Can a low PSA be still metastasize?

Gmad

My hubby is 70.
Biopsies 12 of 12 positive.
PSA dbl. in a yr. to 7.6
Robot surgery 18 months ago. Gleason 4=5+9 and 5+4-9.
Invaded the seminal vesicles.
Lymph nodes removed clear.
Stage T3b.
Can a PSA that low metastasize?
Collecting information.
Doctor is planning hormone treatments and radiation.

Gmad

PSA
His PSA was 0.01 for 18 months then 0.03 now 0.13

VascodaGama

Gmad said:

PSA
His PSA was 0.01 for 18 months then 0.03 now 0.13

Grade 5 are aggressive and may produce lesser PSA
Gmad

Unfortunately the constant increase of the PSA signals recurrence. The combi of hormone plus radiation is typical as a salvage treatment in similar cases.
The spread of cancer may be a cause of the aggressive type of his cancer. Grade 5 and 4 are the highest in risk for recurrence and are difficult to treat. In fact aggressive type of cancer cells produce less PSA than lower aggressive cancer. Low PSA levels usually are for tumours of small size (1 to 2 mm) difficult of being detected by traditional scans, but in cancer with grade of 5 (poorly differentiated) the tumour may be bigger. If such is the case of Hubby than an image study may find where the cancer is hiding.

I would recommend you to discuss with his doctor and try getting a MRI or PET with the lattes contrast agents (C11 choline, F18 or Feraheme) and techniques. You cannot expect to hit the targets in the "dark".
You can read about this in this link; http://csn.cancer.org/node/245110#comment-1269039

A List of questions to the doctor may help you when meeting him again. Here are examples that you can adapt to Hubby’s case;
http://csn.cancer.org/node/224280
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

Welcome to the board.
Wishing Hubby luck in his journey.

VGama

Gmad

VascodaGama said:

Grade 5 are aggressive and may produce lesser PSA
Gmad

Unfortunately the constant increase of the PSA signals recurrence. The combi of hormone plus radiation is typical as a salvage treatment in similar cases.
The spread of cancer may be a cause of the aggressive type of his cancer. Grade 5 and 4 are the highest in risk for recurrence and are difficult to treat. In fact aggressive type of cancer cells produce less PSA than lower aggressive cancer. Low PSA levels usually are for tumours of small size (1 to 2 mm) difficult of being detected by traditional scans, but in cancer with grade of 5 (poorly differentiated) the tumour may be bigger. If such is the case of Hubby than an image study may find where the cancer is hiding.

I would recommend you to discuss with his doctor and try getting a MRI or PET with the lattes contrast agents (C11 choline, F18 or Feraheme) and techniques. You cannot expect to hit the targets in the "dark".
You can read about this in this link; http://csn.cancer.org/node/245110#comment-1269039

A List of questions to the doctor may help you when meeting him again. Here are examples that you can adapt to Hubby’s case;
http://csn.cancer.org/node/224280
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

Welcome to the board.
Wishing Hubby luck in his journey.

VGama

Thank you so much. I will do
Thank you so much. I will do that. A little scared here. Always need to know what I'm dealing with.
We are just going to do whatever is necessary to fight this thing.
Hugs

Kongo

Metastasis
Gmad,

So sorry to read of your husband's situation. When he was first diagnosed the high Gleason scores you write about were strong indications that his cancer may already have spread outside the prostate. The seminal vesicle invasion was evidence that his cancer had already moved beyond the capsule.

As prostate cancer becomes more advanced (as indicated by the Gleason score) the cells become less and less differentiated and more primitive. Eventually these cells produce less PSA because they act less and less like a normal prostate gland cell. If there had been no metastasis, your husband's PSA level should have been undetectable after his RP and it should have stayed there. The rising PSA is an indication of metastasis at this point even if they have not pinpointed where it might be growing.

Radiation to the prostate bed, that tissue area adjacent to where the prostate used to be, and hormone therapy are the most common treatment options for a patient that experiences a recurrence after RP. You should also discuss with his doctors advanced imaging techniques that might help identify the location of the metastasis although in it's early stages it may not be visible with a MRI or CT scan.

While this is a serious situation it is not a death sentence so it's important to do some research at this point to understand what is happening and what options your husband has for treatment and the potential side effects of treatment. Encourage your husband to be an assertive patient and press for the answers you need from the medical team.

Best of luck to you both.

K

Gmad

Kongo said:

Metastasis
Gmad,

So sorry to read of your husband's situation. When he was first diagnosed the high Gleason scores you write about were strong indications that his cancer may already have spread outside the prostate. The seminal vesicle invasion was evidence that his cancer had already moved beyond the capsule.

As prostate cancer becomes more advanced (as indicated by the Gleason score) the cells become less and less differentiated and more primitive. Eventually these cells produce less PSA because they act less and less like a normal prostate gland cell. If there had been no metastasis, your husband's PSA level should have been undetectable after his RP and it should have stayed there. The rising PSA is an indication of metastasis at this point even if they have not pinpointed where it might be growing.

Radiation to the prostate bed, that tissue area adjacent to where the prostate used to be, and hormone therapy are the most common treatment options for a patient that experiences a recurrence after RP. You should also discuss with his doctors advanced imaging techniques that might help identify the location of the metastasis although in it's early stages it may not be visible with a MRI or CT scan.

While this is a serious situation it is not a death sentence so it's important to do some research at this point to understand what is happening and what options your husband has for treatment and the potential side effects of treatment. Encourage your husband to be an assertive patient and press for the answers you need from the medical team.

Best of luck to you both.

K

Great advice.
I think with
Great advice.
I think with some men even though very worried it is easier to say the Beast may not really be back. Wait and see what the Doctor says.
We knew nothing about Cancer in the beginning we went to a highly recommended Clinic for advise. We thought that was the practical thing to do. In hindsight because it took us by surprise and you just want to get it out. We can't do that again.
I have a much better understanding now then I did 18 months ago.
We can just Pray for the best and do our homework.
Thank you
D

Trew

Low PSA
My PSA was never over 10.
biopsey gave me a gleason of 4+4 and moved up to 5 + 4 at time of surgery.

My cancer had moved into the bladder neck area.

I have not seen any corelation between PSA and Gleason scores.

And cancer seems to go where it wants to go.

I think that is why they do the bone scans when the gleason hits a certain number.

Gmad

Trew said:

Low PSA
My PSA was never over 10.
biopsey gave me a gleason of 4+4 and moved up to 5 + 4 at time of surgery.

My cancer had moved into the bladder neck area.

I have not seen any corelation between PSA and Gleason scores.

And cancer seems to go where it wants to go.

I think that is why they do the bone scans when the gleason hits a certain number.

I'm sorry
I feel really bad for you. I have been very worried about hubby because of a low PSA and high Gleason 9 t3b,
His Gleason now is only 0.19 but has been undetectable for 18 months.
Take care and do all you can!
I truly hope you are doing better
Hugs
D

Gmad

Gmad said:

I'm sorry
I feel really bad for you. I have been very worried about hubby because of a low PSA and high Gleason 9 t3b,
His Gleason now is only 0.19 but has been undetectable for 18 months.
Take care and do all you can!
I truly hope you are doing better
Hugs
D

Trelstar Hormone Depravation Shots
Does anyone have any problems with Trelstar and heart problems? Tom started the shots last week. One every three months. Just wondered if anyone has had a problem? I do realize every medicine added is a risk. Radiation in a week or so.
Thank you.
Diane

albert2

Gmad said:

Trelstar Hormone Depravation Shots
Does anyone have any problems with Trelstar and heart problems? Tom started the shots last week. One every three months. Just wondered if anyone has had a problem? I do realize every medicine added is a risk. Radiation in a week or so.
Thank you.
Diane

I also have a similar dilemma
I also have a similar dilemma like this, concerning with a friend. All help will be nice...

ralph.townsend1

albert2 said:

I also have a similar dilemma
I also have a similar dilemma like this, concerning with a friend. All help will be nice...

GMAD

Gmad, I'm sorry for this condition, but all these people are so on it. I hope the best and a great future.

I hope that you are getting the best medicine and doctor's!

 

God Bless and good luck!!!

Ralph

PJToo

https://csn.cancer.org/discussion/comment/1275090#Comment_1275090

PSMA-PET

Pylarify

ASAP

If current doc/facility can't/won't do. Shop till ya'll find a doc with current treatment/diagnostic commitment.

ADT is best course for low PSA. AFTER PSMA-PET!! My doc preferred I be .4 or above to avoid inconclusive diagnostics for tiny tumors. I prefer Orgovyx over Firmagon due to side effects, but Firmagon put me at indetectable. Orgovyx went to .1 for last 8 months. This to me indicates prostate cancer mets are still low level active.

No pelvic radiation! Pluvicto is modern SOC. Target cancer cells, not healthy tissue.

If patients can't research state of art of cancer care, lotsa docs use outdated old techniques AND COLLECT BIG PAYCHECKS. Legacy investments in radiology equipment is a greedy bias!

Keep eye on DT(double time).

Please google above key words!

PJToo

https://csn.cancer.org/discussion/comment/1705713#Comment_1705713

I await Pluvicto approval for mHSPC with bated breath. FDA sits on new treatments FAR FAR TOO LONG, when benefits are absolutely crystal clear!!

Old Salt

PJToo: Please start a new thread, rather than commenting on one that is a decade old.

The New Topic button (blue) is on the right.