PSA and Gleason

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JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 2/24/2009 3:12 PM (GMT -6)   
I know it's possible to have a low PSA and a high gleason score with aggressive PC. My question, is it possible to have a medium to low gleason score (4,5,6) and a high PSA?

Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4840
   Posted 2/24/2009 3:26 PM (GMT -6)   
I have a friend who's PSA was over 12 for several years and the Biopsies all came back clean. (he had three) Then the PSA shot up and the rest is history.
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
 
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/24/2009 6:54 PM (GMT -6)   
There is a table on this page which relates Gleason cell grade to PSA production
www.prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess2.html
Roughly, according to the table, PSA output per cubic cm is halved with each step up in grading. i.e. grade 5 cells per cc. have 1/2 the output of grade 4 per cc. who in turn have 1/2 the output of grade 3 per cc. With normal prostatic tissue they expect to see .066 ng/mL per cc. (e.g. A "normal" enlarged prostate of say, 50ccs, should produce 50x0.066 = 3.3 ng/mL. In my own case I had quite a substantial amount of tumour (2cmx2cmx2cm within a 32cc prostate) while the PSA moved from 2.8 to 3.2 to 3.9 over 2 years. As an exercise in maths my benign PSA (normal gland) reading should have been 2.11 ng/mL.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01

Post Edited (BillyMac) : 2/24/2009 5:14:02 PM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4252
   Posted 2/24/2009 7:24 PM (GMT -6)   
You can absolutely have a high PSA with a low gleason score. There are a couple of things that can cause this. A large tumor that is nonaggressive, a transition zone tumor, and PC metastisis that has spread to the lymph nodes. High PSA usually is associated with metastisis.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 2/24/2009 7:41 PM (GMT -6)   
I thought the longer the PC remained in your body the more aggressive it became (gleason 5 to 6 to 7 to 8 to 9 to 10). The more aggressive, the larger the tumor. The larger the tumor the more PSA. 
 
I ask because the father of a friend of mine died of PC back in 2006. He had a really high PSA and a gleason of ten. My friend stated his father wasn't a gleason ten when he was first dx'ed back in 2000. 

Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/24/2009 8:33 PM (GMT -6)   
It's not the cancer itself that causes you any harm for they are your genetic cells, not a poisonous invader, but rather what it does. As it spreads to other areas of your body it forces out and replaces other tissue disrupting the function of those various vital organs. If it can spread to the liver and as grows it will begin to break up and disrupt liver function. If it spreads to the brain it will begin to break down the connections and the disrupt the way the brain controls and maintain the functions of your body. I guess the rate of speed this happens is somewhat dependent on aggressiveness (Gleason influence). I would assume that grade 3 cells would be quite liable to become more altered with time and increase in grade and thus aggressiveness. I wish somebody somewhere would hurry up and find a marker to attach to the errant genes so that our immune systems recognizing the marker would wipe out the cells to which they are attached.
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01


bigote
New Member


Date Joined Feb 2009
Total Posts : 4
   Posted 2/25/2009 11:25 AM (GMT -6)   
To; BillyMac, Thanks for the web page on Glealon cell grade to PSA production. I printed out 14 pages to read on the way to work. Have a great day ! "Bigote"

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 681
   Posted 2/25/2009 8:10 PM (GMT -6)   
JerseyG said...
I know it's possible to have a low PSA and a high gleason score with aggressive PC. My question, is it possible to have a medium to low gleason score (4,5,6) and a high PSA?

As you can see by my profile, my psa was somewhat moderate, but the cancer that was found was an aggressive gleason 8.  The urologist seemed to think we found an early but active cancer.  Everyone I consulted (even the radiation docs) recommended surgery, despite my preference for brachytherapy.
 
I have been pleased with the quick recovery and apparent success, but I am still very upset by my long term ED problems.
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion identified
Few continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02) (two years+.03)
One side nerve spared
success but some plaque with bimix 
born in 1941

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