Metastatic spread without PSA rise

User

Posted 01 Jun 2018 at 18:54

I was diagnosed with Stage T1c prostate cancer Gleason 6 Psa 2.7 age 47 in Jan 2015 --Mri scans clear no spread beyond prostate gland.March 2015 urinary problems so i opted for a Radical prostatectomy --post operative pathology showed 2 tumors both extending through prostate wall ,extensive spread into nerve bundles and left seminal vescicle --Stage 3a and 3b Gleason 6.Offered Hormone therapy and 6 weeks of radiation as part of the Radicals trial but i refused the radiation and came of the trial,so the offer of Hormone therapy was withdrawn as well.

3 years on my urinary symptoms are no better and i had intermittent pain in hips and ribs, now the pain is constant in my hips and other joints with intermittent left side paralysis but no PSA rise and last bone scan 2 years ago only showed indeterminate uptake in groin area.

My question is can prostate cancer spread without elevated PSA

User

Posted 01 Jun 2018 at 22:15

I can't answer this for certain but I've had hip pains for 2 years and have asked several doctors at post operation assessments if with an undetectable psa can you have bone spread and they all said not. Although I didn't tell them why I asked.

My GP sent me for a psa test to rule it out as well. He said it seems like Arthritis and offered strong Ibuprofin gel which did nothing.

I'd think you can have very small spread and have undetectable psa but not enough to give pain and it will grow so the psa becomes detectable. That's just my thinking.

I've had other medical staff saying you should not imagine every pain is associated.

Someone else might have some real knowledge on this as it's something I've been interested in but decided time will tell.

Regards

Edited by member 01 Jun 2018 at 22:30 | Reason: Not specified

User

Posted 02 Jun 2018 at 00:00

I am struggling with why you refused radiotherapy at the point when you were possibly still curable but it is in the past now. What might really help would be confirmation that you definitely had adenocarcinoma - there are other more rare prostate cancers that do not give off PSA even when metastatic.

Have you still got the pathology report?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User

Posted 01 Jun 2018 at 22:15

My GP sent me for a psa test to rule it out as well. He said it seems like Arthritis and offered strong Ibuprofin gel which did nothing.

I'd think you can have very small spread and have undetectable psa but not enough to give pain and it will grow so the psa becomes detectable. That's just my thinking.

I've had other medical staff saying you should not imagine every pain is associated.

Someone else might have some real knowledge on this as it's something I've been interested in but decided time will tell.

Regards

Edited by member 01 Jun 2018 at 22:30 | Reason: Not specified

User

Posted 01 Jun 2018 at 23:05

Short answer is yes, it can spread in a minority of men without the expected rise in PSA. We have had (a very few) members on this forum who have experienced ithis. A widely respected Mayo oncologist said he had experienced rare cases where the cancer had spread when the PSA was zero. I won't post the link again unless requested, as it has been posted several times previously.

It could help identify the present situation if you had a PSMA scan, but where the cancer has spread more widely and extensively, regardless of the result and what you have previously told us, it is likely that further treatment would be systemic.

Barry

User

Posted 02 Jun 2018 at 00:00

Have you still got the pathology report?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 02 Jun 2018 at 16:10

I regret not having the radiotherapy but as you say you cannot turn back time ---

The Pathology report says The foci of tumor are identified,both peripherally located .The first lies posterio-inferior and the second right lateral superior .Both lobes of prostate are involved .

There is extensive perineural invasion and extracapsular spread is identified within large nerve bundles .Extracepsular spread reaches 0.5mm beyond capsule and this point,the circumfirential resection margin is 2mm .Circumferential surgical margins are clear .

Tumor extends into the base of the right seminal vesicle but there are no seminal vesicle metastases.The vas deferens are not involved .The bladder base and apical margins are clear .

Both foci of tumor occupy 1.5cc approx each .Total tumor volume is 3cc approx and tumor involves 15% of total prostate volume.

Diagnosis:Prostate --Adenocarcinoma

--Gleason 6

--pt3a AND pt3b

User

Posted 02 Jun 2018 at 16:15

I was tested for various forms of arthritis all came back negative ,then i was sent for a brain scan which came back some foci changes to both hemispheres but nothing really unusual so they want to proceed to a spinal tap which i have read horror stories about so now in limbo a bit with what to do next.My urologist is seeing me on Monday but i don't think i will get any more answers apart form stronger painkillers again.

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