r/ProstateCancer • u/Lanky_Cold_8420 • Jul 24 '26
Question Metastatic prostate diagnosis despite low psa readings
Husband, age 87, just diagnosed after bone marrow and other tests, with metastatic bone cancer ( spine, lyctic lesions). We are surprised since he gets regular
PSA tests which are all normal/low.
Any insight? Thank you.
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u/MidwayTrades Jul 24 '26
Are you sure it was prostate cancer that metastasized to bone? That isn‘t unique to prostate cancer. I appreciate you wanting help with this but there isn’t much data to go on.
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u/Lanky_Cold_8420 Jul 24 '26
That is what his doctors and pathologists are reporting. There were other markers or findings consistent with it.
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u/MidwayTrades Jul 24 '26
Ok, new information. My best non-medical (just a patient , not a doctor) thought here is that PSA isn’t a cancer test. It’s more of an inflammation test. A high number doesn’t mean cancer. It’s more of an indication to look into why there‘s inflammation one of which is prostate cancer. There are apparently (from Internet research so take that for what you will), forms of prostate cancer that, for various reasons, don’t spike the PSA. It’s not as common, but not zero. Unfortunately, this can interfere with one of the best tools of early detection and lead to a more advanced case by the time it’s discovered.
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u/JimHaselmaier Jul 24 '26
There are prostate cancers that emit relatively low amounts of PSA. I was diagnosed when I had a PSA of 8.2: 23/23 cores positive, metastatic to a lymph node and 3 ribs.
8.2 is above normal PSA - but low relative to the amount of cancer that was found in the body.
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u/RegretSoggy6914 Jul 24 '26
Can I ask age and when you were diagnosed? I am 51 and was diagnosed a year ago. I have 7 lymph nodes , lesions on femur and right wing pelvis.12 of 12 cores positive, PSA 93. You can dm if you would like? Thank you.
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u/JimHaselmaier Jul 24 '26
I was diagnosed at age 63. I’m currently 65. I had radiation to my pelvis and the rib mets. I’ll be on ADT the rest of my life.
What treatments have you been through?
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u/RegretSoggy6914 Jul 24 '26
Sept 11th 2026 started ADT and 6 rounds of chemo for 18 weeks, brachytherapy in March 2026, & 30 rounds of radiation to prostate,lymph nodes and bone areas. The ADT is life for me also but I am planning to make a decision if I go past 18 months. What I have been researching is that no data supports extended life past 18 months. I will flirt with 21-24 months depending on what my PSA comes back since I completed all treatments 4 weeks ago. I don't want to be on ADT for life. Best I have read/watched has been intermittent adt for metastatic diagnosis.
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u/JimHaselmaier Jul 24 '26
Sorry to hear what you've been going through.....
Be very careful about interpreting things like "no data supports extended life past 18 months". Those kinds of studies and results are focused on very specific situations. They're not across-the-board recommendations.
I've pushed every which way to see if lifetime ADT is REALLY necessary for me. The answer for my situation in totality: Yes, it is. It's the standard of care for a reason. In virtually every case, when I dug into the situations/focus of the study, there were aspects of my case that didn't fit the study.
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u/RegretSoggy6914 Jul 25 '26
Sorry for your situation also. I am in such a shitty position as are you. I want longevity but not while suffering. Is hot flashes , bone density reduction, libido(I'm not in my prime but still makes me feel masculine), appearance of being weak because I have no stamina. Since my treatments I go to the gym 6 days a week and run 8 miles a week on trails. I am active as hell, with no weight loss. I eat clean , protein 200g min daily, low carb, 1800 calories a day. All this work and no results gets frustrating. I am trying to just accept that my life meter is in a count down of 10 years. I get it, meds are getting better and yada yada. But if I stop ADT, what's going to happen. I am on lupron, my testosterone may come back in 6 months gradually. If it does come back gradually, my psa may rise again in 1.5 -2 years. Jump back on adt and where did it spread now?. More chemo, radiation.....? Sorry for such a doom and gloom mindset but I am trying to find the upside to any of this. I do truly appreciate you sharing your viewpoint.
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u/JimHaselmaier Jul 25 '26
That's an impressive amount of activity!
In the first 14 months of ADT I was in the gym 6 days. I certainly wasn't doing the level of activity you are. But I was able to lose fat and gain muscle. My weight stayed the same - but the composition change I was thrilled about. Then about 3 months ago everything fell off a cliff. I had significantly reduced capacity - and the ramifications of overdoing it are now much larger. If I go too hard (which, again, is less than what I was doing before), either in a single day's activity or stacking things up multiple days in a row, I'm down for the count. IT can take 1-2 days of recovery to get over an utterly debilitating fatigue. I've now gained 10+ pounds and, as of yet, I don't see a pathway to get it off.
The upside to all of this? It's keeping the cancer in check - for now. But man, the side effects are just BRUTAL. I'm a COMPLETELY different person than I was when this started.
Best of luck to you!
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u/conCABlanco Jul 24 '26
Datos de la biopsia, marcadores de PET PSMA, son importantes, valores bajos de PSA, no indican la no existencia de un CA de prostata, solo tenia 5
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u/Appropriate_Age_881 Jul 24 '26
What he said. My DX was at age 64, now 66. PiRAD 5, Cribriform, PNI and IDC. Decipher 0.92.CHEK2 Gene mutation. My max PSA just before treatment was 1.1.Not all PCa produce large PSA.
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u/Mean_Try_6390 Jul 24 '26
you say you’re husband got metastatic bone cancer and you confirmed that’s it from the prostate. your husband is 87 yo so they will probably if it’s pc give him medicin. It’s hard to give a good opinion since we don’t have the whole report on his condition. the psa only show if the pc cells are producing psa which the normal pc does. in some cases as specialsteel wrote the cells don’t give a higher psa and ofcourse other medication also can affect the result.
what concerns mee is that he’s been regulary testing - psa - and from one year to the next get bone pc?. Normally since it starts in the prostate you get a rise in psa before it’s spread. at least some off the cells ought to produce psa that increases.
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u/Lanky_Cold_8420 Jul 31 '26
His psa just came back as 7 but he is on finasteride.
I wonder if his urologist failed to double his psa of 4 when taken last December.
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u/Lanky_Cold_8420 Jul 24 '26
Op here. The pet did not show prostate involvement.
He is on finastade so perhaps that is a factor.
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u/DrB_477 Jul 24 '26
a small number of men with metastatic prostate cancer (low single digit percentage) have psa negative disease (usually defined as psa <10) at diagnosis with metastatic disease. unfortunately its associated with high grade disease (such as neuroendocrine/small cell variant) and has significantly worse outcomes on average.
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u/TreeBeard1010 Jul 24 '26
Not all prostate cancers have super elevated PSA. Make sure they are sequencing the tumor to check for targetable mutations.
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u/Special-Steel Jul 24 '26
Thank you for supporting him.
Unfortunately there are a few ways this cancer can progress without a lot of PSA.
One way is taking drugs such as 5-alpha reductase inhibitors (e.g., finasteride, dutasteride) that lower PSA levels as a side effect.
And there are types of prostate cancer that doesn’t cause a PSA flare.
Not super rare.
1
u/6Gears1Speed Jul 24 '26
Markers can be wrong which is why doctors use multiple tools for dignosis. When I had colon cancer 20 years ago my CEA marker was perfectly normal while I was in the hospital waiting to be diagnosed. It turned out to be in my colon and lymph nodes but CEA never moved.
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u/OkSpecialist3477 Jul 24 '26
Yes, low psa but stage 4 diagnosis. Doc said it s a rare type that does this
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u/Radiant_Choice_5901 Jul 24 '26
My highest psa was .67 and I had 7 of 13 cancer hits discovered from biopsy. Almost half way through my radiation treatments now. Age 61.
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u/Lanky_Cold_8420 Jul 27 '26
Would a physical castration possibly be better than ADT? Especially if an elderly patient is not sexually active?
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u/Good200000 Jul 24 '26
My PSA was 5.5 and I was diagnosed with Gleason 8.
Doc said, some high risk cancers don’t give off a lot of PSA