Is it possible to have PSA=2.3, tumor > 10cc, Gleason 6 (seven cores) Without Neuroendocrine

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reinhartdm
Regular Member


Date Joined Feb 2005
Total Posts : 20
   Posted 4/28/2009 2:34 PM (GMT -7)   
I have been searching the PC literature for an explanation for my stats other than Neuroendocrine carcinoma mixed with the Adenocarcinoma. 
Age = 64, family history
Enlarged Prostate = 47cc,
PSA = 1.6 (27 months ago)
PSA = 1.3 (15 months ago)
PSA = 2.3 (2 months ago) free PSA = 26% (2 months ago) No DRE nodules evident
Biopsy 15 cores (6 weeks ago) = 7 positive cores (Adeno) 80% to 5% on left; one 2% core on right.
All positive cores Gleason 6 (well differentiated) - no indication of small-cell
PSA = 2.4 (5 days ago)
PAP = 1.4 (5 days ago)
 
I asked urologist/oncologist for NSE and CGA; he has not returned my call. 
Next week 3.0T e-coil MRI at National Cancer Institute; In week and half, PET scan with tracer.
 
Who can help me figure this out?  Can't find knowledgeable oncologist in DC.
Dan

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 4/28/2009 2:48 PM (GMT -7)   
Just a question for you...do you know where in relationship the tumor is within the gland itself. I think that the location, primarily in the transition zone can reduce the PSA readings...or could be the other way around...dont remember for sure. But the point was that the location of the tumor has an effect on the PSA reading...just a thought anyway.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4168
   Posted 4/28/2009 3:19 PM (GMT -7)   

Les,

It's the other way around. Transition zone tumors have high PSA.

The PSA leak from a gleason 6 tumor is 4.2 per cc. of tumor volume, so a 10cc G6 tumor with a psa of 2.6 doesn't make sense.

To make sense it would have to be a G9 or above (high gleason = low psa leak) or a very small G6.

Why don't you call Stephen Strum in Ashland Ore for a phone consult.

Dr.Charles Meyers in VA is closer to you, but I would go with Strum for anything dealing with PSA.

JohnT

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 4/29/2009 6:42 AM (GMT -7)   
Thanks JohnT for the clarification...

How did they calculate the 10cc volume for the tumor size?
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06


reinhartdm
Regular Member


Date Joined Feb 2005
Total Posts : 20
   Posted 5/1/2009 7:15 PM (GMT -7)   
I just guessed at my tumor size based on having a 47cc prostate gland (based on TRUS) and 7 of 15 positive biopsy cores.
The positive cores had 80%, 70%, 60%, 60%, 50%, 5% on the left side and 2% cancer on the right. It seems reasonable to assume that 10cc would be a reasonable low estimate. Let me know if I am wrong?
Dan R
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