Metastasis with undetectable PSA?

Hi hfo.

Good afternoon and welcome to our prostate cancer family but I am very sorry to have meet you under these circumstances.

I was myself diagnosed in June 2023 with terminal prostate cancer "treatable but not cure able"

My PSA was 1000+ upon diagnosis and I was also put on to HT which instantly brought my numbers down to single figures which was great.

Unfortunately my last three PSA tests have started to rise. I have recently received Palliative Radiation to my right pelvis/hip which calmed down the cancer "thank goodness"

The assumption is that if my next PSA test continues to rise then I will be starting chemotherapy in the new year.

I do hope that you will receive further help/support from other members on the forum shortly???

Prostate Worrier.

Good Afternoon hfo 

A warm welcome to the Macmillan online Prostate Community although I am so sorry to find you here. I must say that your command of English is excellent considering it's not your native language.

The answer to your question is yes, although a nuclear bone scan can diagnose bone tumors, bone infections, tumours and fractures.

I think you need to trust your team to find out just what the scan has found and even if it is Prostate Cancer related the chances are it can be treated with Radiotherapy.

At present the Hormone Therapy is doing amazing work keeping his PSA undetectable and whatever is on his hip bone may well have been there for somewhile undetected.

I do hope the above helps, remember, non of us are medically trained and for reassurance you could always pose the same question to our specialist nurses - here's the link:-

 Ask a Nurse 

Please do let us know how dad gets on.

Best wishes - Brian.

Hello hfo and welcome. Your English is excellent and puts us English expats to shame -I live in Greece and have to rely on Google translate for all correspondence in Greek.

In answer to your question then yes it is possible to have metastases with a negligible PSA. Most prostate cancers are made up of different types of cells (heterogenous). What can happen is that a single cell could have broken away and settled in the hip at the time he was first diagnosed. Over time this cell might multiply and produce a lesion of that one cell type (homogenous) which is not as sensitive to the hormone therapy he is currently on. This type of cell could be what is called a non secreter in that it doesn't give a PSA reading and needs a different strategy to deal with it either with a different type of hormone therapy in addition to his current one or with a type of targeted radiotherapy called SBRT. The other thing to say is that the bone scan can show up anomalies which are not necessarily cancer. No matter what, the experts will have a plan, firstly to either confirm that it is a metastasis or not and then to decide how it will be dealt with. 

Hello!

I just wanted to update you about my father's health.

So, he had CT, MRI and a Pet-CT and the doctors concluded is not a metastasis, but a lesion caused by the radiation treatment he had two years ago.

Alwayshope we live in Greece too!

I wish everyone to have only good news and stay healthy and strong!

Thanks for the support!

Thank you for the update and I am glad that he doesn't have any metastases.

Have they told your father how long he is going to be on Hormone Therapy? There is some thinking that if the patient achieves a negligible PSA then it might be of benefit to have intermittent therapy where he stops HT and only restarts it if it reaches a certain level again. What this would do is allow the PSA to rise above 0.2 at which point he could have a specialist PSMA PET scan which can accurately pinpoint where the problem is at an early stage and then treat it so that your father can hopefully stay on a curative pathway. We have to go to Athens for this scan but it is now available under the EOPYY system and our medical oncologist organised it for us.

The oncologist asked him to stop the HT two weeks prior to the last scan, which was PET scan. He had this scan in a public hospital in Athens (Evangelismos). His PSA was still undetectable before the scan.

This scan was on Tuesday. For now he hasn't started HT again. He will meet the doctor next week to find out what to do next... 

I will inform you!

Hi hfo . There are different types of hormone therapy which act to either stop testosterone production or to block the cancer from getting to its food of testosterone. The first type remain in the system for weeks or months wheras the second type such as Bicalutamide stop working fairly quickly. My husband had his PSMA PET scans (60 Euros) at Hygeia hospital but it is dependent on having a detectable PSA. We also have a meeting with the medical oncologist next week to decide on the next steps in this fight against prostate cancer.

All the best.