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Measuring Gleason 9 Reoccurance

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Posted 12/11/2022 7:49 PM (GMT -5)
In addition to my husband having stage 3b prostate cancer with a Gleason 4+5 = 9…..my friend’s boss also has this diagnosis. She raised a question that stumped me…..if Gleason 9 psa gives off so little psa, then how does measuring psa after RALP find the cancer left behind. Wouldn’t annual pet scans be more beneficial. Hoping you can give us both your thoughts. Thanks!

Stephanie
Posted 12/11/2022 8:22 PM (GMT -5)
The premise is not correct. Higher grade cancer may exhibit less PSA. Less is also relative so you might have a PSA of 2.5 vs 10. However, any PSA after surgery is not good so it may take a little more time to get a measurable PSA although the bar is pretty low with high sensitivity testing. I suppose a stealth cancer could occur and never show up with PSA or possibly PSMA tracers.
Posted 12/11/2022 10:50 PM (GMT -5)
I agree with Mumbo; it's not generally (!) true that Gleason 9 cancers generate little PSA. Mine sure didn't!
Posted 12/11/2022 11:55 PM (GMT -5)
Thanks Mumbo and Sr. Sailor! And Happy Holidays!
Posted 12/12/2022 12:16 PM (GMT -5)
90% of prostate cancer produces PSA, but not all do.
Posted 12/12/2022 8:31 PM (GMT -5)
open question to anyone who knows: If someone's prostate cancer produced strong PSA numbers at diagnosis, would it certainly produce PSA if there was a recurrence after treatment?
Posted 12/12/2022 9:15 PM (GMT -5)
The key point of using PSA to monitor for recurrence after surgery is really simple: without a prostate, the ONLY source of PSA would be cancer cells that avoided the knife.

Hence the use of the ultrasensitive (<0.006) test post surgery. PSA is also used as first monitoring indicator after radiation therapy--but it's not as fast, and it's a bit more fuzzy in the definitions. After radiation, one expects to see the PSA drop over time to a minimum value (nadir) that is usually not zero. After that, recurrence is defined as nadir + some value (like 1.0 or 1.5).
Posted 12/13/2022 3:41 AM (GMT -5)
It's been 7 years since I've had my RALP. Just had a PSA test at the VA. come back as .02. It's actually been a rare occurrence to get a <.01 at the VA. 90% of the time it's low detectable. I get tested by QUEST too. <.02. When I got Labcorp tests - it was always <.014 or <.006.

The VA test (ADVIA Centaur) might be picking up some benign tissue that was left behind during surgery. Can't imagine how .02 would remain .02 if the measurable cells were cancerous. Odd that QUEST and LabCorp always tested undetectable.

Go figure.
Posted 12/16/2022 3:03 PM (GMT -5)
I have the same diagnosis.
G9 4+5, I had surgery and radiation.

If you are still showing a PSA, then you need to watch the rate of increase of your PSA.
Any doubling of less than a year is considered troubling.
Memorial Sloan Kettering has a PSADT calculator.
Follow this link to calculate his PSADT.
PSADT Calculator
Posted 12/16/2022 3:43 PM (GMT -5)
Thanks everyone. I am also going to ask about the ultra sensitive tests at our March meeting, and work hard to try and not worry about any psa rises until then. It is encouraging to know that there are veteran members here with my husband's diagnosis that continue to do well. Happy holidays to you all, and thanks for all the advice!

Stephanie
Posted 12/16/2022 3:54 PM (GMT -5)
There are a few parameters that can be taken into account in this regard such as (1) the current PSA, (2) the rate of climb, or doubling time; (3) the difference between the post-op and current PSA; the Gleason score, Decipher score, and adverse findings at surgery.

Djin
Posted 12/16/2022 4:25 PM (GMT -5)
I have been doing so much research, talking to so many patients and reading so many journals and diaries. One of the biggest pieces that brings optimism is that most everyone I have spoken to with stage 4 disease have lived way longer and outlived the treatment success timelines. Patients who were given 10 years are still living and enjoying life. Patients who became castrate resistant are still living for years and years on treatments like Zytiga. Many men may have rising PSA 's but on treatment then plateau and are moving up so slowly, it is not keeping them down and may never get them in the end.

I am not nearly as worried as I was initially now. This forum is part of the reason. For the record, I am making sure my husband takes daily anti-inflammatory supplements (Tumeric/Ginger, Pomegranate Extract, Green Tea Extract, as well as a baby aspirin, 4,000 units of vitamin D and Calcium plus Vitamin C). If/when my husband's cancer returns, I will treat it like my diabetes.......it may never be cured but may be treated like a chronic illness. That gives me hope, and there is new hope all the time in the research. Happy Holidays to you all!!!!
Stephanie
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