Low psa , high cancer grade

I know many people that are grade group 5, like you. I know a lot of people that have been alive for well over 10 years with grade group 5.

The treatment ou have picked sounds about right. There are more than three different types of radiation. There is SBRT, IMRT And brachytherapy.

It would be useful to know how old you are.

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Unfortunately level of PSA often is not indicative of actual aggressiveness . Our surgeon told us that very aggressive cancers often have low PSA . My husband was 5.6 before surgery and his gleason post RP was upgraded to 4+5 with cribriform and IDC .

Wishing you all the best and super successful RT 🍀.

Surf is right, sometimes the most aggressive PCa produces only little PSA. We had to deal with this question because my husband had a low PSA and Gleason 4+5 after the biopsy. However, your cancer may have been caught early? Is your prostate still rather small? What does the imaging show? Is the lesion small? What is your PSA history? How regularly have you gotten tested? Does all this indicate an early stage?

Also, your PCa may be less aggressive than your biopsy implicates. My husband has been downgraded to 3+5 "only" after surgery. With radiation you will never know the real picture. All the best to you!

@jeffmarc I am 75 years old . Had psa tests regularly. On an ultrasound they found a tumor , led to MRI , AND CAT SCAN . Then had 21 biopsys. 6 were positive. Fortunately per scan showed no spread. I have a meeting with the radiologist on Monday. Had the shot yesterday and will continue with shot every 3 months. Also took pills 2 weeks before And 2 weeks after this shot.

@rogo Was the ultrasound for an ongoing bladder situation like BPH?
Sometimes common issues like urinary retention, frequency, etc will obscure signs of PCa - especially with a low PSA.
You are quite lucky indeed that such a high grade cancer is still localized and can be successfully treated by either surgery or radiation.
Hopefully, genetic testing may reveal much about the inner workings if your particular disease and possible immunotherapies -and others- can be utilized to further combat it. Best,
Phil

@heavyphil my psa was only 4.5. Just as precautionary, doctor suggested an ultrasound. I had no issues or symptoms at all. Ultrasound showed a mass , or tumor and mri confirmed it. After that pet scans etc……and here I am on hormone therapy awaiting my consult for radiation. I am very lucky it did not spread as it is grade 5 and very aggressive. Hopefully the treatments will keep it stable .

Adopted also without a medical history. Found my birth family and they were so dysfunctional they couldn't provide one. Diagnosed with Gleason 9 grade 5. Had RP and BCR after 2 years went BCR and had 25 sessions of IMRT radiation with 6 months of ADT. 3 Lupron and 3 with Orgovyx. The Orgovyx was easier on me. Currently 13 months undetectable. I can't remember the dna study I did but many in the room did it and it was free. Radiation/ADT brain side effect.

@rogo Thanks…and ask your RO about HDR brachy plus IMRT or SBRT.
For high grade or aggressive cancers, some RO’s like to place a seed implant into the prostate next to the tumor for about an hour or so to really deliver a killing dose.
Then they treat the rest of the gland with either five sessions of high dose radiation or 25 or more sessions of lower dose radiation.
While Both of them are equally effective, however, the lower dose treatments can also hit areas outside of the prostate.
Another thing to know – and I’m sure your RO knows this – is to be sure your pelvic lymph glands are included in any treatment you receive. Just because your PET scan is clear it does not mean that you do not have microscopic spread in your pelvic region. PET scans are really good but they need a tumor at least 2 mm in diameter for it to show up.
Phil