Advanced Metastatic P C with a PSA of 1.2?

[GranPaSmurf]

At the time of diagnosis, 29May19, the PSA was only 2.14. I've had Casodex and a 6 month shot of Lupron. This week the PSA is down to 1.2.

Is there any significance to having an aggressive Prostate Cancer despite having a low PSA? Ten years ago my PSA was 1.5, five years ago it was 2.1.

Biopsy: "FINAL DIAGNOSIS UROLOGICALProstate, RM: Adenocarcinoma, Gleason 8 (4+4)"

CT scan: ...lesion in the T6 vertebral body corresponding to increased radiotracer uptake on bone scan, likely representing osseous metastatic disease.

Bone scan: Findings concerning for osteoblastic metastasis involving the T6 vertebral body and right proximal tibia.

I see my MO (first visit) next Monday. It should be a learning experience.

[George71]

What prompted you to have a biopsy? Based on those PSA numbers (2.1) -- ordinarily people would have never had a biopsy in the first place or even be suspected of having prostate cancer. Even hip or joint pain would be thought of as arthritis or aging.

[GranPaSmurf in reply to George71]

The tumor was detected by digital exam. I was seeing my Urologist / 6 months. The digital exam was normal 6 months earlier.

The next step was MRI:

1. Large infiltrating PI-RADS 5 mass with likely extracapsular extension. Another PI-RADS 5 lesion with suspected right seminal vesicles involvement.

2. Subcentimeter pelvic lymph nodes as above.

[George71 in reply to GranPaSmurf]

The digital exam was normal 6 months earlier and the PSA at time of diagnosis was the same as it was 5 years earlier and it was just 2.1.. even if G 4+4 -- It still makes you wonder if the bone scan is a false positive or just aging or arthritis.

[NurseRatched]

Hello. My husband has metastatic disease with an undetectable PSA; so yes, I would assume it’s possible with your numbers.

At his worst (2009), John’s PSA was “only” 15 - however, it had tripled to that number in a month. One MO that we saw indicated that some men simply do not express a lot of PSA.

I’m glad that you and your urologist have remained vigilant. All the best to you!

[LearnAll]

"Is there any significance of having aggressive prostate cancer with low PSA ?'

Answer : YES. Low PSA in many cases can be associated with aggressive cancer.

WHY ? Because prostate cancer cells which reach to a semi destroyed state can not

produce PSA...on the other hand..Prostate cancer cells which are churning out lot of PSA are still in good shape and can react by releasing PSA.

That is why some people have very high PSA and with treatment ,they do well compared to

people with half dead, non functioning ,disorganised cancer cells unable to produce much PSA.

A friend told me PSA is like tears of a sad, ailing prostate and in last stage of a tragedy

tears get dry. Interesting analogy.

[GranPaSmurf in reply to LearnAll]

So, it's good that I've lived a rich and full life, right?

[Tall_Allen]

Low PSA types are usually more aggressive. If the hormone therapy shrinks the vertebral met, it is prostate cancer.

It has been found that early use of Zytiga in situations like yours improves survival:

pcnrv.blogspot.com/2017/06/...

[GranPaSmurf in reply to Tall_Allen]

Thanks Tall Allen

[tango65]

If you are oligometastatic (it seems you have only 2 metastases) you could discuss treatment of the primary tumor with radiotherapy.

thelancet.com/journals/lanc...

[tom67inMA]

My PSA went from 2 to 216 in thirteen months. Either I was metastatic before the PSA went up, or my cancer grew wicked fast.

My guess is some cancers puts their resources into growing instead of wasting them to make PSA.

[j-o-h-n]

Whatever you and your MO decide this Monday.... I would suggest you change your ID to GreatGrandPaSmurf......🧙‍♂️

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/22/2019 7:06 PM DST

[GranPaSmurf]

Great grandkids... I've got a few. I can't keep up with how many - Grandkids keep marrying people that already have families.