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Gleason 10, PSA 3.16, bone scan and MRI negative

grandpaofmakaela
Posts: 6
Joined: Aug 2019

Hi

 

Just found this board today.  Had DRE which found suspicious firmness.  Biopsy result Gleasons 8, 8, 9, 9, 9, 10, 10.  Remaining 5 of the 12 cores benign.  Both sides affected.  Perineural invasion found in two cores, extraprostatic extension present in two others.  Age 73

 

Total PSA 3.16 ng/ml, .59 free PSA.  Cat scan found "no evidence of acute disease",  Bone scan found "without evidence of metastatic disease". 

 

Looks like stage IIIC if I read book correctly.  Appears radiation and androgen deprivation therapy are in the near future.

 

But is it likely that lymph nodes are affected but CAT scan didn't detect (yet)?

 

Looking also for insights on treatment options and facilities in Southern Maryland area.  Hopkins is 60 miles away, Georgetown a bit closer.  Currently working through local urologist. 

 

Thanks

 

 

 

 

eonore
Posts: 47
Joined: Jun 2017

Hi,

If there is one thing I have learned in my own cancer journey, it is that there is no point in treating at anything other than a top cancer center.  If I was you, I would schedule appointment at Hopkins as soon as possible with surgical and radiation oncologists.  Your two negative scans would indicate that the disease is not metastatic but is still confined to the prostate area.  Therefore, your theory that radiation and hormone therapy are in your near future is probably a good one.  I would talk to a surgeon anyway, just to get the perspective.

Eric

grandpaofmakaela
Posts: 6
Joined: Aug 2019

Thanks for input Eric.  I plan to contact Hopkins. 

Clevelandguy
Posts: 456
Joined: Jun 2015

Hi,

Agree with eonore, with scores of 8,9,&10 it should be investigated sooner than later. Urologist & Oncologist can reccomend the next step in your treatment depending on general health & disease progression.  Sounds like the cancer is already outside of the prostate so surgery is probably not a good idea to go towards for a longer life.  Some form of radiation and hormone therapy might be something to look into with your doctors.

Dave 3+4

grandpaofmakaela
Posts: 6
Joined: Aug 2019

Hi Dave, thanks for reply.  Going to appointment this afternoon with urologist to review results, options, etc. 

grandpaofmakaela
Posts: 6
Joined: Aug 2019

I see I messed up on subject of original post, have not had MRI yet, it was CT.

grandpaofmakaela
Posts: 6
Joined: Aug 2019

Wondering if there are others with low PSA (3.16 ng/ml in my case) yet lots of cancer (7 of 12 biopsy cores showing Gleasons of 8, 9, 10).  I thought PSA went up if you have prostate cancer.  Also wondering what implications this combination has for progression, treatment success. 

Thanks

Georges Calvez
Posts: 276
Joined: Sep 2018

Hi there,

It is not absolute but there is an inverse relationship between Gleason Score and PSA production.
Gleason 7 cells are stil trying to be prostate cells so they are still making PSA, etc. They are also less invasive and less likely to throw distant metastases early on.
Gleason 10 cells have given up being prostate cells, they are really purely cancerous, they tend to metase a lot earlier and turn up in more and different places.
So the higher the score the lower the PSA level for the same level of cancer. It is possible to have a huge 7a tumour that is almost entirely confined to the prostate producing a lot of PSA. When it is removed the PSA falls from the low hundreds to only a few.

Best wishes,

Georges

grandpaofmakaela
Posts: 6
Joined: Aug 2019

I appreciate the input all have provided.  I have found several other forums/support sites that I am also using.  I am coming here less often but will check back periodically. 

For those interested I have MRI scheduled in a couple days and Hopkins PC clinic the following day.  Also have appointment soon with local radiation therapist and appointment with urologist shortly after that. 

I am looking at clinical trials currently recruiting at Hopkins as I expect to be recruited for some at the clinic.  I am interested in PET with 18F-DCFPyL, to better define the tumor, look for mets in bones, lymph nodes, etc. and to guide BT (HDR or LDR). 

I am concerned that low PSA numbers and high Gleasons suggest that mets may be transparent to bone scan and PET; that is, the radioisotope used does not get attached to the cancer cells.

Given concern for mets I am considering pursuing chemo at earliest possible after initial treatment (surgery + EBRT or EBRT + BT + ADT).

In studying BT I am learning that it is difficult to get all the tumor without doing damage to adjacent normal tissue such as bladder intestine and urethra and that there is rapid evolution in hardware and software for planning and performing the BT treatment and determining the dose distribution.  I am learning that sensitivity of cancer (and normal) cells to radiation is not constant over time, differs between different types of cancer (and therefore varies between Gleason values).  Given the undertainties with RT treatments I am wondering if, in the absence of mets and with a well defined tumor, surgery isn't the best first step, followed by EBRT and chemo to deal with possible mets. 

I don't know if current treatment protocols will permit chemo with no evidence of mets.

At this point I am becoming overwhelmed with information.  I have 5 binders of stuff printed and quite a bit more electronically.

Thanks for listening.

Marv

 

hewhositsoncushions
Posts: 274
Joined: Mar 2017

Hi

Also consider adding HT to the mix for that extra whammy.

There is also a school of thought that removing the main mass with RP then doing RT (both in conjunction with HT) improves outcomes but it is not a universally accepted belief.

H

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