Can someone help me with this Brain Biopsy, told have PCa primary and mets to brain???

One might independently refer to sources like the Pathology Outline's - Stains and Molecular Markers reference page:

pathologyoutlines.com/stain...

The positive for PSAP is a likely driver for an association with a primary of prostate origin.

The negative for PSA, itself, may be ambiguous. Its status is sometimes used to help differentiate between advanced colorectal carcinoma and prostate carcinoma primaries.

The important thing to discuss with your doctor is whether or not you may have the small cell neuroendocrine type of prostate cancer, and any implications of that for future treatments and for interpreting test results, such as PSA tests. You may also want to send the pathology sample to a highly qualified lab that has lots of experience in prostate cancer for a second opinion. Perhaps ask about doing genetic testing on the sample. Maybe do some independent learning about neuroendocrine prostate cancer, yourself, if so inclined. No need to get the cart before the horse, but this recent presentation provides a good overview on the topic:

am.asco.org/daily-news/trea...

I am not a doctor, but just some initial thoughts.

Meanwhile, here's to living well, savoring each precious day, and, hopefully, experiencing more gratitude, compassion, acceptance, and meaningful times ahead on our mysterious journeys.

We may not always be Cured, but we can often be Healed in many other ways.

Charles

If it is Prostate Cancer---it is probably refractive stem cells that do not give off PSA, while Hormonal Cancer sensitive ones do. These cells divide into daughter cells and travel along an enzyme called Hyaluronase to far parts of the body.

I pray that this is not the case, and that whatever is discovered, can be controlled, and put into remission. This is not an area of expertise for me, I kind of know how some processes work.

Best In God,

Nalakrats

You might also ask about the pros and cons of possibly going onto a Carboplatin Etoposide option, if that is deemed appropriate for your evolving tumor/met(s) type.

On another line of thought, have you ever read the book:

Being Mortal -

Medicine and What Matters in the End , by Atul Gawande?

Highly recommended.

They also made a PBS Frontline documentary, based on ideas in the book.

pbs.org/wgbh/frontline/film...

Charles

Wishing you well. There are some types of prostate cancer that can not always be followed by PSA nor have biopsy/pathology samples stain positive for PSA. Two examples are Small Cell and Ductal (what I have). You can even have mixtures where some percentage of the cancer will show up on PSA tests while the rest does not. (In my case it is about a 70:30 ratio). In these cases it is critical that you follow it with scans in addition to PSA testing.

Note, from what I have read, "normal" prostate cancer does not usually migrate to the brain, but Ductal often does. You may want to ask you doctors about these rare forms.

Dr. WHO ( not a medical doctor)