High Gleason/Low PSA = Caution

[Esteban]

Some of us with high Gleason scores are pleased when PSA tests come in with low numbers.

I don't want to rain on anyone's parade, especially my own :blink: but it is necessary to understand that in a high Gleason / low PSA dx, PSA should not be relied upon as an accurate measurement of one's clinical status.

Here, from the encyclopedic site of the Prostate Cancer Research Institute, is some wisdom:

"High Gleason score cancers often have reverted to an embryonic state in which PSA secretion into the blood is markedly reduced.
Checking the serum for abnormal elevations in markers such as CGA (Chromogranin A), NSE (Neuron Specific Enolase), CEA (Carcino- Embryonic Antigen) and PAP (Prostatic Acid Phosphatase) is important to discern PC activity secondary to these de-differentiated tumor cell populations. Therefore, in cases such as this, the normal guidelines for PSA velocity and doubling time may not be applicable. HOWEVER, the concept of slope or trend in a biomarker of disease activity remains valid, and any biomarker elevation should be tracked at regular intervals to determine the presence of abnormal growth of primitive (embryonic) tumor cell clones."

See: http://www.prostate-cancer.org/educatio ... dKnow.html

Also: Strum has recently posted this on Physician to Patient (P2P):

From patient:
"Date of Diagnosis: October 2008 (Stage 4 with lymph gland
involvement--prostate had grown into rectum)
PSA at time of Diagnosis: about 3.4
Gleason Score at Diagnosis: 10"

Strum's reply in pertinent part:

"This is the one major weakness of PSA as a marker based on absolute
value in PC. High Gleason score PC does not express (leak) much PSA
into the serum. Therefore, the change in PSA over time is important
to stress with calculation of PSAV (PSA velocity), PSA doubling time
(PSADT) and PSA density (PSAD). The latter calculation requires the
gland volume since PSAD = PSA divided by gland volume. In the real
world, most docs doing a DRE (digital rectal exam) do not train
themselves to determine the gland volume. They do a brief DRE and give
a rough (very rough usually) guestimate of small, mod large, large or
very large gland size. I rarely see a doc, be he or she a urologist
or a medical oncologist give a gland volume in cc."

This is one reason, I think, that such tests as listed above,
NSE (neuron-specific enolase
CEA (carcino-embryonic antigen)
CGA (chromogranin-alpha)
PAP (prostatic acid phosphatase)
can be very helpful in development of information especially relevant to the clinical situation.