Gleason 6.....but decreasing PSA

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User

Posted 03 Nov 2014 at 16:19

Following a Gleason 6 diagnosis in November 2013 my 3 monthly PSA tests have steadily decreased (most recent at 1.8) so on the face of it, good news and confirmation of low volume, early stage PCa. But I have just a niggle - would the MRI scan and biopsies have ruled out the existence of "small cell prostate cancer" - the type which apparently give off very little PSA?

Many thanks for reading this.

John

User

Posted 03 Nov 2014 at 20:27

Hi John.
As far as I am aware it's almost impossible to define when one has small cell PCa, that is by MRI scans. Whether it can be established via a biopsy I am unsure also, it may be possible that Small Cell has different markers from other PCa,s. As you apparently were diagnosed about a year ago and now if you do not have other symptoms it may well suggest that it's not Small Cell, as that PCa is very aggressive tumour and would manifest other symptoms by now.
It's a question I suggest you should direct to your Urologist at an early date to put your mind at ease.
What was your initial PSA result prior to diagnosis plus what treatment are you currently on if any.
Larry

User

Posted 03 Nov 2014 at 23:12

Hi John,
I seem to remember there was a thread for "Small Cell PCa" which, if you can find it, could be helpful to you, even if only to rule it out. The MRI should pick up any PCa which the biopsies could miss.

Hope this helps,
Chris.

PS. Just read the main part about Small Cell PCa, and I would rule it out as as Larry says you would have other symptoms.

Edited by member 03 Nov 2014 at 23:16 | Reason: Not specified

User

Posted 03 Nov 2014 at 23:40

John, do you still have your diagnosis letter? All likelihood is that it says on there what kind of prostate cancer you have - probably adenocarcinoma. If the letter doesn't say, just ask your Gp or nurse to check the biopsy results for you.

Small Cell cancer is very rare and presents as aggressively attacking bone whilst refusing to respond to hormone treatment. It wouldn't show itself as a G6 and they would not have allowed you to opt for active surveillance. Occasionally there are people who start off with adenocarcinoma or one of the other 26 types of prostate cancer and then Small Cell is also diagnosed later (Mrstommofire's husband for example) but you are not showing any indicators of this as your scans are clear.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 04 Nov 2014 at 19:29

It seems quite feasible that your psa has dropped as the prostate has settled after biopsies. Maybe you have changed diet a bit ? Supplements ? Hence less inflammation. Could be helping on your low figures.

Your biopsy results of 3+3 & 5% core certainly indicate low volume . Really can't see you would be on AS if any suspicion of small cell type which the biopsy would likely reveal.

User

Posted 17 Jan 2020 at 09:55

Current position:

My last biopsy in 2015 showed no change in diagnosis, nor did MRI scans in 2018 and early 2019.

The urology consultant has said there is no clinical need for a further biopsy and that my low grade disease will never cause me any issues; however he did say in an appointment meeting with my wife and I in early 2019 that he would be prepared to book me in for a biopsy simply to "cover his back" (his own words) in the unlikely event I moved elsewhere and another urologist found some advancement.

I declined the biopsy (because of his advice on there being no clinical need) and I have been discharged from the Active Surveillance programme and thus have no "safety net".

I remain concerned that I have untreated prostate cancer, albeit hopefully still at a low grade.

What should I do?

User

Posted 17 Jan 2020 at 16:21

Continue to have the PSA test every 6 months or so at your GP practice and if you ever see a significant or persistent rise, ask for a referral back to urology.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 18 Jan 2020 at 18:21

Because of certain similarities between your situation and my own early circumstances I would suggest you ask to stay on AS, with annual MRI scans thrown in. Just my own personal opinion based on my own experience of course.

User

Posted 18 Jan 2020 at 19:34

He can't do that Bean - they have taken him off AS because he refused to have the biopsy.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 19 Jan 2020 at 13:26

Seems a contradiction here. If Biopsy not needed as reported, I can't see declining this being used as a valid reason for removing patient from AS.

Barry

User

Posted 19 Jan 2020 at 15:27

Sorry, I misread it.

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