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Signet Ring Cell Cancer~~ HELP!

zirbel25
Posts: 4
Joined: Jun 2018

My father was diagnosed Friday with prostate cancer. Needless to say I am devastated and desperately seeking information. I will tell you what I know and excuse me if I am not speaking same language, but this is new to me. Learning as quickly as I can!!!

Some background... he has been going regularly to same urologist for 10 years. There have been various issues, one that sticks out to me is that his urine kept testing positive for having a UTI, but no symptoms of UTI. This went on for a long time. 

His PSA elevated and doc sent him for biopsy in April I believe. They took 12 cores and one came back inconclusive. Doc did another biopsy and took 16 cores this time. 5 came back positive for prostatic adenocarcinoma. All Gleason score 4+4 =8) Occupying between 30%-50%  All of the cancer is on right side.  Notes on Pathology report said "Perineural Invasion is identified. The carcinoma cell have focal signet ring cell feature."

Dad had his bone scan and MRI today. WAITING IS TORTURE. 

His doctor did not mention signet ring to my dad when he told him the news, he said he did not want to scare him because he knows how my dad is. Kind of crazy to me. But thats neither here nor there. My sister and I saw it and looked it up- Alarming is not the word. TERRIFYING is. Such little info out there, and what is out there is just awful.

I saw a post on here that it was incorrectly identified by pathologist. I can only hope and pray that happens here. 

Reading as much as I can as fast as I can, but so overhwhelming... all of the treatment options. 

Any information is appreciated. So desperate. I know this is the worst time, the beginning. Trying to be strong for him, its tough. Anything on Signet Ring would be appreciated. 

THANK YOU!!

hopeful and opt...
Posts: 2226
Joined: Apr 2009

I am sorry for your Father's diagnosis, and, the stress that you and your family are experiencing.   Here is information from Dr. Google. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996149/

zirbel25
Posts: 4
Joined: Jun 2018

I have spent hours searching Google. I have seen this article which is scary, but also old. Hoping to find more answers on here from people who have experienced this type of cancer.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3313
Joined: May 2012

Zirbel,

If you are "frantically searching Google," you are doing the wrong thing.  Any "learning about cancer" via the internet is ill-advised, unless you restrict yourself exclusively to scholarly journals and medical center sites. 90% of what you encounter otherwise will be trash/nonsense.  Why not learn about his disease from his doctor ? Legitimate sites would be places like Johns Hopkins Medical Center, MD Anderson, Sloan Kettering, the Cleveland Clinic, Stanford University Medical Center, and so forth.

Signet ring is a specialized form of adenocarcinomic cell, meaning granular cells derived from epithelial tissue. Virtually all PCa (prostate cancer) is derived from adenocarcinoma, but the signet classification is rare. As such, you will need an oncologist with special familiarity regarding this. Most likely, such doctors are rare. Actually, in my 4 years here, I do not recall signet ring mentioned before.

The remainder of your dad's biopsy report suggest aggressive disease (Gleason 8, with high volume involvement).  "Perineural involvement" means that the cancer cells have gotten under the sheathing or "insulation" around the nerves in the gland, a common avenue for metastatic escape.  But discovery of perineural involvement does not by itself prove metastasis, just the possibility thereof, which would have to be established otherwise.

Most likely the doctors will  view his case as what it would be, given these facts minus the signet attribute. This would suggest rapid start of radiation therapy.  This may involve neoadjuvant therapies, like hormonal treatments or even chemo, but chemo against PCa  generally is not as effective as it is against many other types of cancer.  But as I said, I would expect a combination of modalities begun.   

What sort of medical center is he at ?  He needs better-than-average.   As to you, "frantic" is never an effective mentality to operate from. Understandable, and not uncommon, just not effective.  Relax, and focus only on authoratative sources.

max

VascodaGama's picture
VascodaGama
Posts: 3033
Joined: Nov 2010

Signet Ring Cell in prostate cancer is rare. This type of cancer is more common in gastrointestinal (GI) cases. I recall just two cases reported in this PCa board. You may try starting a thread in another of the boards involving GI.

Your comment regarding the UTI issues makes me think that the bladder is involved in the condition. I wonder if the doctor has investigated further at organs close to the prostate (colon and bladder), looking for the same type of cells/cancer. Here are links of posts by patients diagnosed with this type of cells. You may try contacting the members via CSN mail.

https://csn.cancer.org/search/node/Signet%20Ring%20Cell

I am not a doctor to give you an advice but from reading materials it seems to me that prostatectomies (or cystoprostatectomies) have provided longer living outcomes. Your dad needs to act the soonest.

Best wishes and luck in his journey.

VG

Old Salt
Posts: 720
Joined: Aug 2014

The report  stated: The carcinoma cell have focal signet ring cell feature.

Even without this statement, it is highly (!) advisable to have the slides re-read by a specialist. Dr Jon Epstein at Johns Hopkins is THE ultimate specialist. You just need to ask your urologist to have the slides send to him. The urologist's office should know how to do this.

Further info:

http://pathology.jhu.edu/department/services/secondopinion.cfm

zirbel25
Posts: 4
Joined: Jun 2018

We live in New York and we are going to Sloan Kettering tomorrow. All of his slides and info should be there. I assume that they will be re-reading it. Do you suggest sending to Epstein regardless? My parents are so anxious and overhwhelmed right now that I can't suggest anything else to them at the moment because I am afraid it is causing them more stress. I guess we will see what we are facing tomorrow down at Sloan. Hoping for some good answers. Thank you all for responding, I know that this initial stage is the hardest. Thank you all again.

Old Salt
Posts: 720
Joined: Aug 2014

Why don't you wait for the MSK evaluation? The slides can't be in two places at once anyway...

MSK is top notch of course, and your father should get expert care there. Please keep us informed.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3313
Joined: May 2012

zir,

I had said you would likely need better-than -average care for your dad.  MSK is arguably the best in the world.

Dr. Peter Scardino is on staff there, their former director of surgery for many years, and still a senior resident surgeon. If your dad needs surgery (which I feel is probably doubtful), Scardino is one of the very best in the world. I'm glad you're in great hands,

max

hopeful and opt...
Posts: 2226
Joined: Apr 2009

YES, ask the doctor to send the slides to jon Epstein at Johns Hopkins...excellent advise by Old Salt.

graycloud
Posts: 38
Joined: Jan 2018

Memorial Sloan Kettering - can't say enough good things about this prostate cancer center.  My husband's surgeon/oncologist was Dr. Behfr Ehdaie. 

We had Dr. Jon Epstein at Johns Hopkins do a 3rd opinion on my husband's pathology after we received our 2nd opinion at MSK.  MSK and Johns Hopkins both agreed on grading, etc.  This knowledge helped us in our choices for treatment which was robotic surgery.

Knowledge is power - -

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