In recurrent Pca, is it possible to know to which gleason-grade group the surviving cancer cells belong?

[traveller64]

I have recurrent Pca, my path report showed gleason 4+3, with tertiary 5. So I had cancer cells from all of the three grades. Is it possible to know to which gleason-grade group the surviving cancer cells belong?Do the highest grade cells always survive and spread? Is there a chance that gleason 3 cells spread?

[dac500]

When I had extra-capsular recurrence 4 years after brachytherapy for Gleason 3 + 3 (diagnosed by biopsy), the recurrence appeared to be of higher grade (Gleason 8 to 10). The biopsy for the recurrence did not grade. But later on when the biopsy was reexamined before start of treatment for metastatic cancer, the report mentioned higher grade:

Part N: Patients history of Brachytherapy in 2011 is noted.

Post-radiation prostate adenocarcinoma is not asigned a formal Gleason

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

Grade group 4 cancer.

[Tall_Allen]

If there is a big enough tumor in the prostate bed, it can be biopied. Or if there was a positive margin, they can find the grade at the margin.

Gleason 5 is more likely to spread and metastasize than Gleason 3

[traveller64 in reply to Tall_Allen]

Allen, my understanding of biochemical recurrence is that some cancer cells that were not eliminated by surgery or radiation are living and multiplying somewhere in the body. If these cells are not big enough to be detected by scans you're considered non-metastatic. In my case, I had gleason 3, 4 and 5 cells. Is it possible that my recurrence is coming from grade 3 cells? The reason I'm asking is that it has been 6 years since recurrence and my cancer responded very well to bicalutamide mono therapy. Today I got my blood test results, PSA is at 0.019. I'm on 50 mg bicalutamide/day. So I'm thinking that may be I'm lucky to have all the 4's and 5's eliminated by primary treatment and some 3's are alive?

[Tall_Allen in reply to traveller64]

Recurrence after prostatectomy can happen for 2 reasons:

(1) Cancer cells were incompletely removed from the area around the prostate

(2) Cancer has metastasized to places distant from the prostate (lymph nodes, bones, etc.)

In either case, the cancer may be too small to be detectable.

Pattern 3 seldom metastasizes directly, but can evolve slowly into something else that does. Here's what we know:

prostatecancer.news/2017/11...

[Stevecavill in reply to Tall_Allen]

That’s a very thorough explanation of metastasis, thanks. I did hear Klotz a few weeks ago at the PCRI conference say that GS 3 has zero metastatic potential, based on their genetic makeup . I don’t know if that’s because the data have been updated or I wasn’t listening correctly. He did talk about the importance of genetic testing for the mutations that result in metastatis before starting Active surveillance.

Of course, I guess the point is moot AFTER it has spread!

[timotur]

One way to get a rough idea of the Gleason of remaining PCa is to look at the PSA doubling time. In general, a DT of less than a few months would indicate a higher Gleason, a DT over a year would indicate a lower Gleason, from what I’ve seen on the forums.

[dac500 in reply to timotur]

During my extra-capsular recurrence in 2016 PSADT was about 6 months. When I was diagnosed with lymph node metastasis n 2018 PSADT was less than 2 months.

[traveller64 in reply to timotur]

At the time of recurrence, PSADT was less than a month. So most probably the gleason of the remaining PCa could be 5, may be 4. However the cancer is under control with casodex mono therapy and I think it's unusual for a high grade cancer to be so responsive to treatment. Anyway I'm happy that my cancer is still hormone sensitive and is under control

[ron_bucher in reply to traveller64]

After my second recurrence 3+ years ago, I was able to stop ADT at 9 months by having additional radiation and Taxotere. PSA is still undetectable with normal testosterone.

[mcp1941]

In 1996 when I was DX my gleason score was 4 + 3 = 7. I just had a metastatic growth in my bladder biopsied and the gleason score was 5 + 5 = 10. I don't know if that helps you.

MikeP