen AS 

Tdoyle

VascodaGama said:

Expect different results from different assays

Different assays provide different results. The test done at your GP used a sensitive assay of two decimal digits while the one at the oncologist used a higher sensitive assay of three decimal digits. The time difference and the value in both assays is big when judging the PSA doubling. In any case, you still do not know if the lupron effect was masking the initial PSA result. As commented by Old Salt above you need a T test to check your hypogonadism status. Normal T can take longer to reach.

I think that waiting six months till the next meeting is OK. In any case, if worried, you can take again another PSA at the same laboratory to declassify errors. You should also be attentive to your life style the day before drawing blood for the test. Any massage of the prostate or sex or riding a bike, etc, can influence the level of the PSA greatly.

Best,

VG

 

T test

Thnaks I will check into getting this test

G53

Tdoyle said:

test

G53, 

I have went for 2nd opinion since the first diagnosis of mets and with further testing and a bone biopsy the mets have been ruled out...i have had a 12 core and a 24 core biopsy done... I have posted all test results and have chosen AS 

PSA value
If you had no cancer, a PSA value up to 4 would be OK. You know you have cancer, so you should expect a higher PSA value.
In this article: http://www.cancernetwork.com/oncology-journal/active-surveillance-prostate-cancer-how-do-it-right it says: "AS is appropriate for men with a Gleason score of 6 or less and a PSA level of less than 10 ng/mL". So you do not have to worry as long as your PSA value stays below 10.

G53

Tdoyle

G53 said:

PSA value
If you had no cancer, a PSA value up to 4 would be OK. You know you have cancer, so you should expect a higher PSA value.
In this article: http://www.cancernetwork.com/oncology-journal/active-surveillance-prostate-cancer-how-do-it-right it says: "AS is appropriate for men with a Gleason score of 6 or less and a PSA level of less than 10 ng/mL". So you do not have to worry as long as your PSA value stays below 10.

G53

Thanks G53

Thank you for the link

Tdoyle

6 month psa

Had my 6 month psa results today, I havent been on here for a while ...my original psa was 5.56 in 8/1/2017 and as in my former post I went through some scares from bad  adviise from local doctors and had a 4 month hormone shot the end of 2017...psa 6 months ago 8/30/2018 was 3.620 and 4.44 in december and today it was 5.260  ...... so looks like it is about to where it was originaly...so I guess continue active survialance another 6 months and then go from there....sound like s wise decision?????

VascodaGama

I wonder the AS protocol at your clinic

It is wise to me. I think you do well in waiting for the next PSA. You are under treatment on AS which follows the protocol of the clinic where you are attended for. In any case, if you have to stop AS then you should think in getting additional exams before advancing with an option. I would recommend you to get a 68Ga PSMA PET?CT exam if your tendency is surgery.

 Let's hope that the PSA stabilizes.

Best,

VG

Tdoyle

VascodaGama said:

I wonder the AS protocol at your clinic

It is wise to me. I think you do well in waiting for the next PSA. You are under treatment on AS which follows the protocol of the clinic where you are attended for. In any case, if you have to stop AS then you should think in getting additional exams before advancing with an option. I would recommend you to get a 68Ga PSMA PET?CT exam if your tendency is surgery.

 Let's hope that the PSA stabilizes.

Best,

VG

next biopsy

When using AS as treatmeant is there an average time when biopsys should be done again? It has been about a year and a half since last one was done...

Thanks in advance

VascodaGama

Your doctor should give you the answer

Tdoyle,

AS protocols differ from clinic to clinic. In some the biopsy is done every two years but some doctors request it annually. In my lay opinion, the need in repeating the biopsy depends on the type of tumour found initially (G-grade), its location (within the gland, of course) and the variation of the PSA (along the treatment). It all starts from two principles; 1) Patients with G-grades of 4 and 5 should not be in AS, and 2) The grades of the cells do not alter (increase or decrease) along their lifetime.

Accordingly, repeated biopsies would be needed to verify any particular outstanding data (a positive DRE, sudden increase of a more-or-less stable PSA, a high level of PSA above the threshold that triggers treatment, etc) or simply to further checking those missing areas not cored yet (particularly those related to the negative cores of previous biopsies).
An increase of the PSA along the treatment is expected because Gleason grade 3 types (the ones that made such patient to be on AS) act more like normal benign cells in producing PSA but are more consistent than the benign ones which increases the values. These are cells well differentiated very alive. However, too much alive may lead to spread (even within the gland) which could lead to the finding of more positive cores in the repeated biopsy. Such a condition would oblige stopping AS.

I hope my explanation helps but you should inquire your doctor or clinic where you are assisted.

Best,

VG