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Detectable Metastasis with Undetectable PSA?

Posts: 32
Joined: Oct 2011

Can anyone tell me if it is possible to have detectable metastasis with an undetectable PSA? My PSA at RP was only 2.2 and my concern is that my undetectable PSA due to Hormone Treatments may mask the detection of bone metastasis because my starting PSA was so low in the first place. My Gleason Score is 9.


60 years old when diagnosed
PSA only 2.2 at diagnosis. (Don't trust only PSA as indicator)
DRE (digital rectal exam) lumpy
Bone scan negative for mets
CT scan negative for mets
Biopsy (November 13, 2009) Yes, it was a Friday
12 of 12 biopsy samples positive for cancer
Radical Prostitectomy (December 14, 2009)
Positive margins, seminal vesicle involvement. negative lymphnodes, negative mets
Gleason score 4+5= 9
Stage T3b N0 M0
Current PSA is less than .1 (August 2011)
I ware a Cunningham clamp during work hours to cut down on leaking. (hurts after a while so can't leave it on for more than a few hours)
If I don't ware it I change pads from 6-8 times per day.
At night I get up 5 or more times to go to bathroom and sometime wake up with hot flashes from hormone treatments.
Besides that, Life is good!

VascodaGama's picture
Posts: 2012
Joined: Nov 2010


In your previous thread (http://csn.cancer.org/node/229375) you commented about your scheduled meeting with the surgeon that operated on you. That will be a good opportunity to find details on your doubts. Make a good list of questions and take them with you.

As far as I know, cancer cannot be “detected” with PSA but with biopsies and image studies. Symptoms and PSA tests can be indicative on the presence of the cancer. Localized metastases and metastases in bone are usually declared from image studies (CT, MRI, BS, etc.). However, these scans can miss small tumours so that one can only control any progression based on past experiences using markers as the PSA.

When under the influence of the hormonal treatment, the PSA level is also considered by the oncologists as a reliable tool to verify the status of a patient, because doubling cancerous cells will increase the amount of PSA produced by the cells and circulating in the body. In such a case low variations would have a significative meaning. Some doctors still use ultra sensitive assays that can provide levels on the three decimal place (0.XXX ng/ml), but the norm is for a LDL <=0.01

Some types of cancers are not hormone dependent and some do not produce prostate specific antigen (PSA) so that other markers are used in their control. I believe yours is an adenocarcinoma of the prostate which usually is hormone dependent. You can get details of the type of cancer found in you from the pathologist report done at biopsy and after surgery.

Have a look into this site; http://www.prostatecancerguide.net/types.php


Posts: 32
Joined: Oct 2011

Once again, thank you for your response. I checked my Pathology report and I do have Adenocarcinoma. Staged at pT3b N0 MX.

I have a PSA test due at the end of this month. I have not yet scheduled the appointment with the doctor that did the RP but that is my intent and I will pose those questions when I meet with him.

The links to sites that you post are very informative and appreciated.


Posts: 193
Joined: Aug 2006

It is extremely unlikely that a prostate cancer metastasis is created and spreads (while under hormone depletion therapy or not) and a psa less than 0.1. It is possible that a previously undetected metastasis may exist. It is certainly possible that metastasis from a tumor from some other source may occur. It is also possible that a tumor of the prostate of neuro-endocrine type can spread with very small psa leak to the bloodstream. It is this last possibility that VdaG refers to and that your pathology rules out.
Therefor, if you are in good general health and this is confirmed with full medical monitoring, if you have no symptoms, and you feel good, sleep well, et cetera, then carry on. You have a long time to go.

Posts: 32
Joined: Oct 2011

I am a Vietnam Veteran with a presumption of exposure to Agent Orange. I come from a large family of 6 brothers, a father and six uncles none of which have had prostate issues and since I was stationed at the Air Force Base in Vietnam where they stored the agent orange and because Agent Orange typically presents with an aggressive strain of prostate cancer I am convinced that this was the source of my Gleason 9 stage pT3b cancer.

I met today with the surgeon that performed the RP in December of 2009 for the first time in a year. (I have been seeing the VA doctors) and asked him the list of questions that I prepared ahead of time as suggested. I feel that the meeting was informative and that it was the right decision to meet with him. He told me that he was shocked to find the extent of cancer that I had knowing that I had a stable 2.2 PSA prior to the RP.

He explained his feeling that the strain of cancer that I have was so aggressive that it no longer represented a typical prostate cell and therefore doesn't give off a large amount of PSA. That being said, I voiced my opinion of my concerned that if the VA waited until my PSA was at .2 (the VA's marker for recurrence)the cancer might have spread much further than it might have had I had a normal PSA producing cancer. He said that if he was me, he would feel the same way.

I had a PSA blood test done today because the lab they use carries the results out to .XX and The VA only out to .X. We also scheduled a complete bone scan for next Wednesday, November 16th in an attempt to get ahead of, or at least keep up with any bone metastasis.

At any rate thank you for your suggestions and I feel much better now that I have a course of action and I'm not just waiting every three months to see if my PSA has increased when I know that a more sensitive test can be performed which can show me a trend below a >.1 results.


2ndBase's picture
Posts: 220
Joined: Mar 2004

Since you have started treatment and found a gleason of 9 you need to know that the psa readings you get mean very little as far as your survival goes. There is no point in making a goal of a lower psa because in the long run the number will mean nothing. The psa will do what it wants and you need to worrry about quality of life with less stress. I had to take one hormone treatment to shrink my prostate and then I had radiation on the prostate. Bone mets are hard to find early on, very hard to find. I now have tumors of good size throuhout my body and have had pallative treatment for pain on several different tumors. Your hormone treatments however will not mask any bone mets now or ever. The side effects are not good and I would not take another hormone treatment for all the tea in China. Hormones can not cure you but if having a lower psa means that much, then do what you want. Since you were dx. at 60 years your cancer might be slow enough to need no treatment which is what I would have done but I was only 52 and given a 50% chance to survive 2 years with psa of 24 and Gleason 9. No mets. were "found" until much later but they are big now and all you need to do is feel them to know they are there. If you want a better quality of life the hormones have to go away. You can not let fear affect your quality of life.

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