PSA 60, G3+4

Hi Lyn,

You are a ray of hope that I desperately need right now even if it's just to calm my mind till the next storm. Tonight I could feel the stress in my chest as tension so tomorrow I'll be taking myself off on a very long walk in the countryside. I don't yet have my diagnosis in writing and it wasn't mentioned so I'm wondering if they are going to wait for the results of the PET scan. Thank you again.

I've got a lot of reading lined up since my initial diagnosis and I know I need to start taking notes and making sure I understand what's going on. 

One thing that occurred to me today was he mentioned I had a lesion on or in (can't remember which he said) my left arm and would request an MRI be done. It just occurred to me I'd fallen off my bike onto my left side a couple of weeks ago, it was a bit painful at the time but that's all. 

I'm trying to figure out the relationship (if there is one) between PSA and the spread of the cancer. In other words is it possible to have a high PSA going into the 100s for both localised, localised advanced and advanced prostate cancer?

There isn't always a relationship between the two; all the PSA does is indicate that further assessment is needed. We had a man on here whose PSA was 3 but he had bone mets all over his body; we have had a few men recently with PSA of 80 or more who were subsequently told they did not have cancer. My husband's PSA was 3.1 and assumed to be a very early diagnosis but it turned out to be locally advanced to his bladder neck.

Obviously, once the PSA gets very high, the likelihood of mets in bone or soft organs becomes very high - generally speaking, men with bone mets fare better than men with mets in lung, kidneys, liver, etc. 

The scan picks up bone activity / growth but would not always be able to tell the difference between a healing injury and mets. 

Looking at https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/ it would seem I'm in the high risk category since my PSA was 60. My Gleason score came out as 7 (3+4) and my cancer had progressed through the prostrate shell. The doctor in Urology who gave me my initial diagnosis said he didn't think my lymph nodes had cancer but I was being sent for an urgent PET scan. He has based his info on the DRE, the biopsy,  MRI & Nuclear bone scans. 

TBH I'm expecting the worst as my PSA level is throwing me in at the deep end. I know it's really hard for anyone to say and it's pointless giving false hope or trying to pre-emptively gives answers until the PET scan is in. But if the PET doesn't throw up bad news am I curative or have I gone past that?

The bone scan doesn't detect prostate cancer directly, but it detects recently growing bone, because mets cause bone changes around them. If you've damaged or broken a bone in the last 6 months, it will show up on the bone scan too as it's healing. So does arthritis (although bone mets don't tend to be on joint surfaces where arthritis is, so that's quite easy to distinguish). So falling off your bike could be the cause if it caused some micro-fractures. If there are just one or two suspicious spots, they will get more detailed scans or X-rays to check for mets specifically.

The reason to delay the bicalutamide is that it will impact the PSA (and they don't want that until they have a second PSA test and can see if/how it's changing by itself), and it would reduce the sensitivity of the PSMA scan.

By the way, if you were interested in Brachytherapy, you need to ask an oncologist who does it if you're suitable. I would not take the word of a urologist on this.

I had what might be a similar diagnosis to you, and I had a combination of external beam radiotherapy, and HDR brachytherapy. (It's all in my profile.)

Edited by member 15 Nov 2022 at 15:07  | Reason: Not specified

The information was on the BAUS website, but it vanished a few months ago. I did ask a BAUS surgeon, but he was unaware it was being taken down, so he didn't know why.