Hi everyone.
My dad’s PSA has always been low, so when he was diagnosed, we were very shocked. His team checks his PSA, although PSMA have been more telling for him.
His PSA today is the highest it has ever been at 17. His last PSMA was better than the one before. Is it possible for prostate cancer to start making PSA even though it did not from the start?
Low PSA subtypes have to be watched with imaging, possibly an FDG PET too.
Hi TA.
Could it be that his pca is not psma avid, thus not being detected on the psma pet scan?
That's why I suggested FDG, but it shows up on his PSMA PET scans.
So we just might not be seeing everything on the PSMA pet scan and should request additional imaging? Does prostate cancer ever start making PSA after not? Even when his PSA was at 5, his PSMA showed extensive Mets, so I’m concerned now his PSA is 17 on the day we started chemo.
I cannot answer your question but based on my experiences and the volume of mets you share in Bio, I would be looking beyond PSA; as I do. There are multiple imaging contrast agents to consider, and I look beyond generalized rankings of which is 'best'. I also seek second options on imaging findings. Recently I had my second liquid blood biopsy - IMO worthy of consideration. Hope this helps. All the best!
I have not heard of a liquid biopsy, so I will look into that. Thank you. All the best to you too!
My PSA was 3.5 when my Dx came back as Gleason 9 and 3 lymph node mets.
Does your MO not follow your PSA as much then? That’s been the case for my dad, but now with the PSA being the highest it’s been, I’m not sure how to interpret that. Thank you for responding!
I am getting my blood drawn every 3 months and scans once a year. I am currently undetectable. I was told by my local MO and the one at MD Anderson that they will closely watch any movements in my PSA and that it should give an indication iof any growth. Regardless, they wouldn't do anything until it got to a level where a PSMA PET scan would be effective.
I would stay away from the scans until your PSA hits 2.0.
If you do it earlier it still works, but you get materially more false negatives.
For some reason most of the docs have premature ejaculation on this issue.
Unless the doc is willing to do a second round of scans when you hit 2.0 or 3.0......
You want the most accurate scan the first time. To do that you must exercise some patience.
Also, some insurance companies like mine will not authorize a psma scan unril psa is >2.
Similar, mine was fluctuating between 3-5, Gleason 9and 10, that was in 2016.
It usually goes in the other direction.
The cancer that doesn't generate PSA is very fast growing and makes its presence known very quickly with or without scans.
Tall Allen is way more current than me, but I don't think it's very treatable.
I would recommend going to his personal blog. Read his research.
If you are still concerned get both an fdg scan and a psma scan. They each can see what the other can't.
Don’t think it’s very treatable as we shouldn’t even bother with treatment at this point?
A drug for BPH called Finasteride reduces the PSA by half! I was on it for three years and PSA only spiked the last year and then below 4. Unfortunately, my doc did not know the drugs effect and waited 6 mo. to repeat the PSA. Then it climbed to 25 still on Finasteride. Scans showed 4 rib mets and 2 Pelvic mets and subsequent bx was Gleason 8 (4+4).
My PSA is consistently undetectable, but my PSMA and Choline 11 scans show mets. There are a subset of men like us. I get either a PSMA or Choline 11 scan every three months.
Thank you for the information! I hope you are doing well.
Where are you being treated? Did your PSA ever increase substantially with PC, or was it never reflected in an increased PSA?
When the cancer was just in the prostate my PSA was something like 1. When I was diagnosed as metastatic my PSA reached its highest ever at 2.8 or something like that.
After I restarted Lupron (full ADT) it dropped to non detectable and has been there since (a little over two years.) Despite that, tumors have appeared and I am clinically castrate-resistant.
I see Dr. Kwon at Mayo. According to his videos, he sees a large number of us who don't show any PSA. In fact, I know another guy who sees him -- same thing.
The highest my PSA ever got was 4.8, and yet, I was diagnosed with Gleason 9 and spread to my pelvic lymph nodes. After radiation and doublet therapy, it’s now at <.01.
Cancer that doesn't express PSMA
Psa and Prostate cancer
Treatment options for metastatic prostate cancer? 
Advanced Prostate Cancer Treatment
Whats high PSA? ( when you havent been diagnosed with prostate cancer)
