Low PSA and still progression?

[Daddysgirl83]

How is this possible?

Just curious, came by this article

ncbi.nlm.nih.gov/pmc/articl...

[Tall_Allen]

Low PSA subtypes are very rare, thankfully.

[Justfor_]

"His initial PSA was 21.6". So, at diagnosis had a typical PCa expressing PSA. Then he had 3 years of continuous ADT and another 6 years of intermittent ADT. Within this combined period the PSA expressing cells were driven to extinction and were replaced by their nastier "silent" counterparts. This sequence is the norm, not the exception. Evolution theorists try to stretch the timeline with containing the stress upon the initial hormone sensitive strains, as long as possible. Silly people prefer the "kitchen sink" approach which is equivalent to betting all their money on a single number on the roulette table.

[32Percenter in reply to Justfor_]

By kitchen sink are you referring to triplet therapy? It's becoming the gold standard for de novo diagnoses and is found to work better than using agents individually in sequence after failure.

[Justfor_ in reply to 32Percenter]

Gold standard my foot. Marketing terminology employed in order to dress up sloppy practice. Any exaggeration, regardless of number of agents, is bad. More isn't better. Don't they say "Everything in moderation"? Where can "moderation" be found in the "one fits all" consept of Maximum Tolerable Dose? Individualized medicine, this is the no kitchen sink approach.

[RMontana]

The article provide some explanation. This is taken from the body of the study. Go to footnote number two if you want to dive deeper.

“Those patients with metastatic prostate cancer and a low serum level of PSA account for less than 1% of all patients with metastatic prostate cancer [2]. ”

…but there’s other things wrong with with the treatment regime that the patient got. He chose radiation over surgery but his dose was only 68 gray. That may be too low a dose for salvage. Otherwise my salvage dose was too high...

…also I don’t see PSMA PET scans done before radiation. I insisted on this to rule out, metastasis before surgery. For all we know, he already had metastasis when he was radiate. Traditional scans, are not as specific as PSMA PET at the PSA level that he had, which was 21.6. That’s very high.

…so this is a very unusual case and I don’t think 99% of us need to worry about this. I’m very sorry that this happened to this person I can only imagine how he and his family felt. Rick

[Justfor_ in reply to RMontana]

"Published online 2010", at least one year to get published, plus 9 years before that, brings us to circa 2000. Unfortunately, no PSMA PET at that time.

[RMontana in reply to Justfor_]

My bad...what I should have said was, if we are going to worry about this scenario then this case study 'should have' included a PSMA PET as part of the SOC, not just regular scans. I was not that all suspicious of the dates of publishing as I STILL SEE case studies today where PCa patients are not given PSMA PET as SOC and shuffled off to treatments blind...that is what I should have said. The way I wrote it makes no sense as you correctly point out; PSMA PET came out Dec19...

I know. I got my scan at UCLA 1st week of Jan20...the scan had just been approved for the USA by the FDA and it was so new my insurance had no procedure code for it...how I got the scan, what I paid for the scan via insurance vs if I had paid cash out of pocket, is another story...Rick

[Justfor_ in reply to RMontana]

Totally agree. No blind sRT, PSMA PET scan first. Got tired of writing that over and over again, so had this thread about it:

healthunlocked.com/prostate...

[V10fanatic in reply to RMontana]

I paid $3k for the trial PSMA-PET, yet my insurance company was billed $26k for my most recent PSMA PET-

[RMontana in reply to V10fanatic]

Amazing!!! I was about to pay out of pocket, Jan20, $2700 when my insurance company said they would "cover" the scan...they made up a procedure code quick and processed the scan...

UCLA then charged my insurance almost $27,000 for the SAME SCAN!!! It was only then that I remembered; Co-Pay and Deductibles!!! I ended up paying $3800 for a scan that I could have paid $1000 less for in cash...

I have a lot of other examples that are along the same line...was self insured for 12 years and had to negotiate cash payments for a lot of stuff medical...people would be amazed at how much less Doctors will take if you pull out cash...Rick

[j-o-h-n in reply to RMontana]

A Doctor's love call to his paYtient:

youtube.com/watch?v=IpwSXWq...(Not working as expected?)

Good Luck, Good Health and Good Health.

j-o-h-n Monday 10/23/2023 6:52 PM DST

[SeosamhM]

This article provides the explanation. The pertinent excerpt is:

"Cancers developing in the transitional zone tend to produce large amounts of PSA. High-grade cancer cells tend to lose their ability to produce PSA. A Gleason grade 5 prostate cancer produces less PSA than a grade 3 cancer does. Some patients with advanced prostate cancer may have low or undetectable PSA levels."

See:

emedicine.medscape.com/arti....

This is why PSA trending is more important to me than PSA value. My 0.50 now may not be my 0.50 of 5 years ago.

[TuffNuttoCrack]

When diagnosed a year so my PSA was 6 and I was quite symptomatic with bulky lymph nodes covering up my rntire retroperitoneal cavity and attack on my pelvis that it was extremely painful to sit down, I read the story of like 1/100, myself having the rare variant of poorly differentiated cells like different types of weeds growing all over, like the patient I flunked chemo after one round winding up with pneumonia requiring hospitalization, a near death experience, I can only attribute my being here due to God’s grace and the prayers of many! I think PSA and Testosterone are very poor markers. It isn’t what the number is necessarily, it’s the rate of change between successive numbers.

[Medline]

PSA has anti-angiogenic [pubmed.ncbi.nlm.nih.gov/195...] and anti-metastatic [pubmed.ncbi.nlm.nih.gov/344...] properties, so loss of the ability to produce PSA causes progression!