Low PSA Metatastic Prostate Cancer

ron9213

I am a 55 year-old African American male diagnosed with PCa in Feburary of 2002. My PCP refered me to a urologist in December of 2001 based on the doubling of my 2000 PSA level(from 2 to 4). I underwent a radical RPP at Johns Hopkins in May of 2002 (PSA of 6.5). Post-op pathology indicated microscopic pelvic lymph node involvement (2 out of 6 sampled). I participated in an adjuvant Taxotere clinical trial at JHH for 6 months (June-December 2002). My post chemo PSA (Jan 2003) was .5. From January 2003 to January 2004 my PSA level had a doubling rate of 6 months to 13.5. Last month, a bone scan indicated pelvic abnormalities and an MRI confired the presence of bone metastasis, single location. I started hormone therapy last month. There is no history of PCa in my family and I have been taking PSA tests since the late 1980's. My oncologist, Dr. Mario Eisenberger, said that he believes that the boney metastasis was present (but not detectable) at the time of my RPP, thus at a PSA level of 4.0. Is my case unusual? That is to say, how often does one find such advanced involvement at so low a PSA level?

mikebur

Hi Ron. I'm sorry that the cancer has spread. I do not know if your case is unusual but I do know that doctors keep saying, lately, that the psa to detect cancer should be lowered from 4 to 2.5 (especially in younger men - I too am 55 years old). My psa was 4.6 at diagnosis and I also had an RP. My surgeon said that there was some cancer at the edges and in the capsule but so far my post op psa is down to 0.04. I'm sure if they knew that it had spread, before you had surgery, they would not have had you going for surgery. I will keep you in my prayers. God bless - Mike

ron9213

mikebur said:

Hi Ron. I'm sorry that the cancer has spread. I do not know if your case is unusual but I do know that doctors keep saying, lately, that the psa to detect cancer should be lowered from 4 to 2.5 (especially in younger men - I too am 55 years old). My psa was 4.6 at diagnosis and I also had an RP. My surgeon said that there was some cancer at the edges and in the capsule but so far my post op psa is down to 0.04. I'm sure if they knew that it had spread, before you had surgery, they would not have had you going for surgery. I will keep you in my prayers. God bless - Mike

Mike,

Thanks for your concern and kind words. I concur with the lowering of the psa standard for cancer detection. Your prognosis sounds fairly promising and you obviously believe in the power of prayer. As for my case, there was no evidence of progression beyond the prostate capsule. As such, prostetectomy was the best option at the time. I am not bitter and do not regret having made the decision. I believe that God's hand will shape my future. I also believe that His intervention will be in the form of a medical breakthrough. Again thanks for taking the time to respond. May our mutual prayers reach God's ear. Ron

Bhdon

Ron, Read your post and your question " how often does one find such advanced involvement at so low a PSA level? " My husband, now 54, was also diagnosed soley via rate of rise, and then subsequent biopsy, in May 2002, at the age of 52. His PSA at the time was 3.7, and like you, it was the rate of rise that caught the attention of his doc. He had a RP in August of 02.The post op pathology report came back with a Gleason 3+4 = 7, moderately aggressive. All margins were clear, all nodes were clear, no sign of mets, bone scan prior to surgery was negative. Because there appeared to be no involvement outside the prostate, the surgeon decided to do the nerve sparing technique. All PSAs have been zero since surgery, but his most recent PSA in January, came back 0.15, which indicates a recurrance ( 17 months post op). My understanding is, that if your Gleason score is 7+ the odds of microscopic mets increases significantly, even if everything looks 'clear' at the time of surgery. My understanding as well, is that some of the more aggressive, poorly differentiated tumors do not produce PSA. We have an appointment in May with the surgeon and the oncologist. Apparently waiting until May will give them more information re: the doubling time, which will then help them make some suggestions re: treatment. They will also consider then, the possibility of a Prostascint Scan to check for bone mets. So, in response to your question, my understanding is, that anytime the Gleason score is 7+, the odds of microscopic (undetectable) mets, i.e. spread beyond the prostate, increases, even with a low level of PSA. You don't say what your Gleason score is, but your physician/oncologist will be able to tell you. Those higher Gleason scores are trickier to manage, but you are not alone. Based on hundreds of hours of reading that I have done, I seriously believe that diet, super nutrition, and exercise can make a difference in the rate of growth, even with more aggressive cancers. Lots of information, on the internet regarding this! Just go to a search engine and type in keywords: prostate cancer diet nutrition. Or, you can go to any online book vendor, and type in the same keywords, and pull up dozens of books now available on the subject. Hope this helps. Becky

2ndBase

Bhdon said:

Ron, Read your post and your question " how often does one find such advanced involvement at so low a PSA level? " My husband, now 54, was also diagnosed soley via rate of rise, and then subsequent biopsy, in May 2002, at the age of 52. His PSA at the time was 3.7, and like you, it was the rate of rise that caught the attention of his doc. He had a RP in August of 02.The post op pathology report came back with a Gleason 3+4 = 7, moderately aggressive. All margins were clear, all nodes were clear, no sign of mets, bone scan prior to surgery was negative. Because there appeared to be no involvement outside the prostate, the surgeon decided to do the nerve sparing technique. All PSAs have been zero since surgery, but his most recent PSA in January, came back 0.15, which indicates a recurrance ( 17 months post op). My understanding is, that if your Gleason score is 7+ the odds of microscopic mets increases significantly, even if everything looks 'clear' at the time of surgery. My understanding as well, is that some of the more aggressive, poorly differentiated tumors do not produce PSA. We have an appointment in May with the surgeon and the oncologist. Apparently waiting until May will give them more information re: the doubling time, which will then help them make some suggestions re: treatment. They will also consider then, the possibility of a Prostascint Scan to check for bone mets. So, in response to your question, my understanding is, that anytime the Gleason score is 7+, the odds of microscopic (undetectable) mets, i.e. spread beyond the prostate, increases, even with a low level of PSA. You don't say what your Gleason score is, but your physician/oncologist will be able to tell you. Those higher Gleason scores are trickier to manage, but you are not alone. Based on hundreds of hours of reading that I have done, I seriously believe that diet, super nutrition, and exercise can make a difference in the rate of growth, even with more aggressive cancers. Lots of information, on the internet regarding this! Just go to a search engine and type in keywords: prostate cancer diet nutrition. Or, you can go to any online book vendor, and type in the same keywords, and pull up dozens of books now available on the subject. Hope this helps. Becky

I was diagnosed with terminal prostate cancer in Nov. 2002. 2nd opinion urologist gave me two years if I decided to get treated. My psa was 23 with a Gleason score of 9. I took one shot of Lupron and then 40+ radiation treatments. Took 2 months off work to recover and when I tried to go back to work was told I had been replaced. Then took a job for 1/4 the money for six months until the pain was just unbearable. I applied for SS disability and was denied. I now have no job or insurance and am trying to live on retirement money. I am only 52 years old. Had I not started with treatment I firmly believe I would still be working even if slightly closer to my demise. I really don't want any more treatment and am not afraid of the future. My last psa test after radiation was down to .2 but I realize it doesn't mean much. Anyone else have a terminal diagnosis with similar circumstances? If so please contact me and let me know how you are doing. Thank You. www.secondbaseny@cs.com

Medcomglen

Bhdon said:

Ron, Read your post and your question " how often does one find such advanced involvement at so low a PSA level? " My husband, now 54, was also diagnosed soley via rate of rise, and then subsequent biopsy, in May 2002, at the age of 52. His PSA at the time was 3.7, and like you, it was the rate of rise that caught the attention of his doc. He had a RP in August of 02.The post op pathology report came back with a Gleason 3+4 = 7, moderately aggressive. All margins were clear, all nodes were clear, no sign of mets, bone scan prior to surgery was negative. Because there appeared to be no involvement outside the prostate, the surgeon decided to do the nerve sparing technique. All PSAs have been zero since surgery, but his most recent PSA in January, came back 0.15, which indicates a recurrance ( 17 months post op). My understanding is, that if your Gleason score is 7+ the odds of microscopic mets increases significantly, even if everything looks 'clear' at the time of surgery. My understanding as well, is that some of the more aggressive, poorly differentiated tumors do not produce PSA. We have an appointment in May with the surgeon and the oncologist. Apparently waiting until May will give them more information re: the doubling time, which will then help them make some suggestions re: treatment. They will also consider then, the possibility of a Prostascint Scan to check for bone mets. So, in response to your question, my understanding is, that anytime the Gleason score is 7+, the odds of microscopic (undetectable) mets, i.e. spread beyond the prostate, increases, even with a low level of PSA. You don't say what your Gleason score is, but your physician/oncologist will be able to tell you. Those higher Gleason scores are trickier to manage, but you are not alone. Based on hundreds of hours of reading that I have done, I seriously believe that diet, super nutrition, and exercise can make a difference in the rate of growth, even with more aggressive cancers. Lots of information, on the internet regarding this! Just go to a search engine and type in keywords: prostate cancer diet nutrition. Or, you can go to any online book vendor, and type in the same keywords, and pull up dozens of books now available on the subject. Hope this helps. Becky

ProstaScint Scans
Hi Becky,
My second opinion Oncologist scheduled a ProstaScint scan. First group of Doctors suggested RP surgery, Casodex, radiation right away. The ProstaScint scan complimented my decision not to have Davinci RP surgery due to the Metastatic results found. I was surprised how many don't suggest ProstaScint scans for further detection. Please let me know if you have found any research regarding ProtaScints credibility. 56 at diagnosis with 14.7 PSA, 3+4=7, Gleason 7. Now I'm 58 with PSA 0.6 from intermittent lupron and Firmagon therapy.

Wishing you and yours good health.
Glen