Is there a difference between advanced prostate cancer vs aggressive prostate cancer?

[FormulaRob]

65 year old father had bone scan and CT scan early September that ruled out bone spread and organ spread.. although it showed some swollen lymph nodes just outside the prostate that may or may not be cancer. PSA climbed from 226 to 286 from Sep to Nov now.

My father told me they said to him that it is caught early but it is aggressive. Im wondering if my father heard incorrectly because don’t they need the biopsy results (which will be in on Nov 23rd) to know if it is aggressive or not?

And my next two questions

1. if it turns out to be aggressive, does that mean that the good results from the bone scan and CT scan are pointless now since it’s been 3 months .. assuming aggressive prostate cancer would spread within just 3 months?

2. I’m researching online but can’t understand why when I type in aggressive prostate cancer .. it automatically speaks about advanced prostate cancer. Can’t it be aggressive yet caught early enough before the spread ?

A part of me wants to ask if cancer has likely spread from September to end of November.. I can’t find any kind of info on how fast it can spread online.. zero info on that anywhere and I’m just trying to stay positive and was hoping to read it would take longer than 3 months. His spine was clear and everything … I’m so scared that it may no longer be the case

[FormulaRob]

thank you for this reply.. looks like we’re hoping for only locally advanced at this point.

So G score is basically the aggression.

So for most people with advanced prostate cancer .. was it just caught late? Because if it can spread in just months.. that means you can go for a scan say today.. everything is fine. Tomorrow cancer starts and by the time of your next yearly scan.. it’s already spread !! This is so messed up

[Gl448]

Similar concerns for myself that I literally just posted in a new thread.

How fast can “aggressive” cancer grow? I went from no indication of cancer to stage 4B with lots of spread and Mets in just 8 months. Now I’m wondering how much it might have spread in the last 3 months just as you are. 🤔

[FormulaRob in reply to Gl448]

oh fuck dude I’m sorry to hear that. Sorry for my language but I’m in an angry state of mind right now. I hope for the best for yourself and my dad and anyone else going through this.

So frustrating on how different things could go with quicker appointments , testing and reviewing. Instead left in this terrified state of mind. At the end of the day they have so much treatment options available that I’m sure a long life is still ahead .. but man it’s a scary journey.

Best of luck my friend ❤️

[Gl448 in reply to FormulaRob]

I think I suggested to you in an earlier post you made that our focus needs to be on now and how to treat it, not on how it was missed or got so advanced in a short time.

But when the medical system seems to be dragging its feet, it’s natural, and reasonable in my opinion, to wonder how fast is this beast growing, and what fuck are the docs going to do about it and when.

Your dad’s PSA rose? Has he had any treatment besides tests? ADT at least?

Best wishes to you and your dad. Cancer sucks.

[FormulaRob in reply to Gl448]

Yes you did give me that advice, I don’t know why I’m taking steps back here suddenly and feeling so damn angry. Maybe because anxiety increasing as the time to face the music is almost here.

PSA was 226 all the way back in July. So it rose now to 286. Doctor said he wasn’t concerned as the scans that came back clear were more important and the spike of the PSA was expected and it’s not a lot apparently.

Absolutelty zero treatment .apparently will start with some hormone treatment end of this month once biopsy results are in to shrink the tumour before starting radiation

[pakb in reply to FormulaRob]

I'd be angry too if PSA was 226 in July and all he's had is a CT scan- no biopsy or treatments? I haven't read all of the replies here yet but that doesn't seem right. They usually base 'active surveillance' on Gleason score (aggressiveness), PSA and spread from my understanding. Is your father seeing an oncologist? I'd suggest he see a medical oncologist who specializes in prostate cancer at a teaching hospital or large cancer center.

[meowlicious99 in reply to FormulaRob]

PSA increase in absolute numbers matters less than the velocity

doubling-time.com/compute-P...

[FormulaRob in reply to meowlicious99]

his velocity comes out to 24.36ng/ml/month … I believe this is horrendous as it says anything over 2.0 over a YEAR is aggressive and higher chance of death.. ugh

[Hidden in reply to FormulaRob]

Well FormulaRob? “ wasn’t concerned” ? what a jackass! Imho Time is of the essence . My urologist was not concerned either . I went into k failure awaiting a biopsy from my urologist .

[Teacherdude72 in reply to Gl448]

What do you mean by "no indication of cancer"? No symptoms? Many don't have symptoms. I didn't and was diagnosed with Gleason 9 (5+4). Aggressive but no mets even now in my 8th year since diagnosis.

[Gl448 in reply to Teacherdude72]

not sure what your issue is. I had zero symptoms and PSA of 1,1 or less. The last DRE I had was okay per the doctor. To me that’s “no indication of cancer.” If you have issues with that, keep them to yourself. I’m not going to argue it with you.

[Teacherdude72 in reply to Gl448]

No intention of issue or to argue or offend. Just trying to understand your situation. I agree on your supposition of no indication of cancer. I guess I didn't understand that you had already been diagnosed with pca then the recent Dr visit & dre then ok statement. Please accept my apology.

[Gl448 in reply to Teacherdude72]

no apology necessary. Cheers

[Tall_Allen]

"Advanced" refers to staging. It means the cancer has spread outside of the prostate - it is no longer "localized". In terms of staging, T4 (spread to nearby tissues), N1 (spread to pelvic lymph nodes), and M1 (spread to distant locations) are all "advanced."

There is no technical definition for "aggressive." But high PSA, rapid PSA doubling time, many new metastases, failure of therapies, aberrant phenotypes, and poor prognosis genomics, protinomics, transcriptomics, and metabolomics all indicate aggressive cancer.

[Seasid in reply to Tall_Allen]

Thanks, I learned a lot. This site is very useful and helpful. It makes me think more clear and in a structured way.

[anonymoose2 in reply to Tall_Allen]

Thanks TA!

Just reading your posts gets me right to the point without all the opinion noise. Short and sweet, easy peasy.

[dentaltwin in reply to Tall_Allen]

Dammit, Allen--I have to go out and rake leaves before the storm comes up the coast, and now I have to spend the next 48 hours consulting Dr. Google!

[tango65]

My understanding is that he could have a high risk cancer (risk to progress and develop distal metastases) since his PSA is 286.

cancer.org/cancer/prostate-...

I would request a PSMA PET/CT to be sure he does not have distant metastases. Bone scan and CT scan have a much lower detection rate that this PET/CT study. This scan could be also useful to plan the therapy..

Discuss having a mpMRI to see the areas of cancer in the prostate and if the cancer has extended outside the prostate. This study could be useful to plan the biopsies if they were needed. If there are PSMA positive distant mets , he has metastatic PC and biopsies are not required.

[BluesmanNick]

Haha 🤣

[Tommyj2 in reply to BluesmanNick]

ha ha?……unclear as to what is funny

[Hidden in reply to Tommyj2]

Tommy, it was a funny remark by pickle ballplayer, nothing too serious regarding Alans answer to a question.

[Tommyj2 in reply to Hidden]

thanks….

[Hidden in reply to Tommyj2]

Tommy, all of us on this site understand how hard it is to laugh, that said, when we laugh we forget for a minute the sh— we have to endure every day. ❤️

[Tommyj2 in reply to Hidden]

don’t disagree…the placement of the comment that I responded to had no touches of humor around it and impressed as a bit of a non sequitor

[Hidden in reply to Tommyj2]

Yes, understood.

[Seasid]

Could you fill out your profile?

[FormulaRob in reply to Seasid]

yeah I should’ve done this a while ago. I’m at work so when I get a free gap of time today I will update this profile: thank you for the friendly reminder

[anony2020]

Second that

[Seasid in reply to anony2020]

Genesis Care RO ordered only the PSMA PET scan. It is visible that I don't have any visible mets and that the PSMA SUV max value is 14.

95% of my prostate has cancer.

[Hidden]

Haha pickle, Alan described it perfectly...loved it!

[Seasid]

You are very competitive.

[reichel]

Mine was 4+4 with spread to one lymph node. Had surgery as they thought it was just in the gland. PSA undetectable but doctors wanted to be aggressive and I had radiation and also ADT.

They waited for a few months after surgery to start

Good luck from another Rob

[Hidden]

yes pickle, your answer was good, but Alans more thorough, although he kind of lost me at the end.

[Granica4818]

Great questions. I also wondered the difference and what makes one type of prostate cancer more aggressive than another? Is it Gleason score? or are there actual different types of prostate cancer?

[Andy1569]

We are all fortunate to have you and Alan sharing with us! (I love the humor!)

[Burk]

With a PSA of 286 your father is most likely going to be high risk and will need systemic treatment, Do not allow the "clear scans" to deter you from seeking systemic treatment. This cancer can hide from scans as micromets and reappear years later. Just sayin- with a psa of 286 don't expect the scalpel to cure your dad. Your dad will be fine until the biopsy. He should initiate ADT (Androgen Deprivation Therapy) as soon as cancer is confirmed. ADT will stop cancer progression and allow you time to evaluate and choose primary treatment.

[FormulaRob in reply to Burk]

that’s a little disheartening to hear after the specialist tells us that the scans look really clean so they believe it was caught early.

I was pushing for ADT right away but they’re insisting we waiting for biopsy results on Nov 23rd first

One thing I was reading was that a high PSA could also be a result of just the tumour size itself ( 1cm and basically he can’t pee.. almost completely blocked so his bladder is always at least 80% full at all times and can only basically trickle when he pees giving him basically zero relief .. very painful but he’s refusing the catheter at this time) . So maybe the high PSA is more because of the size of the tumour rather than any kind of actual spread. I sure hope so anyway !

[addicted2cycling in reply to FormulaRob]

FormulaRob wrote --- " ... One thing I was reading was that a high PSA could also be a result of just the tumour size itself ( 1cm and basically he can’t pee ... "

1cm of a confirmed 3+3 does not spell doom. I've spoken to men who have had HIGH PSA (400+) and were on AS for YEARS!!!! with nothing major ever developing. HIGH PSA does not have to be PCa just as a low PSA can mean extremely aggressive PSA

[Burk in reply to FormulaRob]

That's why you need a biopsy before you can make an intelligent decision on treatment options. My PSA was 34. Biopsy showed GL7 in11 of 12 cores (T2a N0M0) I chose RT + 24 mo adt. PSA is currently <.1. There is far too many men on this forum who chose RP only thinking they were going for a cure, only to come back in a year or two with advanced PCa. It sounds like your dad is a likely candidate for RP if he has urine retention.

I'm sorry if my reply was disheartening. PCa is not good news; however, you are blessed to have found this forum so early in the journey and your dad is blessed to have you as an advocate.

[Hidden in reply to FormulaRob]

this is painful, as my husband had this. He kept getting up all night long and couldn't empty his bladder, like your Dad, just awful situation. I'm sorry!

[WillowHawk]

i think your dad is working with a urologist? When cancer is confirmed (Nov 3 biopsy?) I think he needs an oncologist specializing in PC. But of course I’m just saying what I think I’ve learned here.

I’m so grateful you’re getting quick help from the great guys. Don’t procrastinate on the bio - that will save you time and help get the most pertinent advice. Put in there what type doc is on the case.

Love you!❤️👋❤️

[lokibear0803 in reply to WillowHawk]

I have to agree with others here, high PSA does not automatically mean … anything. It may not mean there are a lot of tumors, rather that there are some that produce a lot of PSA. In fact, my understanding is that lower Gleason score tumors are more similar (in phenotype, function, etc) to healthy prostate tissue than higher ones; so they spend their time doing more of what healthy ones do: make PSA.

In fact, there is at least one mutation — SPOP (which I have) — that’s known to produce more PSA, but ends up with better outcomes.

If this were me — I’d look for at least the germline part of genomic testing, PSMA-based scan, and starting some kind of systemic treatment ASAP (sorry if I missed this, is your dad already doing this?)

If after PSMA, it makes sense to biopsy something, this is even better for the genomics part (get somatic in addition to germline). Getting the PSMA is much better idea than trying to guess whether the cancer has spread in the last 3 months — guesswork here is not useful.

Most importantly, I’d find an MO (not a urologist) that I trust, and work as a team to agree on a plan.

Best of luck to you, regardless.

[Hidden in reply to WillowHawk]

Your brother has tremendous energy and gusto for life. It was a pleasure trying to keep up with him as we hiked around the lake . He’s an amazing guy! ❤️

[WillowHawk in reply to Hidden]

yes! Lucky sister ❤️

[Hidden in reply to WillowHawk]

He is lucky too! ❤️✌️