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Advanced Prostate Cancer
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Can PC patients get new mets with a non detectable PSA

I have a question for the brilliant minds on this site. I had three mets (2-pelvis and 1-rib) found about 10 months ago after my PSA started rising again. After four chemo sessions, 9 months of lupron prednisone and Zytega and radiation on the three mets, my psa is now .02. However, since my fourth Lupron shot about two weeks ago I’ve had really a bad pain in my left hip/butt. Walking is now painful. Interestingly the last shot was on the right side pretty much exactly where the pain is on the left. A chiropractor thought it was related to the shot but that seems odd. Wondering if it could me a new met (despite my low PSA) or somehow related to the shot on the other side and if anyone else experienced something similar from their lupron shots. Thx guys for being there.

Schwah

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It's a great question. There is evidence of progression despite non-rising PSA for CR guys on Zytiga (Abiraterone) but I don't know about hormone sensitive men. nature.com/articles/pcan201671

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Without being examined, no one can know.Does not sound like met.

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Only a scan can tell.

Nalakrats

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I think the way our former oncologist would describe it is the cancer becomes so dedifferentiated(Deformed) that it no longer produces PSA. Yes it can happen. A scan can help with diagnosis.. best if there is a previous scan(To compare) .. My husband had scans say things were cancer that were not... luckily we were able to dig up a scan from long ago to compare.

Lots of hugs and prayers

Softwaremom

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Well, to be honest, from all I know about Prostate Cancer, I would say it is possible to get new mets without a PSA being detected. I really don't think that the PSA screening suffices to determine whether a cancer is progressing or not. If I were you, I would ask for a scan to be done. Mel.

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It would be highly unlikely, this occurs in only 1-2% of those with PCa. Both of my medoncs including Dr. Sartor advised me to skip getting regular Aximun scans unless there is an uptick in my PSA for this reason.

Ed

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II have heard from oncologists that it is possible for a tumor to not generate a PSA, but it is rare. You wont know anything until you start getting your doctors to start looking at it. A biopsy will tell if something is cancer or not without a rising PSA.

I had Left hip pain with a clean CT scan. Only a pelvic MRI identified that I had a met, but my PSA was rapidly rising. MRI is more accurate. Pain in ribs or hip could also be a fracture, not a met, caused by osteoporosis or excessive use of bone building drugs like Fosamax which can make bones brittle, or perhaps they were already brittle because of osteoporosis. Happened to me more than once. I cracked several ribs over the years until I got on Xgeva which is a better bone drug.

One doctor told me to radiate my Left hip + my rib, and I said no on the rib on a hunch that it was an osteoporosis fracture, and I was correct. Radiation got the met, and the rib was only a crack. PSA dropped to zero. If the rib was cancer, my PSA would have not dropped to zero. Subsequent bone scans showed that the rib they wanted me to radiate no longer lit up after a couple of years. Ii was a crack

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Short answer: yes. Some of us and our cancers don’t trigger rising PSA as much as others. An F-18 PET bone scan just discovered two new mets though my PSA remains “undetectable.” For me, bone specific phosphatase is a much better marker of new activity than PSA. BTW, Medicare no longer covers the F-18, but if you can afford it, pay for it yourself. Since Medicare does cover the T-99 Scan, I had one of those at the same time. The T-99 showed no new growth or new mets at all. The F-18 showed both new mets and new growth, and this discovery triggered a new course of chemo. If I’d waited until the T-99 showed anything my prognosis would be poor.

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Could it be much simpler than that? After the injection in one side, was it uncomfortable enough to unconsciously alter your gait, so that you put pressure on the other side?

I’ve had all sorts of pains in the last seven years, but none were cancer or new Mets, just old age, muscle spasms, sleeping on a different bed, sitting on a hard surface and aggravating the met in my pelvis which pushes on my sciatic nerve.

This is the best place to ask though.

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Sounds like they hit the sciatica nerve. Happened to me too my 2nd injection

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Hello. I just came across your post - any update on your condition? After almost 9 years on Lupron, my husband HAS had PC recurrence with an undetectable PSA, so the comments made by 'MelaniePaul' & 'Softwaremom' are correct. Like you, it was horrible [groin] pain that aroused his suspicions, which were confirmed by CT & bone scans. He received radiation and the onc added Zytiga + Prednisone to his regime late last year. Our new normal is quarterly scans. Initially, he continued to develop a couple of tumors on his skeleton; however, the July scans showed no new lesions. He goes back again this week.

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My hip got better a couple of weeks later and I continue my regimen of lupron Zytega and prednisone and my PSA remains “undetectable” at .02. Planning a “vacation” from the drugs at month 15-18. By the way I also went on zometa and Celebrex. A combination shown in clinical trials the reduce deaths by 22% with minimal side affects.

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My Firmagon shot has been tolerable and Dallas Doc wants me to stay the course with monthly Firmagon shots; since I am tolerating them so well not changing to Lupron. Is it generally accepted that adding Zytiga and predisone will increase the SE?

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Not sure what “SE” means. But it is more than generally accepted that adding Zytega prednisone to ADT on newly diagnosed metastic PC patients (who are still hormone sensitive) increases life expectancy. It was proven to be the case in double blind clinical studies where deaths of men who received ADT along with Zytega prednisone were 40% less likely to die than those who only did adt.

Schwah

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