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Advanced Prostate Cancer
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Low PSA at initial Diagnosis

I read somewhere that low PSA at metastasic Prostate Cancer Diagnosis shows that it is a so agressive prostate cancer.

Father was diagnosed in December 17 with 8.17 PSA. He had T3b , 2 pelvic nodes and two-three bone mets

He had 10.43 ng/ml PSA level on November and 8.85 ng/ml on July which it is quite rare.

After starting ADT and Prostate and pelvic node Removal PSa he quickly went down to 0.06. And 0.08 now with Zytiga starts( Doc says difference is not relevant)

Do you think PSA low levels at diagnosis shows a prognosis in Survival? Is this a case of a rare cancer?

Father is also Type 1 Diabetic, could his diabetes have been related with low PSA?

Is somebody here went through a similar journey?

Thank you very much

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His initial PSA (8.85) wasn't all that low, especially if he had a large amount of Gleason pattern 5 (which puts out less PSA). The almost-eliminated PSA after surgery shows where his PSA was coming from. As to why his "bone mets" are not putting out much PSA - I'd be suspicious that they are not actually bone mets. He should repeat the bone scan/CT after hormone therapy to see if they shrank. If they didn't, they are probably NOT bone mets (arthritis and old injuries show up on bone scans too). Yes, there are rare cancers, but they are thankfully rare. Go with the more reasonable assumptions before looking for rarities.

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Thanks for the quick reply as always Tall_Allen.

One urologist and 2 MOs agreed the 2-3 mets were for sure bone mets.Is it possible after two or three scans they are all wrong? Those met and in sacrum,illiac

Father is now in ADT+Radiation+Zytiga+Predisone.MO will show us scan results when he finish radition in July .He is on radiation to aliminate surgery remaining but MO ie also giving radition to bone meta.How is the best way to find out if the current bone mets are old injurees or arthtritis besides they can shrank?

When you talk about doing an scan after ADT you meant as soon as he become castrate resistant in the future?

You are right about Gleason, he was Gleason 9 score at diagnosis.

Thank you very much for all the knowledge and help, I am scared and I really need to undertand as much as I can

P.D. sorry for my English!

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He should have a scan while he is on hormone therapy but before they irradiate those mets. That will show if hormone therapy shrank them. If so, it is prostate cancer. Mets in the sacrum and illium are often associated with prostate cancer. He may be able to get a biopsy to confirm they are due to prostate cancer. Did the CT radiology report mention whether those mets were lytic (reduced bone in the lesions) or blastic (increased bone in the lesion)?

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I am afraid he is currently in radioteraphy for bone mets as well.I am sorry if I didn't explain myself properly.

MO have all the scans before Radioteraphy so I will ask her about this.

the CT says "suspicious blastic lesion in right side acetabulum,sacrum and illiac"

Also it says again below" suspicious bone lesion in acetabulum, sacrum and illiac"

I supposes it means the mets are clearly mets right?

Thank you very much for explain me everything

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They're probably mets, but the acetabulum and the place where the sacrum meets the ilium are typical places for arthritis too. Both arthritis and prostate cancer usually form areas of bone overgrowth (blastic). The fact that it is blastic rather than lytic helps you rule out rare forms of prostate cancer.

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Thank you very much for explanation I will ask MO about this anyway to check if she is 100% sure

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Tall Allen as always so impressed with your continued support and knowledge. Leo

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my mets are also lyctic. what does that imply?

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There is one other way to help know if the spots are actual bond Mets. Did he have any previous scans related to injury or for other reasons. I did and they compared the scans and 6 year earlier scan did not have those spots this increasing the likelihood of them being mets. I asked about a biopsy and mine were so small that ucla said only 50/50 it would hit the cancer. Since ucla and another dr felt my increased psa and what they called “highly suspicious for Mets” made me decide no need for a biopsy because I’d do the treatments even with a negative biopsy because of the 50/50 chance it was negative anyway.

Schwah

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Thank you Schwah.I am afraid he did not have any scan. He began with a lot of pain in the bones in summer, then he went to physioterapist and he felt better after 1 season but pain came back.Are bone mets pain eligible to being reduce with physioterapy?

I guess after radioteraphy+ADT+Zytiga+Presdisone we will find out that the mets are bone mets

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do you think initial psa is 11 is low with confirmed wide spread spine mets? mine are definately mets since the largest was directly biopsied and all shrunk with chemo.

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Yes, that is low for confirmed widespread spine mets. I'm glad chemo shrank them. It's always a good idea to confirm response with a scan, especially when PSA isn't a great indicator.

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Right now, sounds like ADT drugs may hold his pCa back for years. Good luck and keep us posted.

Doug

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Thank you Doug I really hope he continues doing well

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Slow down, we have lots of guys who started with 6-8-10 PSA. My Barber---sorry Hairdresser, had a PSA of 2.5, but his Urologist was suspicious with no negative DRE. His results of his Testosterone was very low. His Urologist was a Fan of the Doctor that wrote the book on T--forgot his name for a sec--and persuaded my Barber with no evidence of Pca, to do a biopsy---well they found 4+3 Gleason--and he had immediate Surgery--as they went for the cure. 3 years now undetectable.

It would be a long shot---but somewhere you picked up on Pca with low PSA, and bone mets indicating Neuroendrocrine Pca---these cancer cells do not give off the PSA Antigen.

You could spend the money on a Chromogranin A---blood test, that could give you results Indicating NEPca.

So you can repeat scan, and do the extra blood test.

Nalakrats

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Thank you very much Nalakrats.The biopsy excluded the small cell carcinoma but I am aware that it is not the only Neuroendocrine type.

I am taking notes and Will ask MO

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Ductal Pathologies are or can become NEDPca. The term highly differentiated would be on your pathology report if having Ductal.

Nalakrats

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isnt "high differentiated" tumors considered low grade and slow tumors? is ductal usually low grade?

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Yes--it is highly undifferentiated tumors that are high grade, as well as most ductals, depending upon the Gene Mutations---so if you are highly undifferentiated, and have something like Ductal Cribriform, and you have the Gene Mutation BRCA-2 and PTEN---like I do---standard of care goes out the window. I am only here due to God's Grace.

Nalakrats

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Getting a Chromogranin A blood test would not hurt. My husband has NEPca(Neuroendocrine Prostate Cancer) Not all NEPca will raise your Chromogranin markers so they use scans to monitor it. The way our oncologist explained it is.. having a high Chromogranin score is bad but a low Chromogranin score one does not mean that you do not have Neuroendocrine Prostate Cancer. Has he had any pathology on his cancer ? Either biopsy of prostate or other ? The treatment is similar except that my husband also got Chemo right away. (He gets Lupron and Zytiga) Make sure you have a good doctor and do not worry about prognosis. (I understand.. I have focused on this as well) Each person is an individual.

How is your dad feeling ? Is his overall health better with treatment ?

Lots of prayers and hugs for you and your dad.

Softwaremom

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Thank you very much for sharing you experience.

In byopsy doctor say it was a common adenocarcinoma but I will ask the doctor again and ask for the chromogranin to be 100% sure as I know even though it is a common adenocarcinoma it can hev NEPc cells as well

Father is doing well.He is quite tired because of Zytiga and ADT but still doing the same things as before.

This sickness is not easy but this site is helping me a lot with having hope.

Does your husband have blastic or lytic mets?

You are completely right, every person is different and we already know people here that broke all the statistics.

Thank you for the help.

send you also a lot of hugs from Spain

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My husband had a lot of mets.. bone wise .. his bone scan lit up like a Christmas tree as he would say. He had some on lymph nodes and some on lungs also.. the organ tumors seem to be gone and the bone tumors are burning out as well. We feel very fortunate.

I am glad your dad's biopsy showed adenocarcinoma.. Generally it is better to have that than neuroendocrine.

Softwaremom

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does it matter if the mets are lyctic? i have them but doc said it didnt matter.

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Also if your on a proton pump

Inhibitors it can increase chromagranin levels.

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If I can ask what is your husband's age? There are a lot of treatments out available to keep the cancer at bay. Remember if it is not too agressive he could live a long time. My Cleason Score is 9 and I've been around for 25 years.

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25 years with Gleason 9 ?

Impressive !!!

What kind of treatment have you gone thru?

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I started with surgery but cancer was found in the nodules out side the prostate. So I had the orciectomy. I immediately became a vegetarian. Next came radiation a few years later. When my PSA begain raising again, I went on Casodex which lasted for 5 years. After that nilandran, then finasteride both came with bad side affects. I then tried an off market drug, DCA. It was effective for 3 years.

After that I went on a drug trial with aboraterone and Prednisone which was effective for 3 1/2 years. Then more salvage radiation. Next I went on the Provenge treatment.

I am now on a drug trial with Xtandi and a mystery drug that is supposed to extend the effective use of Xtandi.

That is a lot to take in. Throughout all of this I have taken other substances, i.e. selenium plus vitamin E, Essiac tea. A list can be found at:

Medlineplus.gov do some searching in this website.

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Inspiring bleith1945. I had a Gleason of 9 also in 2013. Since then psa been ND. But just had a psa test .8 had a bone scan it it shows very small spots around pelvic area that weren’t there 2013:(the

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Sorry for the mets.However a lot of people here is doing really well even with mets

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Thanks

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I am also 60 but acting like a 9 year old😀☕️

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Wow! That is impresive 25 yearss.Father is doing gine but apparently he had 3 bone mets.He is diagosed with adenocarcinoma and responded good to ADT as his PSA went down from 10 to 8.May I ask you for sharing you story? thank you!

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There are tests that can be done to rule out neuroendocrine cancer. I had a relatively low PSA (33) at dx given the amount of tumor burden so my oncologist at the time, Dr. Myers, ran this test. Neuroendocrine cancer is very aggressive and difficult to treat. Fortunately it came back negative. Best wishes to your dad.

Ed

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Thank you EdBar.Small cell cancer have been excluded for sure.They diagnosed an adecarcinome before but I will check again with MO

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They removed prost. With mets?

I was d in 10/16..psa 12..gls 2-8s&9....ductal variant....

P removal not option...doing lupron....forever....good luck to your pops

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Thanks TallAllen. So helpful to us all!!

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