Low PSA (Less than 2 ng/ml) but high Gleason (9) cancer which spread to liver

I never had high PSA. My PC was discovered by accident (in 2014) when I was being treated for excessive nightly urination. A biopsy showed all areas of my prostate to contain high Gleason (9) PC. The biopsy also showed that the cancer cells were highly deformed and produced only low levels of PSA. ADT (degarilex) and radiation (brachytherapy and external beam) controlled everything for a while but in fall of 2016 the cancer spread through the lymph system to bones, lungs, and liver. I am now on chemotherapy (doxitaxil and carboplatin) along with ADT. Dr. believes that the immediate problem is controlling the progression in the liver which biopsy shows has the same characteristics as the cancer in the prostate. Next CT scan is next week (March 2016) after which i should know if the treatment is working. Dr. also says that these treatments should work until they don't work, which does not give me a good feeling. Apparently the cancer in the liver is also very dispersed so surgery or direct chemo would not work there.

I am particularly interested in what works to control low PSA cancer cells, and how to treat prostate cancer which has spread to the liver.

16 Replies

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  • Egg,

    Negative PSA killed same way as positive PSA...watch the video and you will see what the problem is

    Gus

  • Excellent video. I am a little confused about the idea of negative PSA, what does that mean? Does it mean that the cells produce less than the normal amount of PSA or does it mean that the cells actually absorbs PSA produced by other cells? I have been told that my cells are highly deformed and as a result produce very low levels of PSA. Are they negative PSA cells? When I started chemo using taxotere, I saw my PSA rise at first and then drop on subsequent treatments so that follows with Dr. Myers statement.

    Dr. Myers also notes the role of stem cells and the need to kill or remove them from the body. The stem cells must be mixed in with the cancer cells. Can the stem cells be seen on conventional scans. he did not indicate that the stem cells can be killed with chemicals. he indicated stem cells needed radiation or surgery to eliminate them form the body, which is not that easy with metastatic spread of the cancer.

  • "PSA-negative" simply means cells that produce no PSA (not negative PSA).

    My understanding is that stem cells are always PSA-negative. They do not require androgen & lack the androgen receptor - which is why therapy that targets androgen or the androgen receptor cannot kill them.

    The concept of stem-like progenitor cells was by no means accepted when I was diagnosed. So it is not surprising that traditional therapies do not target them.

    There are some natural otc substances that seem to selectively kill those cells. And Metformin:

    ncbi.nlm.nih.gov/pubmed/262...

    For PSA-positive cells, the amount of PSA produced can be much lower or higher than average. PSA is not necessarily a marker of tumor burden. More significant is the PSA doubling-time [PSADT].

    When undergoing a change of therapy, one should not panic if PSADT initially shortens. For instance, there might be an increase in PSA leakage from damaged cells. Ultimately though, the trend will become apparent.

    -Patrick

  • are "stem cells" something other than cells that have undergone the enodthelial mesenchyal transition?

    en.wikipedia.org/wiki/Epith...

    If so, I thought that all or most CTCs had gone through this phase, and then go through the revese priocess

    en.wikipedia.org/wiki/Mesen...

    to hook onto the osteobalstic niche to make bone mets.

    en.wikipedia.org/wiki/Mesen...

    [hence the frequency of mets to the bone]

    OR is he talking about something else.

    He has been talking about cancer stem cells since at lease 2008 (PCRI).

  • The more disorganized and irregularly shaped the cells the more aggressive they tend to be. Vey aggressive PC doesn't always make much PSA.

    Joel

  • My husband's PSA was never over 40, but he has Gleason 9, distant mets, and bad cancer cells. In other words, really aggressive cancer. The PSA is a relative number based on each individual. Some men go into the 1000s (understandably scary!) but some don't every break into triple digits.

    Also have testosterone checked.

    Once one has advanced PCa, it is a combination of PSA, scans, and other tests that really determines where you are.

  • Very true. Even after my cancer spread rapidly, my PSA never was over 25. It is going down now that I am on ADT and Chemotherapy. I am at 2.5 after 6 Chemo sessions.

  • I was diagnosed Gleason 8 with a very palpable tumor ... and a PSA of only 2.7. After watching the video, I am thinking that I need to find a cracker-jack oncologist who understands that low PSA cancer isn't something to be trifled with. So, eggraj8, I am as interested as you are. Good luck.

  • As Joel T says in the post above very aggressive PC produces low PSA. I am finding that many people have this type of cancer, but each oncologist only sees just a small percentage of patients with this type of cancer. So finding a cracker-jack oncologist who understands low PSA cancer is a challenge. Most oncologists seem to want to treat it like the more common high PSA PC.

    Dick

  • Dear Eggraj8:

    My husband is on the same path as you are. His liver mets were diagnosed in January 2016 (he also had widespread bone mets) and he is currently taking carboplatin and etoposide with Lupron and Zometa. He is currently about to have his fourth cycle on chemo (three straight days) that occur every three weeks. When originally diagnosed, we were told he had approximately one year but I look at him and wonder how that can be as in spite of the chemo he seems outwardly to be healthy and managing the side effects pretty well. I look forward to following your posts and hope to learn more about your journey. I wish you the best as you continue your treatment.

    Sincerely,

    Lynnette

  • Dear Lynnette

    I clicked on you and will follow you also on this blog as you are right, your husband and I are on the same path. When I first thought I had a year or less I was very depressed, but now I have learned to appreciate the time I have left whether it be a day, month, year or even twenty years. Hopefully, it will be the twenty years but who really knows. I understand that many new drugs are being tested and hopefully both your husband and I will be able to utilize them.

    I recently walked one of my sons down the aisle and played with my grandchildren. I also hugged my wife and children. While life is not what we cancer patients originally hoped it is important for us to enjoy our lives one day at a time and appreciate what we have. Your husband has a wonderful wife and probably more to be appreciative of. Keep the spirits up.

    Best,

    Dick

  • How are you since you started treating the liver?

  • Have you considered immunotherapy (sorry forgetting the drug name right now)? And possibly Xofigo -- a diffuse radiation treatment via IV that goes after scattered bone mets.

  • I asked about immunotherapy, but my DNA is not typical of the immunotherapies which are used for certain prostate cancers. My major problem is with the liver and to use a drug which goes after my bone mets will require stopping the chemo which hopefully is now controlling the cancer in the liver. I think the Radium 223 is very promising for bone mets but not for me now. It is hard to fight the cancer in multiple sites at the same time when many drugs are site specific.

  • Oh yes, sorry. Visceral (organ) involvement does foreclose the immunotherapy. Sorry. We think the RA 223 did do it's job. My husband made it through 4 of 6 treatments. He was just a bit sensitive to it but his bone scans have been good since, no new spots so maybe we actually did get some buggers early! Wishing you well sorting this out.

  • Something on small cell prostate cancer (which makes less/no PSA)

    ncbi.nlm.nih.gov/pmc/articl...

    University of Iowa is leading on this.

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