High Gleason with high PSA

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Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2460
   Posted 3/26/2009 3:45 PM (GMT -6)   
I've often wondered if a high Gleason with High PSA indicates a more aggressive tumor than High Gleason with low PSA. Is this true? Or is the PSA irrelevant is this case?
Age: 67
Retired in 2001 and living in Austin TX.
PSA 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
Post op Pathology report:
Prostate weighed 57 grams
size:5.2 x 5.0 x 4.9 cm
10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
Lymph nodes: not dissected
seminal vesicles clean

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 3/26/2009 4:11 PM (GMT -6)   
Good question Ed C. I thought that the aggressiveness was determined by the Gleason score only...don't know about the relationship of PSA except that the more PSA usually means the greater the spread of disease. But then I have also read that very high grade Gleason scores 5+5 don't produce as much PSA. I believe that they are used together to develope a treatment plan best suited for each combination of Gleason and PSA in the advanced stages such as yourself.

Will be following this thread for others take on this.
You are beating back cancer, so hold your head up with dignity
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2460
   Posted 3/26/2009 4:21 PM (GMT -6)   
Thanks LV-TX. I'm hoping that others will chime in.
Age: 67
Retired in 2001 and living in Austin TX.
PSA 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
Post op Pathology report:
Prostate weighed 57 grams
size:5.2 x 5.0 x 4.9 cm
10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
Lymph nodes: not dissected
seminal vesicles clean

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 3/26/2009 5:11 PM (GMT -6)   
I think a high PSA with a high Gleason indicates that the cancer has spread and the PSA is being generated from PC cells that are not from the tumor, ie in the lymph nodes or bones. A tumor with a high Gleason doesn't generate much PSA so it must be coming from somewhere else.

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.


Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 3/26/2009 6:23 PM (GMT -6)   
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 3/26/2009 7:01 PM (GMT -6)   

Hi again, Ed,
High Gleason does not mean high PSA.  Conversely, high PSA does not mean high Gleason.  PSA assays are a mesurement of an protien enzyme that originates in the prostate gland and leaks into the blood stream.  This can be for varying reasons.  For unknown reasons, some patients secrete more PSA than others.  One factor I have heard, is if the tumor is closet to the outside of a prostate or a blood stream, even low Gleasons can emit high PSA's when in larger tumors. 

I have met guys with Gleason up to 10 at diagnosis, but their PSA was below 4.  After surgery, the cancer was contained within the prostate, but because of the aggressive tumor, they were still listed as high risk of relapse.  PSA's need to be broken down as to what they were before treatment.  Less than 10 will indicate a contained disease in most cases.  But strangely, some gleason 6's can escape the prostate and still be below 10 where that is less likely for a Gleason 10 that escaped a prostate. 

You will see some guys over time that have as low as Gleason 6 or 7 but PSA's over 100, or even over 1,000.  Once the cancer has spread outside the prostate and tumors begin to grow elsewhere, then PSA's tend to skyrocket.  There is more correlation between the size and amount of tumors than there is Gleason grade. 

That is why it is said that PSA is a surregate for disease progression more so than the grade of the tumors.


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
My Journal is at Tony's Blog  

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 3/26/2009 7:29 PM (GMT -6)   
My father's PSA was 5.5 and he had a lymph node involved. Devastating and surprising. His Gleason was 4+3.
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum

Regular Member

Date Joined Nov 2008
Total Posts : 299
   Posted 3/28/2009 8:35 AM (GMT -6)   

The increase in the PSA from year to year is what a lot of doctors use, along with the Gleason scores. My PSA jumped from 4.1 to 10 in one year. Then my Gleason scores were 8 or 9 in the cancerous half of my prostate. The fact that my father had Prostate Surgery at the age of 70 was another factor. And he had to have to radiation therapy after the surgery for years. He is still alive.

I was hoping to go with the "seeds" but after the biopsy results, none of the Urologists in the practice would recommend it or the Robotic surgery. I am quite happy with my results, pads were gone in two months and the ED is quickly going away.


Age 60
PSA 2007 4.1
PSA 2008 10.0
Diagnosed April 2008
Biopsy: 6 of 12 cores positive
Gleason 4 + 5 = 9
CT and Bone Scan negative
Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared
Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th
lymph nodes negative
PSA Sept 28, 2008 0.00
PSA Jan 22, 2009 0.00

Regular Member

Date Joined Nov 2008
Total Posts : 65
   Posted 3/28/2009 11:10 AM (GMT -6)   
I am offering an observation over ten years rather than any scientific proof. It seems that younger men (30-50) can have very aggressive cancers with low PSA's. Most of us can agree that the (0-4 normal range) is for the naive, if the age of the patient is less than 70. Since we all have heard that most men will die with prostate cancer but not from it, an assumption is made that almost all men will have a normal PSA level of 0-4. The increased rate of screening using PSA and DRE during the past 10 years have changed the statistics. The PAP ingredient of the blood test was previously used to guage increase in cancer. Just ask your local MD for a PAP test and get their reaction.
Dx'd 1999, Age 60, PSA 43, Gleason (3+4=7), T3c
42-3d EBRT w/Lupron/Casodex for 24 months and PSA remaining to be <0.1 for the entire 24 month period.
July 2001 - 2nd opinion required to go intermittent ADT.
MDAnderson biopsy revised Gleason (4+5=9).
Intermittent ADT, Lupron only, with PSA threshhold established at 1.0.
March 2007 - Diminishing returns with Lupron, conferred with MDA urologist for bilateral orchiectomy. Uro asked for biopsy of prostate again. Biopsy resulted in tumors found with Gleason (5+4=9).
August 2007 - RRP and bilateral orchiectomy. PSA <0.1
99% continent immediately
September 2008 - PSA 0.45
November 2008 - PSA 0.67
December 2008 - Resume Casodex
December 2008 - Stricture in bladder neck requiring surgical removal. 99% incontinent immediately.

Life is not waiting for the storm to pass, it's learning to dance in the rain.

Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 3/28/2009 12:08 PM (GMT -6)   

Hi Ed,

I had some curiosity about this subject myself some time ago. If I have understood what I read on the subject it boiled down to the following:

PSA was a measure of gland and tumor volume and was not related to Gleason score.

PSA velocity was a measure of growth rate of the tumor cells.

Gleason score was a measure of differentiation of the tumor cells from the normal prostate cell. Higher grades indicate higher differentiation. Cancer cells do not "die" as quickly as normal cells and do not progress to become full fledged and functioning normal prostate cells. They hang up, for lack of a better term, at some point of immaturety and tend to live longer as a result.

If this is so far off the mark as to be laughable please set me straight. tongue

Best to all,


Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone

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