Low PSA with High Grade Cancer (Gleas... - Advanced Prostate...

Advanced Prostate Cancer

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Low PSA with High Grade Cancer (Gleason 9)


The American Society of Clinical Oncology has reported that patients with Gleason 8 to 10 cancer and PSA values of 2.5 ng/mL or less may harbor hormone-resistant disease that is more lethal than other forms on non-metastatic, node-negative cancers. Prostate cancer specific mortality was 2.15 times higher for low-PSA, high-grade patients than others studied by the National Comprehensive Cancer Network. (NCCN) It is possible to have metastatic disease with a low-PSA as with high-grade cancer the prostate my not produce much PSA. I was diagnosed with high-grade cancer yet my PSA has never been more than 4.4. The study also found that ADT might not improve survival of low-PSA, high grade PCa patients. Further research is needed to learn the best treatment. Clinical trials are needed.

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I seem to fall into this category .. My oncologist spoke to me about this. It was part of his decision to "wait and see" this past year. Says I'm metastatic just can't see it. Held back from HT. Two scans a year .All show nothing.

I was diagnosed Stage 3, Gleason 8 (4+4) PSA 12 in March of 2016. At 62 (no signs other then BIG fatigue) June 2016 had robotic RP. After the RP my PSA rose twice no stopping . I went into radiation 3 months later. I went into radiation with.042 PSA came out with .080 (39 sessions later). Essentially doubling in radiation. First time I heard of PSA persistent from radiologist. Never zeroed. My doubling is every 3.9 months since June 2016 and I'm currently at 1.350 PSA as of last month. I have been accepted at UCSF for their Ga68-PSMA scan trial. Scan next month. Hoping if this works may be a scan that not only helps me but may be one for all in the future. With single digits now "seen or not" HT is coming most likely by years end.

DSEE in reply to MichaelDD

We are very high grade diagnosed 8-2015.

PSA falling on Zytiga.

Extensive bone Mets per scans.

Now ALP or alkaline phosphate numbers through the roof at 500.

Started Xofigo on top of Zytiga and only had one treatment so far.

Hoping that does some good!

IgnatiusN in reply to MichaelDD

Interesting MichaelDD. 2013 I was a Gleason 9 after rp then imrt radiation May 2018 psa went from nd to .4 . June psa hit 1.0

Bone scan reveals spots on pelvic scholder and throadic vertebrae.

July had a Lupron shot. Now psa .10.

I am 60 I am a returning patient at UCSF. I just quit Kaiser

Was your low-ish PSA at the time of diagnosis before any treatment at all, or after ADT?

MichaelDD in reply to john205

John.. don't know if your asking me? Here is mine. 12 at diagnosis March 2016. DaVinci removal June 2016 . First PSA after removal .024 August 2016. First of July last month 1.350

Gleason4042 in reply to john205

John 205. My first inking of trouble was when a small nodule was detected during a DRE and PSA was 4.4. I was advised to wait on active surveillance as the Urologist told me 4.4 was not unusual for a man of 71. His comment concerning the nodule was, "I am not impressed". I never understood that comment. Eight months later I went to a different Urologist and the exact same condition was found, small nodule with PSA of 4.4. This time i insisted on a biopsy as I had read up on the subject. Three days later I was informed I had high grade prostate cancer in four cores. Gleason 6,7,8 and 9. I sent he biopsy to John Hopkins for a second opinion and it was upgraded to Gleason 6,7,9 and 9. I was informed the chances of microscopic cells having spread beyond the prostate gland was 100%. I went through 40 radiation treatments and none months of ADT. PSA went down to 0.01 and has been increasing slowly for the past four years. PSA is now at 0.25 which is low of course but the study I mentioned indicates this could be more dangerous than high PSA.

I flunked the DRE test despite a PSA reading of only 2.7. I was quickly referred to a urologist who immediately scheduled and then performed a biopsy. 5 of 12 cores positive; Gleason 8 in 1, 6 in 1, and the rest 7's. Also started ADT (after we had to kick the the slow moving insurance company's ass to authorize the eligard). Had HIFU surgery. PSA undetectable for a while but now at 0.2.

Many studies on ADT have shown intermittent ADT is as successful as continuous. The side effects were more than I wanted to put up with. I stopped the Lupron shots after three 30 day injections. Lots of contradictions concerning this.

I was hoping someone would have information regarding the low PSA, high grade cancer. Since I could not find anyone that was able to get one of the latest PET/MRI scans to detect if their cancer is spreading with a low PSA it seems hopeless even though this condition may be even more serious than high PSA, high grade cancer. We know highly differentiated cancer cells may not produce much PSA so how does a person with this condition get tested?

Ductal Adenocarcinoma

Tekton in reply to DeanNelson

Hi Dean Nelson

Do you have Ductal Adenocarcinoma? If so, what is or has been your treatment path? I am always watching for others like me to hear their treatment plan.

DeanNelson in reply to Tekton

Zytiga and Lupron and Prednisone. I just had radiation to my bladder, spine, and Prostate. That's all I get..... everything else is palliative for me ...

I read the same article you did. Expect my Ga68-PSMA trial/scan next month. Will update after...

I’ll also be following this. My husband was Gleason 9, SVI and extraproststic extension all with a PSA of 2.3. PSA remains undetectable since RP. PET PSMA did not show any Mets and nodes were all clear.

Could you kindly share the link to the study? My dad falls in this category of high Gleason 9 and current PSA of <0.008 ug/L on ADT.

Cerano123 in reply to Cerano123

PSA before RP and radiation therapy was 6.7 to 7 ug/L

thanks for the good news. Stop reading. Enjoy your life

MichaelDD in reply to Mormon1

Why are reading and responding? Just go live your life it doesn't pertain to you!

Searched American cancer society website for this info and found nothing.

Where did you see this?


This is where I found the article. Mormon 1, you don't have to read it.

Very much appreciated. This could be me. Thank you.

My insurance insisted I have a chest Xray before they would approve a CT scan, why I don't know. My CT scan is scheduled for tomorrow (8-17-18) and a bone scan on Monday, (8-20-18). I will find out the results on Thursday, (8-24-18). With a PSA of 0.21 they probably won't find where the cancer cells that are increasing are at. At least I hope I won't be one of the people that find out too late the cancer cells are in numerous places but the PSA just didn't show it.

My chest x ray, CT scan and bone scan has all been done. No mets were found. I was told the bright spots showing up in my back is arthritis. I hope this is accurate but still wonder if a Ga68/scan might show something.

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