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Can a low PSA be still metastasize?

Posts: 8
Joined: Sep 2012

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.

Posts: 8
Joined: Sep 2012

His PSA was 0.01 for 18 months then 0.03 now 0.13

VascodaGama's picture
Posts: 3405
Joined: Nov 2010


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;

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


Posts: 8
Joined: Sep 2012

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.

Kongo's picture
Posts: 1166
Joined: Mar 2010


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.


Posts: 8
Joined: Sep 2012

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

Posts: 931
Joined: Jan 2010

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.

Posts: 8
Joined: Sep 2012

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

Posts: 8
Joined: Sep 2012

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.

Posts: 2
Joined: Jan 2013

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

ralph.townsend1's picture
Posts: 359
Joined: Feb 2012

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!!!


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