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Can cancer spread to bones with PSA <0.1?

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User
Posted 04 Mar 2026 at 15:44

Hi,

I thought I had already posted this but it doesn’t appear to have went through.

briefly (check my profile for full history) but I was diagnosed in 2014 

Gleason 7 (4+3)

PSA 8

had prostatectomy Nov 2014 - clear margins

Stage 2 (c)

thought all was well until my PSA rose to 0.2 and I had radiotherapy plus 2 years of hormone therapy

since then all 6 monthly PSA tests have been <0.1 (last one November 2025)

however, in an unrelated X-Ray for rib injury - a small white mark appeared on my shoulder that wasn’t on a previous X-Ray 6 years ago

I don’t recall any injury, have no pain or symptoms but this has alarmed me a bit. Am I being a bit paranoid? Or is it possible for cancer to spread without any PSA rise? (Unless it rose in the last 4 months )

any advice appreciated- I have tried to contact my Oncology nurse but had no response as yet 

Edited by member 04 Mar 2026 at 16:33  | Reason: Typo

User
Posted 04 Mar 2026 at 18:35

I’m not sure I agree about the likelihood of spread if a PSA sub 20.  I have advanced PC - Gleason 4+4. -  Metastatic sites in pelvis and spine.  When diagnosed in August 2024 my PSA was 9.1.  But in fairness a PSA at the levels you are at would I think suggest the chance of spread must be very remote.  Mark Scholz (check him out on Instagram) I am sure did something on this a year or so ago.

User
Posted 05 Mar 2026 at 21:25

I've read  through this again. You've mentioned an x-ray spot on your shoulder, but are you getting any pain from your shoulder?

Your profile mentions kayaking, could this be the source of your rib problems? It's a very upper body focussed sport and things can get quite rough on white water.

As for the shoulder, a  bone scan, or PSMA scan if you can get one, should answer your worries, but rest assured if you had active cancer in your shoulder you would know about it. Bone pain isn't fun! As per my previous post DO NOT let the doctors get away with PSA check ups only. Insist on a scan every couple of years as a minimum - pay for it yourself if you have to. Don't be like me and let it slide on PSA tests and consultant reassurance. Otherwise you might end up like me in a world of pain 

 

 

User
Posted 04 Mar 2026 at 18:18

Bill , I remember frequently being told bone spread was unlikely if the PSA was under 20. 

Thanks Chris 

User
Posted 05 Mar 2026 at 00:08
There are quite a number of different kinds of PCa, some of which show very low PSA but these are not common. The well regarded Dr Eugene Kwon of Mayo. (a major USA hospital) has had patients in his clinic with zero PSA who have spread throughout the body, so it is possible but exceptions.
Barry
User
Posted 05 Mar 2026 at 09:03

Hi

The answer is unfortunately yes! My PSA has remained at<0.1, but my new mutated cancer is now in my bladder, ureter, liver, seminal vesicles, lymph nodes, femur, a vertebrae and my pelvis! It is unusual and the oncologist didn't believe me for months when I said I knew something was wrong, due to the PSA levels!

Role on chemo next Tuesday! Due to unusual nature of my new cancer cells I'm having carboplatin and gemcitabine. Anyone have any experience of these?

User
Posted 05 Mar 2026 at 10:19

Hi , I did say unlikely and that was the response from my ,CNS , the nurses on this site and my oncologist. 

I suppose the other thing to consider is that detection techniques have improved since I was asking the question. I remember one of our much loved members being diagnosed with a PSA below five but had bone spread. 

Thanks Chris 

User
Posted 05 Mar 2026 at 10:52

Hi try not to catastrophise! I see a few chaps have come up with very rare examples of worst case scenarios. 

I have also seen one guy who'd had a similar false alarm. Try to just let time pass till you know 

User
Posted 05 Mar 2026 at 11:29

Originally Posted by: Online Community Member

Hi try not to catastrophise! I see a few chaps have come up with very rare examples of worst case scenarios. 

I have also seen one guy who'd had a similar false alarm. Try to just let time pass till you know 

thank you Antoinette,

this is simple yet so wise advice. I’m not usually prone to over-worrying but probably in a poorer state to manage the possibility of another recurrence as I’m having hardly any sleep and in a lot of pain due to costochondritis (rib cartilage inflammation) which took me to to A&E on Tuesday and resulted in the chest X-Ray - which they only decided to do last minute as my breathing was so difficult or I would never have known about this thing on my shoulder 

so feeling physically in pain, immobile and poorly is making me less able to respond with hopefulness and patience- but I shall endeavour to 🙏

User
Posted 05 Mar 2026 at 12:03

Dear KayakerBill, I had been reading these posts and was wondering if ForestJohn would weigh in. Sobering and I am sure we are all deeply hoping for the best there. I am also a worrier myself but that does my husband no good and thankfully his physicians provide him great reassurance when I ask all my what if questions. Plenty of us have shoulder pain as we get on, and it is extremely hard not to worry, but I am with Antoinette on this one. That said, I also know from my husband's mental state how hard that is without actively training yourself to take things as they come. Unfortunately, I think HT makes that worse as you can read from many postings about the emotional effects. So I hope you can find out as soon as possible. Better PSMA-PET if it can be offered. Good luck and try to bear in mind that extreme shoulder pain is quite common in the 50+ population, and I hope you can find a way to train your thoughts in other directions until the appointment.

User
Posted 06 Mar 2026 at 17:35

No expert, but what I have learnt from my journey so far is your PSA score is a good indicator of what's going on. Yours has been very low, November is not that long ago, and hasn't been increasing, so that's all positive. Having another PSA test and PSMA Pet scan will give you more insight.

I don't believe it's true about not being able to get bone metatasis with a PSA under 20. Mine, post op and post RT, went to 2.6 then 10.8 and I have bone mets in my spine, skull, ribs and ferums (St 4 PC). That said you don't have a PSA increasing, so try to focus on that positive until you know more from the follow ups.

Wishing you all the best

User
Posted 06 Mar 2026 at 23:21

From what I've read it's rare to get mets at such a low level of psa.  It also seems surprising an X ray would find them.  I recall my dad having an X ray and they kept pointing at marks and told him they thought he had an unspecified cancer.  It took 2 months for them to say it wasn't, that's about 30yrs ago.

I went to my GP last May with a bad back and rib pain and ended up with an X ray and an MRI.  They then decided after some debate to give me a CT scan.  They found nothing 'sinister' but did find some other 'incidental' problems. I wasn't confident they'd find anything anyway with those scans at my psa level even though it is increasing.

The met level at 20 is usually related to psa before you've had treatment.  Speed of psa increase is normally a feature of mets after an op.

It sounds unlikely but I can understand your mind working it over.  Gook luck, Peter

User
Posted 11 Mar 2026 at 21:13

I think that's one piece of good news. My logic tells me it's far less likely to be a very rare kind than something far less worrying.

Wishing you the best x 

User
Posted 18 Mar 2026 at 16:42

I was Gleeson 6 in march 24 with a PSA of 8.66 RALP in Dec 24 PET scan in Feb 26 with two bone METS one on the Sternum and on in the HIP PSA never went above 8.66 - Prostate Cancer is the gift that keeps on giving, all you get from the vapious doctors is " It isn't behaving as we expect"  no S**T Sherlock.

 

Good luck

User
Posted 21 Mar 2026 at 20:57

Good luck with your results pal. I’ll keep my fingers crossed for you.

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User
Posted 04 Mar 2026 at 18:18

Bill , I remember frequently being told bone spread was unlikely if the PSA was under 20. 

Thanks Chris 

User
Posted 04 Mar 2026 at 18:26

Thanks Chris,

that was my thinking until I started “over thinking” I sometimes feel I have moved on from cancer and live in a kind of denial, then things can pop up and shock me

hopefully it’s something non- sinister and I can relax a bit again. But it’s a reminder of the horror of this illness

User
Posted 04 Mar 2026 at 18:35

I’m not sure I agree about the likelihood of spread if a PSA sub 20.  I have advanced PC - Gleason 4+4. -  Metastatic sites in pelvis and spine.  When diagnosed in August 2024 my PSA was 9.1.  But in fairness a PSA at the levels you are at would I think suggest the chance of spread must be very remote.  Mark Scholz (check him out on Instagram) I am sure did something on this a year or so ago.

User
Posted 05 Mar 2026 at 00:08
There are quite a number of different kinds of PCa, some of which show very low PSA but these are not common. The well regarded Dr Eugene Kwon of Mayo. (a major USA hospital) has had patients in his clinic with zero PSA who have spread throughout the body, so it is possible but exceptions.
Barry
User
Posted 05 Mar 2026 at 09:03

Hi

The answer is unfortunately yes! My PSA has remained at<0.1, but my new mutated cancer is now in my bladder, ureter, liver, seminal vesicles, lymph nodes, femur, a vertebrae and my pelvis! It is unusual and the oncologist didn't believe me for months when I said I knew something was wrong, due to the PSA levels!

Role on chemo next Tuesday! Due to unusual nature of my new cancer cells I'm having carboplatin and gemcitabine. Anyone have any experience of these?

User
Posted 05 Mar 2026 at 10:19

Hi , I did say unlikely and that was the response from my ,CNS , the nurses on this site and my oncologist. 

I suppose the other thing to consider is that detection techniques have improved since I was asking the question. I remember one of our much loved members being diagnosed with a PSA below five but had bone spread. 

Thanks Chris 

User
Posted 05 Mar 2026 at 10:42

Thanks for the replies. My oncologist nurse has spoken to the Consultant and organised a PSA test as well as a bone scan to have a clearer look

I have a bad feeling about it tbh but trying to stay hopeful 

User
Posted 05 Mar 2026 at 10:52

Hi try not to catastrophise! I see a few chaps have come up with very rare examples of worst case scenarios. 

I have also seen one guy who'd had a similar false alarm. Try to just let time pass till you know 

User
Posted 05 Mar 2026 at 11:29

Originally Posted by: Online Community Member

Hi try not to catastrophise! I see a few chaps have come up with very rare examples of worst case scenarios. 

I have also seen one guy who'd had a similar false alarm. Try to just let time pass till you know 

thank you Antoinette,

this is simple yet so wise advice. I’m not usually prone to over-worrying but probably in a poorer state to manage the possibility of another recurrence as I’m having hardly any sleep and in a lot of pain due to costochondritis (rib cartilage inflammation) which took me to to A&E on Tuesday and resulted in the chest X-Ray - which they only decided to do last minute as my breathing was so difficult or I would never have known about this thing on my shoulder 

so feeling physically in pain, immobile and poorly is making me less able to respond with hopefulness and patience- but I shall endeavour to 🙏

User
Posted 05 Mar 2026 at 12:03

Dear KayakerBill, I had been reading these posts and was wondering if ForestJohn would weigh in. Sobering and I am sure we are all deeply hoping for the best there. I am also a worrier myself but that does my husband no good and thankfully his physicians provide him great reassurance when I ask all my what if questions. Plenty of us have shoulder pain as we get on, and it is extremely hard not to worry, but I am with Antoinette on this one. That said, I also know from my husband's mental state how hard that is without actively training yourself to take things as they come. Unfortunately, I think HT makes that worse as you can read from many postings about the emotional effects. So I hope you can find out as soon as possible. Better PSMA-PET if it can be offered. Good luck and try to bear in mind that extreme shoulder pain is quite common in the 50+ population, and I hope you can find a way to train your thoughts in other directions until the appointment.

User
Posted 05 Mar 2026 at 21:25

I've read  through this again. You've mentioned an x-ray spot on your shoulder, but are you getting any pain from your shoulder?

Your profile mentions kayaking, could this be the source of your rib problems? It's a very upper body focussed sport and things can get quite rough on white water.

As for the shoulder, a  bone scan, or PSMA scan if you can get one, should answer your worries, but rest assured if you had active cancer in your shoulder you would know about it. Bone pain isn't fun! As per my previous post DO NOT let the doctors get away with PSA check ups only. Insist on a scan every couple of years as a minimum - pay for it yourself if you have to. Don't be like me and let it slide on PSA tests and consultant reassurance. Otherwise you might end up like me in a world of pain 

 

 

User
Posted 06 Mar 2026 at 00:12

Hi John,

no I have zero pain in my shoulder whatsoever 

the rib pain is totally unrelated, I just injured my ribcage and got painful cartilage inflammation - it was the chest X-Ray for that which showed up the white spot on the shoulder area

its reassuring to know that if I did have bone mets then it would cause pain. I’m hoping it’s an old injury or something harmless but I don’t recall any injuries other than a rotator cuff injury maybe 8 years ago

bone scan hopefully soon 

Edited by member 06 Mar 2026 at 00:33  | Reason: Not specified

User
Posted 06 Mar 2026 at 17:35

No expert, but what I have learnt from my journey so far is your PSA score is a good indicator of what's going on. Yours has been very low, November is not that long ago, and hasn't been increasing, so that's all positive. Having another PSA test and PSMA Pet scan will give you more insight.

I don't believe it's true about not being able to get bone metatasis with a PSA under 20. Mine, post op and post RT, went to 2.6 then 10.8 and I have bone mets in my spine, skull, ribs and ferums (St 4 PC). That said you don't have a PSA increasing, so try to focus on that positive until you know more from the follow ups.

Wishing you all the best

User
Posted 06 Mar 2026 at 23:21

From what I've read it's rare to get mets at such a low level of psa.  It also seems surprising an X ray would find them.  I recall my dad having an X ray and they kept pointing at marks and told him they thought he had an unspecified cancer.  It took 2 months for them to say it wasn't, that's about 30yrs ago.

I went to my GP last May with a bad back and rib pain and ended up with an X ray and an MRI.  They then decided after some debate to give me a CT scan.  They found nothing 'sinister' but did find some other 'incidental' problems. I wasn't confident they'd find anything anyway with those scans at my psa level even though it is increasing.

The met level at 20 is usually related to psa before you've had treatment.  Speed of psa increase is normally a feature of mets after an op.

It sounds unlikely but I can understand your mind working it over.  Gook luck, Peter

User
Posted 11 Mar 2026 at 19:31

So wee update today

PSA still <0.1 so that’s a bit of a relief, and bone scan booked for Thursday 19th March to get to the bottom of this

Just hoping don’t have a rare prostate cancer that has spread without giving off PSA (or that I don’t have a new type of cancer that has spread without giving me any symptoms)

User
Posted 11 Mar 2026 at 21:13

I think that's one piece of good news. My logic tells me it's far less likely to be a very rare kind than something far less worrying.

Wishing you the best x 

User
Posted 18 Mar 2026 at 16:42

I was Gleeson 6 in march 24 with a PSA of 8.66 RALP in Dec 24 PET scan in Feb 26 with two bone METS one on the Sternum and on in the HIP PSA never went above 8.66 - Prostate Cancer is the gift that keeps on giving, all you get from the vapious doctors is " It isn't behaving as we expect"  no S**T Sherlock.

 

Good luck

User
Posted 19 Mar 2026 at 14:55

Well, bone scan and CT scan done today, always a bit anxiety inducing waiting for any kind of results 😬

 

fingers crossed …

User
Posted 21 Mar 2026 at 20:57

Good luck with your results pal. I’ll keep my fingers crossed for you.

 
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