I have seen a few topics on here regarding the level of PSA and the corresponding Gleason, and the topic of PSA and relationship to metastatic disease.
The following has been asked: How can a person with a Gleason 9 and metastatic disease not have a PSA off the charts. As an example when my father was diagnosed at 70ish his PSA was in the thousands and he had advanced metastatic disease.
Perhaps we need to consider how the pathologic model regarding cancer works. The pathology description of the cancerous tissue classifies it from well differentiated to poorly differentiated adenocarcinoma. That is to say that the well differentiated tissue under microscopy looks similar to the source tissue (In our case it is prostate glandular tissue. But it could be breast, colon, or other tissue). The poorly differentiated tissues have very little in common with the source tissue. A theory is, that at some point the tissue becomes so poorly differentiated that it is no longer biologically active and does not function like the source tissue, (prostate tissue in our case) and does not produce PSA. What point this occurs, does it follow a predictable path…I have not found the answers, however from a completely anecdotal perspective it does makes some since of some of cases that are posted here that I have found puzzling.
CAUTION some of the following is COMPLETELY UNFOUNDED speculation on my part. So when metastases occurs regardless if it involves bone or soft tissue the metastatic tissue is still the source tissue, in our case prostate tissue. As discussed previously on HealingWell it takes lots of tissue to become evident. When the body has this dramatic increase in volume of prostate tissue the resulting PSA can and often is in the hundreds, thousands, and even tens of thousands. Perhaps in an individual patient with a Gleason 9, the offending metastatic lesions are composed of a majority of well differentiated tissue and the resulting PSA is off the chart. Perhaps in a different patient for various reasons, known and unknown, the offending tissue is completely poorly differentiated and a lower PSA is noted.
Dad was a Gleason 9…it was 15 years ago and I honestly don’t remember if anybody actually ever said anything about the composite tissue percentages…X %3, X % 4 and X % 5. Do the actual answers to these questions make a difference in my case or any case, probably not? However I have a quest to fully understand this darn disease and because of that I’m always on the hunt.