Low PSA and PSMA scan : Hi, I have a... - Advanced Prostate...

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Low PSA and PSMA scan

godhelpus profile image
18 Replies

Hi, I have a question regarding my dad’s latest PSMA scan , it seems the scan has not found new metastasis and the old mets seems stable!

My dad’s psa was around 0.04 and I’m wondering if the scan was useless.

is it possible that there are mets but the scan did not catch them since the psa is so low? And are there mets that don’t express psma and if so what other scans do you recommend?


18 Replies
Tall_Allen profile image

PSMA PET scans won't show anything in men with such low PSA. There are no scans that are useful. Why are you trying to use a scan to find metastases?

godhelpus profile image
godhelpus in reply to Tall_Allen

He had no scan since 2020 , and he started his vacation few months ago , I was worried for him so I suggested a new scan to compare with the earlier ones, since he is stage 4 and on vacation, I was so worried for him but now I think maybe it was useless and still can’t get some relief from overthinking, so what do you suggest?

6357axbz profile image
6357axbz in reply to godhelpus

I’m surprised your MO ordered such a scan. Did you ask him why with such low PSA?

Tall_Allen profile image
Tall_Allen in reply to godhelpus

So, I infer that you are trying to decide when is the best time to end his ADT vacation? There are no guidelines. He is taking the vacation presumably because the side effects of ADT are onerous. So he will want to have some time with normal testosterone - he should monitor that every 3 months along with his PSA. Most end vacations when PSA reaches 2 or 4, although some wait for 10. I don't think that scans are very useful for this purpose.

Mrtroxely profile image
Mrtroxely in reply to Tall_Allen

I get a few prostate cancer stage 4 update emails, I read through and all give me a great insight and realistic view of what I'm living with and how it can effect us.But when ever I read your tall Allen replays,

They are very concise, practical, they seem to make sense in a mine feild of terminology and wordy words....

So just a thank you from me to you for all your posts I've ambled across.

And for the site.

And every one else posting questions and answering questions.

Really can make a dark grim day open up into a good straight up day.


TEBozo profile image
TEBozo in reply to Tall_Allen

Tall Allen, I am at 0.51. Is it you opinion that I should wait until 2.0 to resume ADT? My T pre-PC was 700 and now 220. BTW

Tall_Allen profile image
Tall_Allen in reply to TEBozo

That is a call only you can make. The only reason for the vacation is to give you a break.

john4803 profile image
john4803 in reply to godhelpus

I had RP, EBT & started Lupron for 2.5 yrs.

Maintained <0.1 PSA. Went off Lupron & after 1.5 yrs. (T rose to 240). 1 mon. later PSA rose to 0.4. Axumin Scan showed lesion, only on T-ll. Considered Oligomestatic. Had it Radiated.

3 mons. later (T rose to 330), PSA shot to 7.3, mets through out skeleton, big one

trying to get to spinal cord on T-4. Went back on Lupron & added Apalutamide & Xgeva.

After 4 mon. PSA 0.2, T down to 12. Will have PSA & T tested per mon. until remains

stable & then every 3 mon.

I am a GS 9 (4+5), so my cancer may be more aggressive, but I would advise

you to be very cautious.

I wish I had stayed on Lupron because my SE's were minimal, except my wife thought

I was getting more "grumpy". Any time I want to make her feel bad, I remind her of this!


dhccpa profile image
dhccpa in reply to Tall_Allen

On that last sentence, did you mean "with such low PSA?" Since how else would one find Mets other than with scans? Just a clarification. Thanks

Tall_Allen profile image
Tall_Allen in reply to dhccpa

You don't typically find metastases when you have low PSA

rococo profile image

I recent researched that adt should be restarted at .2 to 2psa if prostatectomy and 2 to 5 like myself if radiated, Some once won’t prescribe scan less than 2 when it’s 94% accurate

rococo profile image

Hope you got msg, Restart adt .2 to 2 Psa if primary treat. Prostatectomy and 2 to 5 if radiation, Some mo won’t prescribe scan till 2 Psa when 94% accurate

RS265 profile image

My personal experience is that scans under 0.2 give false positives so don't waste time, emotional angst and money. I have had access to these tests since 2017 at age 64 and would not consider using them until I was over 2 (I was GL9, extracapsular and my recurring psadt averages 10 weeks). My experience says that PCa is genetically personal in its treatment response behavior. I restarted Zoladex 12 weeks ago at 2.8 and am now 0.05. (As in, I take holidays, use ADT when needed and also SBRT but the latter's effectiveness is limited for me)

PCa is proving a game of chess where the next move needs calm consideration.

dfridge profile image

.2 or greater. I just did a scan in June with a 1.24 PSA and it showed 3 bone mets that were not visible / or inconclusive from a 2020 non PSMA scan.

Scared the hell out of me initially but was happy to have an actionable treatment plan with very low volume disease. I started Lupron and did 3 rounds of SBRT and 1 month later my PSA was at .5

Docker53 profile image

I wouldn't worry about any scans right now if your Dad's PSA is so low. Let him enjoy his vacation. I know you concerned for the one you love. I'm always concerned about my Husband with stage 4 and metastasized to the Bones. He was on Xtandi for 15 months and then PSA started climbing again January 2022. He started Chemo in May. He just finished his 4th round of Chemo. He has another 6 to go, every 2 weeks. His PSA went up to to 29 and it's down to 26.3 after his 3rd session. Unfortunately he got Covid a few weeks ago and knocked him on his ass. He was justed starting to feel okay and wham, another round of Chemo on Tuesday. Best of luck with your Dad's vacation and we would appreciate a prayer for my hubby.

nobaday profile image
nobaday in reply to Docker53

How is the chemo going for him side effect wise ?All the best!

Docker53 profile image
Docker53 in reply to nobaday

Hair loss, headache, extreme fatigue, stomach problems with nausea, either diarrhea or constipation and joint pain. Not a fun time at all. Symptoms are not as advanced after a week of each Chemo treatment. He has yet another 6 to go every 3 weeks. He just finished his 4th.

nobaday profile image

My PSA IS always less than 0.1 eg last was 0.084. My PSMA PET 18F in December 2020 lit up like a Christmas tree for my Mets at C3 and T8 to T12. I have another PSNA/ PET today. I’m hoping again it will be avid for OSNA at C3 and T8 to T12 so that LU177 will be an option, likely in India or pin a North American (USA or Canada clinical trial).

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