Hello
I wonder if PSA test is low even the cancer cells affect skeleton,
I read about an old gentleman from USA he did a radical prostatectomy he had low psa value but he had cancer cells in his skeleton.How it comes..........!
I'm confusing anout what i read.
Thanks for any answer
George
More than 98% people have regular type of Acinar Adenocarcinoma and generally they have to have high PSA to have skeletal metastases.
About 1 to 2% people have ductal, small cell or Neuroendocrine type whose cancer cells produce very little PSA but these very low PSA producing cells are aggressive and can
go and cause skeletal metastases faster. Also, with long term treatment with prostate cancer treatment, the regular adenocarcinoma may change to Neuro-Endocrine type.
After total removal of prostate gland by surgery, ideally PSA should be zero . Because once the gland is not there ,any PSA which comes has to come from cancer cells only.
Remember...Only two types of cells in human body have capacity to produce PSA (1) Normal Prostate gland cells and (2) prostate cancer cells.
Some types of prostate cancer just do not put express much PSA. In fact, men diagnosed with higher Gleason Grade can have lower PSA than men with lower Gleason Grade with the same tumor volume. PSA is a lousy biomarker for screening.
What else is there???? Besides scans
For pre-biopsy (to avoid unnecessary biopsies) there are some experimental blood tests that aren't at all PSA dependent, like ExoDx Prostate intelliscore, SelectMDx, and Sentinel RNA test. Fortunately, the vast majority of prostate cancers do express PSA significantly, so tests like PHI and 4K score (which are PSA dependent) will still work.
Anomalous don't be so ominous.... and give us your bio. Age? Location? Scores psa/gleason? Treatments to date? Treatment center(s)? Doctor's name(s)? Thank you!!! All info is voluntary but it helps us help you and helps us too. You don't have to post it here just add it to your home page.
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 09/19/2020 9:19 PM DST
The discoverer of PSA called the PSA test a 'profit driven public health disaster'.
The problem is that although it is a useful probe it gives a lot of false positives, it fails to detect some cancers, etc.
It is still in use because a lot of labs are geared up to do it on an industrial scale, community physicians and urologists find it easy to understand and deal with, etc.
PSA? Bah humbug.
Nothing beats a DRE...... especially the cork popping sound when the doctor pulls out his middle finger....
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 09/19/2020 7:19 PM DST
OMG. You know that sound too. First time is enlightening..
LOL ..........It's that wonderful sound to hear from our rear....
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 09/20/2020 3:16 PM DST
Just to confirm Tall Allen's comments. My PSA prior to dx was 2.2 but had jumped to 3.8 over approximately 12 months. My Urologist administered the SelectMDx test after conducting a DRE of my prostate and then taking a urine sample which was sent to a lab. This test provides two results 1) likelihood of prostate cancer upon biopsy and 2) likelihood of detecting Gleason score > or = 7 cancer. My results came back 54% and 26% respectively, which is not good but not off the charts. My urologist ordered a biopsy which resulted in a dx of advanced Pca with a Gleason score of 9. All 12 samples were hot with cancer. While I had a relatively low PSA score I indeed had an aggressive cancer that had advanced quickly. Subsequent MRI and full bone scan showed cancer had spread beyond the prostate to bilateral seminal vesicles and to multiple bone sites.
The point being that PSA alone is not a very accurate measure of how advanced and wide spread your cancer may be. The biopsy is obviously crucial, but the SelectMDx is a good tool that could show you are at low risk even with an elevated PSA score that's higher than mine was. Or it also could allow you to intervene early if your percentages of likelihood of cancer are high. IMO this is a test that should be ordered whenever there is a jump in PSA regardless of how low or high your standard PSA results are. This also is valuable information that should be conveyed to relatives and friends.
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Lu 177 PSMA 
