Can anyone explain why some people have Gleason 8 PC, high PSA and have metastatic disease, yet some with Gleason 9 and 10 have low-ish PSA (as far as PC goes) and no obvious metastatic disease (confirmed by PSMA)? I am trying to understand this damn disease and sometimes there doesn’t seem to be any rhyme or reason to the way things progress. Is it the genetic piece that creates these differences? Or is it something else?
Thanks!
There are several different cancers that we lump together as "prostate cancer" if they originate in the prostate.
Good luck trying to figure it out. I had a PSA of 3.5 - Gleason 9 and Oligometistatic.
Same story here.....low PSA always (well below 4), the BPH symptoms led me to find out I had Gleason 9 and Oligometastatic...
from the Greek "Oligos", to pool together in small pools
the Gleason grade from a biopsy is a random sampling at a point in time, it can be wrong after pathology looks at the tissue.
For the same reasons that metastatic disease can occur 10 years down the track, a high grade cancer may not yet have shown up elsewhere, and a lower grade can show up early.
metastatic progression is not fully understood (to put it mildly) and there are many theories. Circulating tumor cells can continue to appear in blood for years (they are being shed somewhere from a cancer colony in stasis) with no visible cancer on scans. One story I read was a heart transplant recipient got metaststic cancer from the donor who had been in remission for years! the heart literally contained cancer cells that successfully seeded in the recipient. Confirmed by dna testing to prove the new cancer was a chip off the old block of the original resected tumor.
So putting all this together it is possible that a high grade tumor may not manage to metastasize in one person, and in another a lower grade tumor may succeed. The decipher risk tests attempt to spot dna markers in the tumor that make metastatic disease more or less likely but the full story must be some witches brew of patient dna and stress, cancer dna, time and probabilities..
Imagine a factory which produces a material called PSA. In this factory there are workers who work and churn out PSA as this is their job. Out of these workers some starts to work less and start becoming lazy and criminal type. Consequently, these criminal type workers stop producing PSA and start indulging in bad activities...going around and damaging property , wanting all the free food and not doing their job of PSA production. The degree of change in these workers (CELLS) determine how aggressive they will become. In some men the Cancer Cells are less cancerized and they still keeps producing PSA. In others the cancer cells become totally distorted and stop producing PSA or produce very little PSA. These cancer cells are most aggressive and cause lot more damage to tissues then the previous ones. That is why you see men who had high PSA and still alive after 10 or even 15 years. And then you also see men who had only 5 or 8 PSA and passed away within 2 or 3 years. Degree of aggressiveness of cancer cells depends on many factors such as Germline mutations like BRCA 1, BRCA2,ATM etc. , Family history of aggressive cancers, type of diet, other medical conditions and so on. Lower Gleason like 6 or 7 are least distorted cells and cause milder cancer whereas higher Gleason like 9 or 10 are most distorted cells and cause most agggressive cancer. Every man's Prostate cancer is different (heterogeneous) and that is the reason you see on this forum men who left us in 2 to 3 years and there are many here who are alive for 5 ,10 ,15 and even a few almost 30 years. Know your cancer ....is it Dove, Vulture or Dolture ?
great explanation
please contribute more to this group.
You should read Richard Ablins book 'The Great Prostate Hoax'. Explains the issues with PSA in detail.
The PSA test does have uses, but basically PSA is a poor indicator to use by itself.
It's much better to use a PSA reading as a time series rather than a single value.
It's worth noting, you can have a high PSA, but if it remains stable (even though its high) it can be an indicator of no progression. But I would never rely on this measurement by itself.
It is so confusing. When diagnosed in 2020 my PSA never got above 8 with Gleason 4+3 and yet, when I had a bone scan and then a PSMA scan we found I had metastases in skull, spine, pelvis, ribs, pubic bone.
My Onco only seems interested in the fact that my PSA is undetectable although we have evidence that the mets are slowly growing.
I have been on Abiraterone, prednisolone and Prostap, but stopped the Abiraterone last month as it was making me feel so ill, in pain and generally 'zombified' Onco agreed reluctantly. It will be interesting to see if my PSA rises?
There seems little recognition in NHS that the PSA is not a very good measure - merely an indicator.
You Once ignores your growing Mets?
IMO, PSA IS a very good measure, provided it is assessed correctly. Only PSA trending or PSADT provide useful information. "Magic round numbers" used by lazy docs are for the litter bin.
The Gleason score is an interpretation of the tumors in your prostate.
How far it has spread, if at all, before being discovered and diagnosed is a different question.
I have Gleason 7(3+4) with 1.5 psa with many Mets by psma scan.
To answer your question as a Medical Wizard that I am..... the person upstairs (note: politically correct) and the other "ones" (politically correct again) play that kid's counting game of Eeny, meeny, miny, moe and then it depends if you're it or you're not. So see how simple I am and how simple it is.....................
Good Luck, Good Health and Good Humor.
j-o-h-n
Never caught the piggy by a toe but have been hit by 2 of them while bicycle riding causing more issues than my Gleason 10 right half of prostate with PSA 14+. IMO, PSA is a flashing amber CAUTION LIGHT on your road through life. Pay attention and be safer or blow right through it without looking and maybe you might be T-boned like piggy #2 did to me.
That must have hurt.
I didn't cry but I didn't laugh until much later. 😁 p.s. - I don't even eat bacon
One piggy went to market the other piggy went home. Piggy 3 and 4 stayed in the middle of the road and broke a2c's bones. It only goes to prove if you poke a pig with a bike the pig will poke back.....My ex-wife was a pig in a blanket and she and my PSA is what I should have paid attention to at the amber traffic warning light....Anyway install a pig's ahead warning buzzer on your bike next time when you go riding at night.....
Good Luck, Good Health and Good Humor.
j-o-h-n
Been looking for a piggy repellent type thingamajig like the deer thingy they have for cars
I have one of those repellent thingys on the front bumper for ugly women .....women keep pointing at me and laughing...... why so?
Good Luck, Good Health and Good Humor.
j-o-h-n
hystology, cribiform, perineal invasion. location of tumor...i.e. edge of capsule....the cancer has to have a pathway to spread.....i had gl 8- 9 ...ductal hystology...tight cribiform....means aggrsive cancer it attaced to nerve...i.e: perineal invasion....it had a uber to me spine and pelvic area...omly 3 of 12 cores pos. but 90% and on edge of capsule.....pathology report. confirmed metsstisis....by bone scan.....then mri....
oh also semina vesical inv. ....i.e. blood in me cum....
Should my advanced micrometastatic treatment be more aggressive
New here, diagnosed age 52, Gleason 10
Low PSA with High Grade Cancer (Gleason 9)
Trying to come to grips with ADT 
Supplements and alternative therapies 
