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.
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.
He had a neg bone scan/ct when diagnosed, but psma scan aren't usually offered initially in Canada
OIC. I can't think of a reason to jump the gun.
Thanks TA. With mention of neuroendocrine change in pathology, is there anything we should do differently? We're concerned of possible undetected progression.
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.
TA, Thank you for answering. I will study your links.
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?
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.
yes. Small cell neuroendocrine carcinoma diagnosed from the biopsy
neuroendocrine tumors
Xtandi alongside chemo for neuroendocrine cancer? 
Psa
Small Cell Neuroendocrine PC Update
How to interpret PSA results
