Hello,
I have a question about PSA doubling time please. My question is how much does PSADT correspond to Gleason score? Can you have a long doubling time (over a year) with a high Gleason score or do the 2 not go together? Also, can doubling times speed up or do they tend to stay the same? Thank you in advance.
Short answer: There is no correlation between gleason Grade and PSA doubling time. Some peoples cancer cells are fountains of PSA and other peoples cancer cells release very little PSA.
Gleason tells how badly the cancer cells are deformed..PSA just tells how many cells are involved.
Thank you for this. So really the doubling time is the most important thing - a high Gleason grade isn’t such an issue if the doubling time is long?
Both are important in their own way.
PSA doubling time is a measure of how quickly the cancer cells are multiplying,
Gleason Grade tells us how bad and aggressive these cancer cells are.
In simple way, Say a crowd of 1000 people collect outside your house and they are only shouting slogans and have no deadly weapons ...and now, compare it with a crowd of 50 people ouside your house equipped with knives, swords and guns and are very angry.
Which crowd is likely to cause more damage ? the second one ...because the second crowd is deformed, mean and aggressive....in other words, the second crowd has very high Gleason Grade.
So if you have very high Gleason Grade but long PSA doubling time, it means you have mean guys out there but they are not multiplying fast
Answer to Second part of your question: yes. Doubling time can get shorter if you allow cancer cells to dominate over your immune system. The way to keep your immune system strong is By (1) Plant based anti inflammatory foods, herbs and spices (2) Regular excercise and keeping body weight near your ideal weight (3) Meditataion and relaxation tecniques.(4) controlling comorbid medical conditions.
Thanks for your post I'm a few months in after LARP. I am still learning about this monster in my body and have my first PSA 3 months after procedure next week. I have found out more information from you guys than the booklets my URO had me print from the internet and the copies of info I had already found myself online.
I thank all you brothers out there that post you answer many of the questions we have and many times it's someone else question and in answering them sometimes months ago you help me tremendous. You brothers ahead of us give us hope, joy and the most important is your courage. Wow. Thanks again from us new guys. Arlis
Thank you and best wishes for your recovery.
Such useful reply and 4-point advice, thanks.
Hmm... Have you had a biopsy?
In my case, PSA went from 3 to 28 within a year.
Results: G9, S3 and no mets.
Best
Thank you all and for that great explanation LearnAll! So in theory, you could have a Gleason 10 which could actually do little harm if the doubling time was say, 5 years each time... ?
Is there any correlation between Gleason score or doubling time with length of hormone sensitivity time, or again is that a separate entity?
Thanks again for your insights.
Hmm... Are we discussing theory or reality?
I've given you my history without hesitation.
What is yours?
I've found that if you provide details, the great members of this forum will give you their best advice.
Best
I’m messaging on behalf of my dad. His Gleason is 8 and initial diagnosis aged 70 with PSA 43, with small bone mets. I’m messaging from the UK so fortunately our healthcare is provided for free by the NHS. He starts his first chemo session on Friday so I am trying to understand as much as I can to support him through it all. You guys help so much so thank you.
Hmm... thanks for the info!
I just turned 71 and I wish you both all the best.
After all I've learned on this site, I think your Dad will be around for quite awhile.
AJ
Im also in UK, diagnosed Oct 2016. Gleason 3+4, PSA 1096. At this time i had back pain.after 6 sessions of chemo (Docetaxel) and Decapeptyl injections every 3 months, I am pain free with a PSA of 0.14. PSA has risen from last reading of 0.08, my onco says this is OK. Hope your father also has a good outcome. Best Wishes
tonmead
Thank you Tonmead, that’s great to hear you’re doing so well. This has sparked another thought for me. Is the outcome after treatment more important then where you start? So, if you have widespread mets but can get to a PSA of 0 with treatment, are you then in the same position as someone with say, involvement of just a couple of lymph nodes, who also gets to a PSA of 0? I hope that makes sense.
I was 67, psa 59.9, alk phosphatase a little over 200 after beginning of 8 cycles chemo, on my 29 month of xtandi. Extensive bone mets, abdominal lymph node mets. Gleason 9. Will be 3 years in march since diagnosis. That is 6 months longer than original prognosis. Considering I had a t12 compression fracture before diagnosis, seems I am doing well. Take it as it comes, as worrying doesn't do a bit of good. I did not change my life style but that will probably prove to be a mistake. Enjoy every day. I wish you the best.
The problem with Gleason Grade accuracy is that the score may vary from one pathologist to another. Most of the people who send their biopsy slides for second opinion get shocked as there Gleason Grade is most of the time upgraded to higher .
Sometimes there is a conflict of interest as some centers deliberately upgrade your Gleason Grade to scare you to sell you extremely expensive treatments. Sorry..this is the reality of our medical industrial complex. So, make sure to get your slides read by independent, trustworthy pathologists.
Yes. a long doubling time is always a good news. It indicates that your body's immune system is successfully fighting back and keeping the mean cancer cells from growing their population.n Remember, there is no man in this world who does not harbor some prostate cancer cells but they are not harmed because the population of their cancer cells are tiny and their immine system is always killing them ..not letting them to take over.
Comming to the issue of harmone sensitivity and its lenghth.
Out of all prostate cancers, 95% are acinar Adenocarcinoma (means they originate from glandular cells of prostate) The remaining 5 % include small cell, ductal and Neuroendocrine type cancer cells. (This 5% is harder to kill ) Therefore, one criterion is if you have simple, vanilla type adenocarcinoma cells , then you might be hormone sensitive for a longer period. The other factor is individual unknown factors...some people have remained hormone sensitive for 10 to 15 years and other lose their hormone sensitive status within 1 to 2 years. I can only speculate on possible causes of this variation. I believe that if you are in good health, with good immune system, plantbased anti inflammatory diet, regualtr excercise and lower stress..that might prolong your harmone sensitivity longer.
Also, if keep your body's environment hostile to cancer cells like eating herbs and crucuferous veggies , lots of vit C rich food, keep system alkaline ...such changes in microenvironment of your body does not let the cancer cells grow fast or many of them get killed due to inhospitable living conditions. These are my thoughts and observations..I do not have randomized clinical trials to confirmed these.
Anyway, as long as we are on correct path of understanding.I donot much care about randomised clinical trials. e.g. when some one's mother tells her Son that Mr XYZ is his father, does anyone ask "do you have randomised clinical trials to prove what you are stating ?) (LOL)
Hmm... Hey LA, I need your help and clarification.
You mention: "Sometimes there is a conflict of interest as some centers deliberately upgrade your Gleason Grade to scare you to sell you extremely expensive treatments".
I had a MRI fusion biopsy at a local CT hospital and then went to Sloan Kettering, they both agreed that I'm G9.
Are they both working in collusion to up sell me?
Also SC19 Fails to provide details.
Best
Thank you so much - you’ve cleared a lot of my thinking up! Going to go for everything we can to lengthen the doubling time and hormone sensitivity.
Thanks, I'm still learning about all this since I've been here short time.
Indeed, it is correlated, there are some studies showing as such, but depends on the stage of PCa, etc.
In a multivariate analysis of patients with re- currence after radical prostatectomy, Pruthi et al11 demonstrated that a shorter PSADT correlated with aggressive tumor characteristics in the prostatectomy specimen, including the presence of capsular penetration, Gleason grade 4 or 5 tumor, and lymph node metastasis (although seminal vesical invasion was not significant).
mayoclinicproceedings.org/a...
There was a weak but statistically significant correlation between PSADT and PSA at metastasis (r=0.20, P=0.02).
If you have advanced PC, Gleason score no longer matters.
Then is PSADT important for metastatic prostate cancer? Is PSADT less than 2 months indicative of aggressive metastatic prostate cancer?
Yes and yes
Why? Because advanced means already aggressive? So Gleason does not really show difference in aggressiveness in this case?
Advanced means metastatic. Metastases don't have Gleason scores. Gleason score means a disruption of prostate cell architecture. Prostates with higher Gleason scores are more likely to become metastatic, but once metastases have occurred the Gleason score no longer matters. A GS7 with metastases is no different from a GS9 with the same metastases.
But do you think that once advanced a higher gleason does not mean a more rapid development of the disease?
Right, an examination of the metastases tells you more. After the cells undergo EMT, it doesn't matter what the Gleason score used to be.
What about local advancement, could this advance more rapidly in higher Gleason for advanced PCA?
"High risk" means that it is high risk that it escapes the prostate. "High risk" is defined by GS 8-10 or PSA>20 or T3/4. After it has advanced to pelvic lymph nodes, it is stage N1. At that point, it is only important that it has not escaped to distant sites (M1).
Tjanks for the info. In this case even a Gleason 6 once metastatic is not less aggressive. We have some cases here, or do you think they were not classified right in first place?
What do you mean by that? I am Gleason 9 and metastatic. Is it still not an aggressive tumour even now?
If you are G9, then it is still aggressive.
Only the "metastatic" is important now. What the Gleason score of your prostate was no longer matters. How aggressive your metastases are can be judged by their degree of differentiation, and their rate of progression.
Always thankful for your accurate info
Just reading all of these comments
Rate of progression??
So husband diagnosed almost two years
Unable to complete chemo due to recurrent neutropenia
Resistant to cosudex within 6 months
Now resistant to enzalutamide after 12 months
Continues three monthly zoladex And monthly prolia
Nothing more available here
Commence trial this month
Initial Gleason 10
Extensive Mets both bone and lymph
However low PSA
Highest around 36 on diagnosis
Notably unwell at present
Waiting to commence trial
Any thoughts ?
What's the trial? Was Neulasta able to prevent neutropenia from chemo?
Triton 3
Nulasta????
Was never mentioned
Just recurrent admissions after two Docetaxal
Treated as per chemo pathway with ABs
Maybe we should ask to go again
He is unwell
Legs swelling
Fatigued
Commence trial drug Thursday 16th
PARP inhibitors don't seem to work well unless there is a BRCA mutation
Some MOs routinely give Neulasta with chemo to prevent neutropenia. It's something he should definitely do if he tries again, given his history.
There is no exact relation between Gleason score and PSA there are many cases of Gleason score of 9 but their disease is in remission for so long but Gleason number somehow can predict how aggressive the prostate cancer is. Fortunately I see fewer men with Gleason score of 10 and my Dad was one of them he had Gleason score of 10 ,metastasis to bones and liver his intial psa was 62 and his last psa before passing away was 32 . There is no relation between PSA and extend of disease’s virulence either ,some researches shows that those who develop visceral metastasis have lower Psa which means that these cells behave differently
Neither a fast doubling time nor a high Gleason score are good attributes. Having both is a poor prognosis
IMO, Gleason Grade is still relevant even if you have metastasis. High Gleason indicates how disruptive and damage causing prostate cancer cells became inside your prostate...they will be equally disruptive and damge causing even sticking to your bone or lungs. They are like worst kind of criminals wherever you put them they will create damage and cause havoc. High Gleason cells are fundamentally meaner and inherently more aggressive.
Low Gleason Grade cells are basically gentler and kinder who do not have the kind of aggressiveness as much...so the attack on bones is not as penetrating and damge is slower.
Its always good to have mets with a lower Gleason cells than mets with higher Gleason Grade because High Gleason cells are fierce and virulent and end up damaging bones and organs faster and deeper.
Only one part which I I agree to is that non metastatic cancer is better than metastatic.
Some members who say that in metastatic cancer "gleason Grade doesnot matter" are the first ones to suggest that you send your slides to Dr Epstein to get your Gleason correctly.
So if Gleason Grade is not important why there is need to get slides read again ?
There are a number of points herein that need to corrected or perhaps better explained.
Facts:
1, the higher the Gleason score, the more aggressive the cancer and the amount of this type. The more aggressive are these cells, the faster that they grow, and it is these cancer cells that will kill you. Gleason is composed of two numbers from 1 to 5, the most predominant type is listed first, i.e.. 54 is more aggressive then 45. These small difference to not really matter much in terms of treatment at that higher level.
2. the fact is those with higher starting Gleasons are those who succumb the earliest, by percentage of total cases
2. the lower the Gleason, the better outcome in terms of longer survival times, coupled with a greater chance of a cure through early treatment.
3. we have found differences in Gleason scoring but NOT that much, as it is pretty easy to view and chart the cells. lower is always a better way to start and gives the best odds as to a longer life
4. one key point is that the higher the Gleason, the less time one has to make a treatment decision early in the war, once pc has spread, it is too late for a cure so the only course is to battle back as long as one can with the treatment options available
5. living a healthy life style can perhaps give one extra time, but no proof that by going off the deep end is going to make a significant difference, so living large and well while one can, applies
6. I am confused as the cancer cells can still be staged even if out of the prostate so no unknown here as was suggested was the case by one poster
7. the higher the Gleason the more aggressive the cancer cells, the faster that they grow and multiply than for a man with a lower and thus less aggressive cells will have, over time, depending on the man, the more aggressive cells become less responsive to AHT and these are the ones that will eat you alive
8. men with a lower Gleason and thus a lower redoubling time, have more treatment options than someone with a high Gleason whose redoubling times are shorter, some older men may, with little or no treatment, may die of some other ailment, i.e. old age, then from their prostate cancer-which is why in part, that this is considered an old man's disease and was never given the research funding that breast or even aids has received. Women with breast cancer get it in their 40's while we men are in our 50's and 60's and up so the impact on life span can be much greater if younger. this also applies to men who are diagnosed when younger-when in fact, the cancers for them are generally higher-reflecting both the reduction in testosterone and slowing down of metabolism as one gets older
9. lower psa scores and Gleason are used to grade and allow the odds to be calculated in terms of a possible cure and as well, at what stage, a cure is probably not possible, i.e. a psa of above six is not good, and for longevity, a Gleason of 8 to 10 also have worse outcomes
10.a higher Gleason score in fact, correlates directly to a lower survival time, although individual cases may vary as to the time period one has
11. I do NOT believe that any properly operating medical centre is going to upstage a Gleason score in order to get more money from a man, sorry more hearsay that is not fair to the VAST MAJORITY of the service providers.
QUIT looking for the ghost in the room when there is none. Instead focus on getting all the information, current health, age etc. and once properly staged, make a decision on your treatment option, i.e. if early and can be cured then get on with the chopping, if the cancer has spread beyond the prostate, then a cure becomes a long shot no matter what treatment option takes. Quality of life also comes into play while one makes the treatment decision etc.
IN summary, there is still much about prostate cancer that is not known, nor how to best battle it in the war, for prostate cancer cells are brilliant in the war and will endure as long as their host is alive, sadly, that is the way it is at this point in time.
Advanced prostate cancer is a beast, there is no other way to put it, and so are the side effects and negative impacts from treatment once that stage is reached. It is reality for those with APC. With luck, one can die with pc, for many others, it is terrible way to end one's life, which is why I preach to LIVE LARGE, MAKE UP YOUR BUCKET LIST, LOVE THOSE IN YOUR LIFE and life with your cancer and not have it lead your life, i.e. do not spend the rest of your days in searching for some magic cure. There is no going back, there is no getting better, then is only the fight ahead, so it might beat us, but if we can live life to the max, we will have done our best to beat it!!!!!
In future, a pill or shot one or twice a year, will either kill or keep it at bay, i.e. like aids and other killers that we can now control. The is why supporting research by getting into various drug trials is so important Remember, it might not extent our lives, but it might our sons and grandkids, so if you are able, get onto a trial, at least one, if you can. It is the only way for us to payback and give others a better chance than we had, and also show respect for those who have gone before us.
The reality is that Gleason Scoring is a matter of personal opinion.
The pathologist looks at the cells and tries to decide if they are 3, 4 or 5 and how much of each there is.
He then takes the sample that has the highest aggregate score and assigns that as the score.
Depending on the laboratory they may give an evaluation of all the individual samples with percentages and grades as well in the report
Sometimes it is very clear cut but sometimes it is less so. The pathologist then has to use his skill and judgement to decide the grades and the proportions.
One pathologists 7a could easily be another pathologists 7b because the first one grades more cells as 3 than 4 in comparison with the second
The most amazing case I have seen was a 9 on the pathology report that was downgraded to a 7 after the prostatectomy. There was not a lot of cancer, only a small amount in one core, and I wonder if he would have gone for a prostatectomy if the original report had shown only a 7.
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