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undetectable PSA and bone mets ?

I posted a while back about my situation, I had Davinci surgery back in June of 08, my PSA for my three month and six month test was <0.02 on both. I had been having pelvis pain since May of 08 and finally talked my Uro into a bone scan in October. It came back with 2 areas consistent with metastastic disease, one in my pelvis and one in a rib. I have been seen at both the University of Washington and M.D. Anderson, both of the Onco's are stumped. Obvoiusly there are false positive scans but I have pain in the pelvis where the one spot is and am beginning to feel the rib spot from time to time. I have discussed a possible needle biopsy to the rib but both Onco's say they thank it's best to wait a few months and do another bone scan to see if anything has changed. I have done research and have found a very few instances where men had undetectable PSA's and bone mets.

Any ideas out there

David

Re: undetectable PSA and bone mets ?

G'day David,

I'm sorry to say I can't recall all the details of your diagnosis. For example, what was your PSA on diagnosis - and had there been any rapid changes in your PSA? And what was your Gleason Score? How many positive needles?

There is a form of our shared disease that is very aggressive and yet which generates very low PSA levels. Because it is fast moving, it is usually detected by DRE since it will not be detected by an elevated PSA. If that was your case, then the disease may have spread beyond the gland before diagnosis even.

Truly, as the late Aubrey Pilgrim used to say "The Golden Rule of PCa is that there are no Rules."

All the best

Terry in Australia

Re: Re: undetectable PSA and bone mets ?

Terry: Thanx for the response. My inital PSA was 5.5. I had 4 out of 12 positive needle sticks on my biopsy with 3 being Gleason 6 and 1 Gleason 8. I was staged T1c, DRE was clean, bone scan and CT clean also except one of the spots now considered a met was called arthritic on the bone scan Hmmm. Both of my Onco's call me the "mystery man." I'll update you from time to time if you like since I'm one of the more oddball cases.

David

Re: undetectable PSA and bone mets ?

I had pain (bone?) for years in my thighs and lower back and even in my right shoulder, it was all attributed to being overweight (pinching nerves). Finally got a CT scan in Jan 06,keen eyed tech saw something wrong and expanded the scope of the scan, result, bone mets. PSA in mid 90's, DRE showed nothing, biopsy was not good all samples showed some cancer, bone scan showed mets at multiple locations form shoulders to knees. I have been on ADT and radition for three years, I love to read the guys who have been doing this for 10 or more years. Haven't given up hope.

Re: Re: undetectable PSA and bone mets ?

Hello Bernie,
I readwith interest your posting.
My husband was diagnosed in may 08 with psa 93.5 gleason 9 and stage T3b. Bone scans have shown no mets. We were very relieved. I am amazed with such a high psa and gleason that it showed no mets. He was sent for an xray on his hip as the bone scan showed "something". The oncologist said that the xray was ok. I am very suspicious of these "wear and tear" spots on bone scans and xrays which is what they say are on my husband's shoulders and one hip His pelvic MRI scan showed spread to both seminal vesicles and into the borders of the gland. His urologist has said the scans cannot account for micro spread. He has been on zoladex for 6 months and his psa on the last blood test was .70 which is great. I am very worried that with such high initial results that these micro cells are lurking somewhere and waiting for the adt to fail. Was your gleason score and stage high at initial diagnosis. Where did you have the radiotherapy? They have told my husband that he is not a candidate for radiotherapy, only adt. How are you doing with your treatment? Is the treatment keeping everything under control. I do hope it is.
Best wishes
Jennie

Re: Re: Re: undetectable PSA and bone mets ?

Hi Jennie,

My husband was 50 in June of 2007 when first diagnosed. His PSA was 19.8 and gleason of 4+3, Type IV. He was told that his cancer was VERY aggressive and not curative. We were looking into HIFU but had to ensure that the cancer had not spread outside the prostate (11% chance it could have). Well, the lymph node removal and biopsies confirmed that it had spread to the nodes. MRI and Bone scans showed clear back then. He was treated with a three tier approach. Casodex/LUPRON, then tomotherapy for 25 sessions and lastly, HDR. He developed severe hip pain a month after the HDR and a week before his second LUPRON shot. X-Ray showed nothing.
Now he has developed pain in his back and right heel. So severe that he lives on morphine and supplements it with vicodin. His last PSA was .67
Just had a bone scan done last week. Something was there but of course the tech could not comment. We are awaiting the results.
As others have mentioned, low PSA may not tell the true story for those with "aggressive" PC.
Life at 52 is just a constant drug high for Fred. Hopefully, this scan will give us some answers and therefore, some combative ways to fight this awful awful disease.
Thanks,
Doreen

Re: undetectable PSA and bone mets ?

Jennie,

While I don't know the details of your husband's case, I couldn't disagree more that he is not a candidate for Radiation treatment.

From my point of view, that is only true when it has been confirmed that there is distant metastasis.

If there are known mets outside the pelvis, it doesn't matter what you do to the pelvic area. Elvis has left the building.

However, even with a high PSA and Gleason, if his bone scan and CT are clear, he may well benefit from whole pelvic IMRT.

Get another opinion.
Consult with a radiologic oncologist.

Tony - USA

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