The American Society of Clinical Oncology has reported that patients with Gleason 8 to 10 cancer and PSA values of 2.5 ng/mL or less may harbor hormone-resistant disease that is more lethal than other forms on non-metastatic, node-negative cancers. Prostate cancer specific mortality was 2.15 times higher for low-PSA, high-grade patients than others studied by the National Comprehensive Cancer Network. (NCCN) It is possible to have metastatic disease with a low-PSA as with high-grade cancer the prostate my not produce much PSA. I was diagnosed with high-grade cancer yet my PSA has never been more than 4.4. The study also found that ADT might not improve survival of low-PSA, high grade PCa patients. Further research is needed to learn the best treatment. Clinical trials are needed.