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low PSA, small cell prostate cancer? - increasing symptoms
My husband (age 62 now, and otherwise in good health) was diagnosed in Jan. 2009 with advanced prostate cancer with a PSA of 12 and a Gleason score of 9-10, and with mets to the bone (not extensive mets). Because of the mets he was not a candidate for surgery, and also has not had radiation treatment. Instead, he has been on hormone treatment (zolodex), and the psa dropped quickly. In Dec. 2009, he began an intermittent phase of treatment (no zolodex treatment, just continue to monitor psa). In June, 2010, PSA came back at 4.4, and so he went back on hormone treatment (zolodex and casodex). It came down within a month, to 1.4, and now, Sept. 2010, it is .9. Sounds good, but the problem is, symptoms are increasing. He has pelvic pain, and also some pain in the right leg (bone mets are mainly in the right thigh area). Cat scan and DRE in July showed increase in size of tumor in prostate, but not much change in the bone scan. He experiences an urgent need to urinate during the night, but no blockages, and has been taking flomax since initial diagnosis. He has been taking pain medication for the past 2 -3 months, daily.
We saw the oncologist today, and he said it is very rare for symptoms not to correlate with a rising or falling psa, and he said that it is quite possible that besides the usual adenocarcinoma, that he also has small cell prostate cancer. He said it is somewhat rare, and that small cell prostate cancer does not make PSA. He has suggested either radiation or chemotherapy, and the decision is ours to make. He said that without treatment, the symptoms would worsen, and lead to more problems.
Does anyone have experience with this?
So far, quick research on the web indicates that small call prostate cancer is rare and aggressive.
Re: low PSA, small cell prostate cancer? - increasing symptoms
You could have your pathology slides reviewed by Bostwick or Oppenheimer as they do test for variants and ploidy analysis of the PCa cells DNA (3-types of DNA) and atleast 24 variants of PCa have been found. There are a couple of them that are more aggressive and don't respond well to many drug protocols (some of the leading onco-docs use this information and have treated such patients...i.e. Myers, Strum, Scholz, Lam, Leibowitz, Sartor, and others). Sometimes in small cell the psa numbers are almost non-detectable levels or slight, but with symptoms and other things that oncologists might monitor. Dr. Strum recommends a number of additional testings in his book page 35..a couple of them are PAP and Prylinks-D tests and many other markers.
I have a continuing journey with some comparisons to yours (used flomax, had total urinary blockage PCa Dx-2002 Gleasons 7,8,9's and 2 sets like that, bpsa 46.6 all 12- cores 75-95% vol. with PCa). Did ADT3 with unique radiation protocol and later switched drugs to control this with lesser side effects and even better results were obtained...how long is my journey is yet to be determined. All cases are individualized to a large degree. You have alot more choices to try than just chemo or radiations...depends upon the docs you enlist...it varies plenty more than many would believe. Perhaps Terry will have some things to share on this, we all have alot of perspectives as patients dealing with this. Best going forward on this.
