Can a low PSA be still metastasize?

Gmad
Gmad Member Posts: 8 Member
edited May 2023 in Prostate Cancer #1
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.

Comments

  • Gmad
    Gmad Member Posts: 8 Member
    PSA
    His PSA was 0.01 for 18 months then 0.03 now 0.13
  • VascodaGama
    VascodaGama Member Posts: 3,638 Member
    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
    Gmad Member Posts: 8 Member

    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
    Kongo Member Posts: 1,166 Member
    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
    Gmad Member Posts: 8 Member
    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
    Trew Member Posts: 932 Member
    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
    Gmad Member Posts: 8 Member
    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 Member Posts: 8 Member
    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
    albert2 Member Posts: 2
    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
    ralph.townsend1 Member Posts: 359 Member
    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
    PJToo Member Posts: 2 *

    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
    PJToo Member Posts: 2 *

    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
    Old Salt Member Posts: 1,284 Member

    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.