Received my Eligard Injection on Tuesday - PSA a tick lower before injection - Low LDH score ?

[searchingtom]

Received my injection on Tuesday. Had labs done prior to injection. PSA dropped a tick from ".38" on 8/8/2020 to ".37" on 10/6/2020. My LDH was at 127. Literature says it is unusual to have a low LDH score. Anyone have any information on a low LDH score ? Thanks!

Background Data:

Diagnosed with Gleason 7 (3+4) in July 2018. Radical prostatectomy in October 2018. PSA rising to .38 on August 12 2020. Decipher post RP test score was .37 (low risk). Determining next steps. I am located in Wisconsin. I had my robotic prostatectomy perfomed by Dr. Kenneth Jacobsohn at Froedtert near Milwaukee. I have selected Dr. Michael Ray at the ThedaCare Cancer Center in Appleton Wisconsin for my salvage radiation/ADT treatment which begins on October 6. 2020

*Axumin scan results from last week (September 17, 2020) were negative to any definitive metastases.

*Decipher RP Grid Score - ".37" - low risk.

•Prostatic adenocarcinoma, Gleason 3+4 (score =7, Grade Group 2; 15% is pattern 4, not cribriform), bilateral and multifocal, within 2% of gland

•Tumor forms a dominant nodule in the left posterior peripheral zone (levels 8--11) measuring up to 10 mm (at level 8 or 9); also present in the right posterior levels 2—6

•Negative for extraprostatic extension (Stage pT2) - Organ confined

•Resection margins negative for tumor

•Seminal vesicles and vasa deferentia negative for tumor

•All not identified - Intraductal Carcinoma (IDC), xtraprostatic Extension (EPE), Urinary Bladder Neck Invasion, Seminal Vesicle Invasion, Lymphovascular Invasion, Perineural Invasion, Treatment Effect.

•Margins: Uninvolved by invasive carcinoma

•Regional Lymph Nodes: No lymph nodes submitted or found

•Pathologic Stage Classification (pTNM, AJCC 8th Edition)

•Regional Lymph Nodes (pN): pNX

[Tall_Allen]

LDH is only a problem if elevated.

"Normal value range is 105 to 333 international units per liter (IU/L).

Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples."

ucsfhealth.org/medical-test...

[searchingtom in reply to Tall_Allen]

As always thank you for your prompt and insightful response !

[tango65]

The value is not too low. Consider to repeat the study.

Persistent low values of LDH could indicate LDH deficiency which is a very rare condition and it could be associated with:

"Lactate dehydrogenase-A deficiency experience fatigue, muscle pain, and cramps during exercise (exercise intolerance). In some people with lactate dehydrogenase-A deficiency, high-intensity exercise or other strenuous activity leads to the breakdown of muscle tissue (rhabdomyolysis)"......

medlineplus.gov/genetics/co...

[LearnAll in reply to tango65]

When we are talking about prostate cancer ...a lower LDH is better . LDH is a prognostic marker for progression free and overall survival. PC a people with Lower LDH live longer than one with high LDH.

The most important thing about LDH is that if it rises in a continuous pattern while you are on ADT,....BEWARE... androgen sensitive cancer cells are becoming more and more androgen resistant and now there is higher risk of treatment emergent neuroendocrine cells. Time to check Chromogranin A and Neuron specific Enolase to know extent of Neuroendocrine change caused by ADT. These tests are not 100% specific but if used logically and in combined fashion, they can give good idea of status of prostate cancer cells.

[searchingtom in reply to LearnAll]

Thank you for this detailed breakdown. I appreciate it.

[searchingtom in reply to tango65]

Thanks! I will take a look.