Is there a grading for metastatic prostate cancer?

[dac500]

It is commonly known that metastatic cancer is not assigned a Gleason score. Why not? How do you distinguish between metastatic prostate cancer with different PSADT? Can some metastatic cancer be more aggressive than others? Can we use PSADT to determine aggressiveness of metastatic prostate cancer?

[Tall_Allen]

Gleason scores are based on the cellular architecture within the prostate - the cells do not form functional glands in metastases. Yes, PSADT is one biomarker for aggressiveness. But not all aggressive prostate cancers put out a lot of PSA; in fact, some don't put out any.

[dac500 in reply to Tall_Allen]

Thanks for your explanation.

I was examining the photomicrograph of the biopsy I had in 2016 for the extra-capsular mass. Since it was attached to the prostate, it probably had cellular architecture of the prostate. The photomicrograph is clearly very similar to that of Gleason 8 or 10. This probably explains the MO's (who is treating me for metastatic cancer) comment on the biopsy: "Post-radiation prostate adenocarcinoma is not assigned a formal Gleason

grade, however, if this were to be graded, it would at least represent

Grade group 4 cancer."

My lymph node metastasis probably came from the cancer in this extra-capsular extension, which may explain PSADT of less than 2 months.

Now it is becoming clear to me that the biopsy in 2011 that diagnosed me with Gleason 3 + 3 prostate cancer missed a more aggressive cancer close to the capsule that somehow was not killed by brachytherapy.

[Tall_Allen in reply to dac500]

""Post-radiation prostate adenocarcinoma is not assigned a formal Gleason grade" is because radiation messes up the cellular architecture. Cells undergo a genomic change called EMT before they can metastasize.

[hillndale in reply to Tall_Allen]

I have read you saying this and it has me wondering why PSA is the tea leaf after RP? Husband path report confirmed Gleason 9, with SVI. But dr. says let’s see what PSA is in 6 weeks, and I read that doubling psa in 3 months time is a poor prognosis. But if some of the most aggressive forms of pca has low psa, do we just wait for the micro metastis to blow up? The RO says we can start ebrt in june to get any strays in the local region.

[Tall_Allen in reply to hillndale]

I'm unfamiliar with the expression "tea leaf." Was his pre-RP PSA very low? Doubling time is only calculated on at least 3 PSAs> 0.1. But with SVI and GS9, a confirmed PSA>0.03 is an indicator that salvage radiation should be discussed.