Low PSA (2.2) High Gleason Score 4+5=9

VascodaGama said:

USPIO MRI with Fereheme
Cherokee

The pathological report with positive extra capsular extension is highly indicative of risks for recurrence. I notice your comment on the adjuvant hormonal treatment which surely is “masking” your real PSA level. Recurrence is difficult to be declared and tests to find/locate cancer after surgery do not exists particularly if tumours are smaller than 1mm.

Under hormonal influence and with no prostate in place your PSA should be lower than 0.05, to consider your case in remission. I would recommend you to get the test done in ultra sensitive assays of two decimal places (0.XX ng/ml). They are more appropriate to follow up your status.

It is common to see PCa cases with high Gleason scores and low PSA levels. Poorly differentiated cancer cells produce usually less PSA serum (grades 4-5). These grades are also aggressive for spread which implies the need to tackle any advance the earliest.

Dr. Charles Myers, a high respected oncologist in PCa, considers radiation of lymph nodes a must do thing in cases highly susceptive for recurrence. This is what could be your case due to the high Gleason and positive margins. He recalls the need of considering the presence of oligometastases (a state of recurrence cancer at the lymph nodes before it becomes systemic) which could be treatable with radiation. The hormonal treatment is not curative but palliative and it can hold any advance of the bandit for long periods of time.

A newer MRI image study named USIPO (ultrasmall superparamagnetic iron oxide) using ferehame as contrast agent is said to detect cancer at the lymph nodes successfully. The test is done at Sand Lake Imaging in Orlando, Florida.
You can read more about this test in other threads in this forum and searching the net.

Welcome to the board.
Wishing you peace of mind.

VGama

hunter49 said:

Hi Cherokee:
I have a friend
Hi Cherokee:

I have a friend who had a 1.9 PSA and Gleason 4 + 4. In some cases aggresive cells do not make the PSA rise so much. You may want to look into Johns Hopokins they have a lot of trials using vaccines on re-occurnece with decent results. Good luck. I am sure this will be controlled.

hunter49 said:

One other thing. you may
One other thing. you may want to have a PET scan done. This checks for metabolic activity in cells that absorb glucose in a very high rate. they inject you with a glucose formula and within 30 minutes scan you. The areas where cancer mets may be light up as they need 6 to 7 times of suger to survive. Cancer cells are not very effecient engines.

VascodaGama said:

Ultra-sensitive PSA may help
Cherokee

Some of your doubts may be answered with a (0.XX ng/ml) PSA test. You have no prostate gland so that serum PSA should be in the very low ranges close to 0.03-0.05. With the hormonal drugs this sensitivity should be considered still lower close to ranges of <0.01, particularly, if you are on ADT2 (androgen deprivation therapy) with a LHRH agonist plus an Anti-androgen (bicalutamide). All this numbers can be considered 0.1 (present PSA) but they all have different meanings in the diagnosis of your actual situation.

In your above posts you describe a “bad picture” on what was found after RP. In open surgeries (and in some robotic) doctors use their hands and tactfully identify suspicious thickening masses, which they relate to cancer, even if they are not hard tumours. This is typical of masses composed of micro-metastases.

My opinion as a layman and based on the many readings and comments from experienced surgeons (mine included), is that you may be at risk for recurrence due to the micrometastases to which radiation treatments have not been totally effective. Doctors cannot identify all the targets where to aim the rays, killing some and expecting the others to die (but without assurances for total eradication). In such cases many doctors do not radiate and choose instead for the hormonal in the intent of holding the bandit.
I would recommend you to discuss the above with your doctor just for peace of mind.

Hormonal drugs are effective in killing low grade cancer by starvation but aggressive forms (4-5) are difficult to handle because these aggressive types of cells are known to mutate and can live in low levels of testosterone. In some mutations they start producing their own testosterone to survive (this is regarded as intratumoral activity).
To such cases, doctors (oncologists) recommend total blockade (ADT3) adding a third drug to the “cocktail” known as 5-alfa reductase inhibitor (5-ARI). This is to block the production of a more powerful (x5) type of testosterone called Dihydrotestosterone.

Recently newer drugs capable of handling intratumoral activity have been approved to treat advanced cases. You may start taking one of them called Zytiga (abiraterone acetate) now substituting the bicalutamide. This drug has less side effects and better response in aggressive cancers.

I am not a doctor and would suggest you to read details on the above in the net (google the terms) to discuss with your doctor or for getting second opinions from specialized oncologists.
Regarding the MRI, if you can’t get the USPIO, still try to get the test done with a modern 3-testla machine (endorectal) that is higher in resolutions. Testosterone level tests are also recommended to guys on ADT.

My story is similar to yours and we are of the same age (62) but my case is 9 years older than yours.
I was diagnosed with micro-metastases in 2001 after open surgery in 2000. The PSA post op (50yo) was 0.18 (pT3apN0) and recurrence was declared just 6 months after with a value of 0.46. I was not recommended to salvage radiotherapy because of the above “believe/theory” on micrometastases. However, my Gleason score was low at 2+3=5 which grades are for well differentiated cancer cells, low aggressive for spread.
In 2006 with a PSA=3.80 I did SRT and the PSA decreased to 0.05 thirteen months later. My surgeon’s opinion was that the rays successfully hit the bulk of the cancer as demonstrated by the aggressive decline in PSA.
Nevertheless, recurrence was again declared in Dec2009, which confirmed the correctness of the initial diagnosis for the existence of Micrometastases. I am now considered systemic but all the tests and image studies have been and are negative to apparent metastases.

I am on ADT (mono therapy Eligard 6-month shot) since Nov2010 (PSA=1.0). The latest PSA=0.03 shows that the treatment has been effective in holding the cancer “at bay”. I am one of the lucky ones in regards to treatments’ side effects, because I am continent, got mild symptoms from ADT and am still active in my lovely nights (but “handicapped”).

Wishing you find a way to over-pass this bump in your journey.

VGama</p>

hunter49 said:

more than likely that was a
more than likely that was a bone scan. Ask your doctor. Either way any negative is a good one. where are u located near?

VascodaGama said:

PSA
Cherokee

PSA (prostate specific antigen) is produced by prostatic cells (benign and cancerous). Surgery for prostate cancer dissects the prostate gland totally leaving no cells behind. Without prostatic cells in the body there should be no PSA.

Logically, if PSA is found in the serum after surgery it means that some prostatic cells (benign or cancerous) are still alive and producing it. Positive PSA tests post surgery certifies the presence of cells left in the body and if cancerous they are called metastatic prostate cancer. Recurrence is declared when the histological PSA increases constantly and reaches a threshold level of 0.20 ng/ml. Nevertheless this is considered valid in cases not influenced by hormonal therapies.

Here is detail explanation of PSA; http://www.psa-rising.com/med/info/psa.htm

In your case recurrence is not verified, but the pathological report indicates a series of findings that could cause future recurrence which requires “closer" follow up.
Your doctor is using the PSA tests in the control which may be enough to check for recurrence, but it should be in a must lower levels of PSA due to the influence of the hormonal drugs you are taking.

Your pre op PSA of 2.2 is not “novelty”. The usual normal level is in the range between 0 and 4 but it differs from person to person. Many guys are found with cancer at the 2 mark. The importance in PSA screening is the upward trend of a series of results which may signal suspicious presence of cancer. The "baddy" would be only declared with a positive biopsy.

You can do some researches in the net about the meaning of PSA in the context of diagnosis before treatment and as a follow up tool after treatment.

The best to you.
VGama

tonahawk899 said:

At least Respond!
?????