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Neuroendocrine and PSA

tn12 profile image
tn12
12 Replies

Hoping to get some clarity. My husband's pathology says: "Paneth cell-like neuroendocrine change in the adenocarcinoma"

Had RP in Dec 2021. G7 3+4(25%) Stage T3b. EPE, SVI, PSM <3mm. Lymph node Neg.

No other treatment yet. Debating on whether to start SRT + ADT.

PSA Dec 2022 0.03, Mar 2023 0.02

PSA pre surgery was around 20.

Could his cancer progress at this low PSA?

All the best to you all.

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tn12
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tango65 profile image
tango65

Some info

urotoday.com/recent-abstrac...

Tall_Allen profile image
Tall_Allen

I assume he already had a bone scan/CT and a PSMA PET/CT when he was diagnosed because of his high-risk diagnosis (PSA≥20). If so, he can wait for biochemical recurrence according to the SPPORT trial.

tn12 profile image
tn12 in reply toTall_Allen

He had a neg bone scan/ct when diagnosed, but psma scan aren't usually offered initially in Canada

Tall_Allen profile image
Tall_Allen in reply totn12

OIC. I can't think of a reason to jump the gun.

tn12 profile image
tn12 in reply toTall_Allen

Thanks TA. With mention of neuroendocrine change in pathology, is there anything we should do differently? We're concerned of possible undetected progression.

Tall_Allen profile image
Tall_Allen in reply totn12

It's Paneth cell-like neuroendocrine, which responds to SRT+ADT, if needed.

sciencedirect.com/science/a...

The T3b is more concerning, but with pGS3+4, there is no rush to treat. Hopefully, they got it all.

tn12 profile image
tn12 in reply toTall_Allen

TA, Thank you for answering. I will study your links.

timotur profile image
timotur

High levels of Serum LDH, CEA and Chromogranin A may indicate progression to neuroendocrine. Also, there's been quite a few informative posts about it, such as this one by LearnAll...

healthunlocked.com/advanced....

I don't quite understand how this came up post-RP? Was there another biopsy?

tn12 profile image
tn12 in reply totimotur

The biopsy prior to diagnosis didn't mention any Paneth cell-like neuroendocrine change. Only adenocarcinoma.

JGalt profile image
JGalt

to answer your question directly it is possible for neuroendocrine cancer to grow and not raise his psa. My husband’s psa was undetectable for this past year due to his current drug regimen and in the last month discovered a large mass in his groin when he started having urinary issues. We are in the process of dealing with treatment plans to reduce this tumor.

tn12 profile image
tn12 in reply toJGalt

Was it confirmed as neuroendocrine?

JGalt profile image
JGalt

yes. Small cell neuroendocrine carcinoma diagnosed from the biopsy

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