What are the implications for treatment and more importantly monitoring progress of PSA-NEGATIVE metastases?
My PSA was never over 1.1 before cystoscopy found PCa (Stage 4B throughout almost everything connected to prostate and mets in pelvis, sacrum, spine, and pelvic lymph nodes).
The PSA-NEGATIVE finding explains the low PSA despite extensive spread, right?
With that in mind, won’t it be pointless to use PSA as the key metric for judging the effectiveness of treatment?
FINAL DIAGNOSIS
ISCHIUM, RIGHT, CT-GUIDED CORE BIOPSY:
- METASTATIC PROSTATIC ADENOCARCINOMA.
IMMUNOHISTOCHEMICAL ANALYSIS:
- PSMA-POSITIVE, PSA-NEGATIVE TUMOR.*
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Gl448
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If you have PSA negative tumor you have to rely on imaging e.g. CT/bone scan or PSMA PET/CT. Yes, it is probably the reason for your widespread tumor and low PSA value.
Because you have PSMA positive tumor, I would try to get into the PSMAddition trial. Here is a drop-down list of 117 study locations: clinicaltrials.gov/ct2/show...
I’ll check those out. The only treatment I’ve had so far is Eligard in August, will be interesting to see if any of those studies take newly diagnosed patients.
Your IHC (and the "Mixed sclerotic lesion") is showing both PSMA positive and PSA negative cancer, so PSA is not very useful. Have you had a bone-specific ALP blood test? My guess is that metastatic spread is more likely to show up on FDG PET/CT scans, which should be done periodically to show the effectiveness of therapies.
A lot more important information can be gleaned from more detailed IHC of the bone lesion biopsy. But IHC is limited by the amount of material they extracted and the IHC stains available there. They can send the tissue to the Wang Lab at Duke for more detailed analysis. The stains I think you should discuss are:
This will guide your therapy and clinical trial selection more than anything else. Meanwhile, a modified triplet therapy (docetaxel+carboplatin + darolutamide or abiraterone + Eligard) is probably your best bet.
Allen really is the best. He quoted something from my rather lengthy bio/history which shows he considers your actual individual conditions before answering.
Never had a BAP, but ALP was always around 40 for the last few years, then started climbing early 2022 and peaked out at 145 last month (35-130 normal range). It seems to have started right around the time the urinary retention leading to my first TURP and eventual PCa diagnosis.
I’ll ask doc about BAP, or order one myself if MyQuest offers it
Finally discussed the bone biopsy results with the MO who ordered it. She completely blew off the "PSA-negative" labeling when I questioned her about that, explaining that since it was a bone biopsy they sometimes don't stain as well as tissue and I shouldn't "put too much weight on that."
okay. I wish I’d had a PSMA PET instead of Axumin. The Uro didn’t know any better, and the RO I saw said the same but said it was too soon to get another PET or something doing those lines.
Not a lot more to add other than that when I was at Mayo Clinic in September, Dr. Eugene Kwon told me they have a growing series of patients who have low or undetectable PSA with Positive PSMA PET/CT scans. He said there may be a role for a periodic survey PSMA PET/CT despite a low or non detectable PSA i.e. below the PSA levels that insurance has determined as a trigger to pay for said scan.
I think an element of both. I think as we who should be dead live longer we develop more mutations. Also there is no doubt imaging has and is evolving.
Entire prostate, seminal vesicles, nueroblood bundle, bladder neck, pelvic lymph node for localized cancer. Bone mets in the pelvis, sacrum, and three lumbar spine bones.
Yes, was considering chemo via triplet therapy as suggested by several here.
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Rapidly rising PSA and new bone met(s). 
2Nd Biopsy in 3+ years of Bone Met
PSMA scan shows rib met
MRI PIRADS 5, but Biopsy negative?
PSA vs PSMA
