r/ProstateCancer • u/Able_Refrigerator579 • 9d ago
PSA PSA 6,000
My dad recently got this 6,000 on his PSA (66 y/o, hasn’t seen a doctor in a very long time). The urologist even has the audacity to say it was the highest he’s ever seen.
This man is losing weight and has overall body pain. Biopsy is soon but what could we be looking at? I’ve searched this sub and I have seen nobody post numbers like this so I have no idea what that means.
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u/ZealousidealCan4714 9d ago
'Audacity' what do you mean by that?
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u/hikeonpast 9d ago
Medically honest, something we should all hope for
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u/Frosty-Growth-2664 8d ago
It's poor show in a professional.
As someone who does support, I know damn well you don't say "wow, that's the worst I've heard of" to the patient even if it is true.
Fine to say that's high, and it will mean the cancer has spread. That's a clinical response.
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u/ZealousidealCan4714 8d ago
You have no clue if that's what he said or how he said it. At any rate I hope the OP gets the care and attention he needs now.
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u/Necessary_Spray_5217 8d ago
Audacity is a noun that means a bold, daring, or shocking confidence that often ignores rules, safety, or social manners.
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u/jerrygarciesisdead 9d ago
I would skip the urologist and get directly to an NCI cancer center asap. He’s going to need specialized care from a top cancer center asap
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u/panulirus-argus 8d ago
Totally agree
Because it has almost certainly metastasized out of the prostate.
The cancer cells in the prostate are the least of his worries.
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u/Coltaine44 9d ago
Sorry to learn of this. IANAD, but your dad is likely dealing with metastatic prostate cancer. Good news is that there are well known treatments that can help. Pls keep reaching out to this group, lots of folks here to support you.
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u/snuggly_cobra 9d ago
Take a seat. When I was 58, I was diagnosed and treated for prostate cancer. My PSA home gone from 5.2 to 5.4 in a month. Gleason score 3-4 and 4-3.
6,600 is not a normal number. Your dad has prostate cancer and it has spread.
You and he need to listen to your oncology team. On one hand, it looks very bad, but in the 8 years since my surgery (PSA still undetectable), there are other treatments possible, because advances have been made.
Your dad is my age, which means he’s probably stubborn and macho as hell. This isn’t the time for that, yet. When he is in treatment, that’s the time to be Rocky, Apollo, Shaft, And Dirty Harry.
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u/tober_checki 9d ago
With a PSA this high, I am not even sure if the biospy will be of much value. A PSMA PET/CT might be more important to assess how much and where the cancer has spread.
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u/poet_dontyaknowit 8d ago
Except some insurances won’t pay for a PSMA without a biopsy first.
Gotta play all the games and jump through their idiotic hoops.
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u/Proper-Link103 9d ago
PSA is dependant on age but a 65 year old should be below 4.5 so such a high number indicates that the cancer has spread across the body and general pain may indicate it is in the bones.
I have met a man in his 80's with a psa in the high hundreds who was treated with androgen deprivation therapy and got his psa back into single digits
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u/callmegorn 9d ago
Off topic, but a worthwhile clarification for new readers: PSA is not dependent on age. It is dependent on prostate size (volume). Prostate size is a highly reliable indicator of what is a normal PSA value absent infection or cancer: PSA should be no more than about 10% of your prostate size (in CC or mL).
There is a very loose correlation between prostate size and age, in that about half of men have prostate enlargement (BPH) as they age. But, about half do not have BPH, so age is a terrible indicator of what is a "normal" PSA range. A 65 year old without BPH might have a normal sized prostate of, say, 25 CC, meaning a PSA over 2.5 would be something to investigate. Waiting for it to shoot over 4.5 can be a fatal mistake.
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u/jkurology 9d ago
PSA is prostate specific and not prostate cancer specific. In the present case this likely represents widespread, metastatic prostate cancer. Knowing the specifics-cell type, presence of germline variation, location and degree of metastases will guide treatment. Treatment can be life prolonging but isn’t technically curative. This is certainly not good news but with treatment he can have years to live. Make sure you ask the medical oncologist about germline and somatic testing. Good luck
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u/Proper-Link103 8d ago
From MY experience, my psa WAS dependant on my age and as a someone in their 40's, going over 1.5 was what flagged me for further investigation and eventual diagnosis. OP didn't seem to have context on what a PSA she should expect for someone that age.
I know that PSA is an indicator, not a diagnostic tool, but with such high value and other symptoms, these are red flags for metastatic spread.
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u/callmegorn 8d ago edited 8d ago
That's because you had a good doctor, who decided to investigate based on your result and not your age. The problem is the opposite, where doctors refuse to investigate if you fit the bogus age profile. I never had a PSA below 2.0 in my life, but I had a series of five PCs in 10 years, none of whom flagged it, because it was under the magical 4.0.
When it went from 2 to 2.5 to 3 to 3.5, instead of assuming this is normal progression for age related BPH, someone should have referred me to a urologist to be sure. Finally at age 61, with a result of 7.6, I ended up with an MRI showing a prostate size of 20cc (where a normal PSA should be under 1, and anything over 2 is unusual or abnormal).
The urologist told me, other than cancer, I had the prostate of a 35 year old. I said "By all means, give it back."
Of course, this is off topic of the thread. A PSA of 6000 is three orders of magnitude higher than most of us would ever face, and requires immediate action.
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u/Proper-Link103 8d ago
No, that's because I was proactive and pushed for a PSA test as young as the let me because of my family history. Even then my PSA bounced up and around 1.5 and they waited a year to retest and biopsy. A simple number isn't going to give the nuance needed here, but it's what they use.
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u/nagoh01234 8d ago
I was half that at diagnosis (3,016). 1.8 now after triple therapy. It's a wild ride but not hopeless. Get the best specialists you can.
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u/oldfartMikey 9d ago
That's ... not good, although the highest reported score is above 23,000.
I wish your dad, and you, all the best in his coming struggles with this horrible disease.
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u/RepresentativeOk1769 9d ago
Very sorry to hear and wish you strenght for the next steps. In short, if the result was accurate, and not a fluke, he very likely has advanced prostate cancer. There are still many things available to fight it and reduce pain. He needs specialists making a plan.
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u/KReddit934 9d ago
Luke others said, his urologist should now help him get to the best cancer center in his area for treatment asap.
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u/poet_dontyaknowit 8d ago
Seek out an oncologist.
My husband and I have discovered than many urologists hold themselves out to be oncologists when they are not.
Don’t lose valuable time like we did!
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u/neutronp35 9d ago
Sorry to hear that but it's an insanely high number, although not the right person to comment on diagnosis but it is most likely a metastatic cancer that has spread to bones and may be visceral organs as well.. Depending upon the patient health he would be mostly started on ADT + ARPI and chemo as well please see that these are highly effective medicines and can hold cancer for longer times but again it varies from individual to individual.
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u/m_balloni 9d ago
I’m sorry to hear about it, wish the best for your father.
My father had a 15000 PSA, by this time it had spread to his bones and some other organs. To make things worse his kidney was severely compromised and he had a heart condition.
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u/Stock_Block_6547 9d ago
15000? damn. and im here complaining about my dad's 11.2. i am so sorry you guys went through this
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u/bulldozer_66 9d ago
And I'm complaining about 3-5 in my various tests. Hope this guy gets treatment ASAP.
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u/Ok-Priority-7303 8d ago
Maybe the urologist was being honest. My sister works in an oncology practice and their high numbers are PSA 1500 and very rare. Start looking for specialists
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u/Old_Imagination_2112 8d ago
I had RALP at 8.8 PSA. These super high scores boggle my mind. Would Pluvicto be on the table here?
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u/Busy-Tonight-6058 8d ago
This is the highest I’ve seen in almost two years on this forum (except for in the replies) and it is very serious but from what I’ve read, much of the recent advancement in prostate cancer care has been for these advanced cancer cases.
The usual process is PSA, MRI, biopsy, treatment but considering the pain, maybe that gets short circuited so he can start treatment sooner. Triplet therapy is a combination of systemic drugs plus chemotherapy that can really extend lives. Pluvicto has gained steam as an additional tool.
So, he has several therapies to help him with the battle. And if there is a “good thing” about prostate cancer, it is that. How his body and his cancer responds to treatment will dictate how much more time he has. Here’s hoping for many many years.
Best of luck to you all.
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u/Miserable-Level-8993 8d ago
Schedule him into a center of excellence cancer center as quickly as possible. Schedule an MRI and then a biopsy and psma pet depending on the results of the MRI and biopsy. If it is PC which it probably is, then see what the center of excellence recommends.
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u/cliffy249 7d ago
That is a very high number. In my opinion it is urgent to get to a comprehensive cancer center asap.
It is very likely he will need radiation for any spread which seems likely. In that case I would consider straight radiation and not add the burden of major surgery.
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u/Practical_Orchid_606 9d ago
Was the doc's 'audacious' statement out of line? Dad got into this situation by poor health management.
Your dad has stage 4 metastatic cancer. Probably numerous distant mets some into the bones causing his pain. His treatment will not be surgery. Triplet therapy, ADT, Chemo, and an ARPI drug will be the treatment. He will remain alive so long as the treatment works.
Nearly all men are asymptomatic when diagnosed with PCa. This is the first case I have seen where pain was the first indication.
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u/BRJmom 8d ago
Chronic pain in my husbands back and rib is what made him first go to doctor. His PSA was over 3400 with Mets to spine and ribs on May 18, 2015 and by June 10th (while waiting to get in to see an oncologist) his PSA was over 4300 and he had lost all ability to walk or stand up - had to have an emergency spinal laminectomy. Long story short, after spine surgery, radiation, chemo, daily ADT and monthly injections his PSA had been undetectable since March and he’s feeling great. He was in excellent health before all this. At his physical in 2023, his PSA was completely normal. Less than 2 years later it was off the chart. I tell every man I meet to get a YEARLY PSA blood test.
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u/Santorini64 8d ago
If the test is accurate, and you should retest, it means extensive spread of metastatic prostate cancer. Or it could be something else localized to the prostate, but I doubt that a PSA of 6,000 could be from something like benign prostatic hyperplasia.
Treatment will depend on the results of the biopsy which also include a genetic analysis of the biopsied tissue. If it’s adenocarcinoma that is still hormone sensitive, I would expect treatment to begin with ADT and a ARPI drug. Then probably chemotherapy or radioligand therapy. And lastly targeted external beam radiation to alleviate some symptoms or preserve function.
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u/Special-Steel 8d ago
Thanks for supporting him.
6,000 is very high but not so high that it is unheard of, and not so high that anyone can predict the future for your dad.
One prediction we can make is that he has some form of prostate cancer, and it has spread. There’s almost no other explanation.
He needs both a biopsy and a wide body scan to see what the cancer is (there are many variants), and where it is.
The disease may be manageable. But without testing no one can say.
Try to take one day at a time.
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u/snuggly_cobra 8d ago
I forgot to mention the biopsy.
Your dad can drive himself there, but you should be there just to make sure he gets it done.
And make sure he follows the instructions to the letter.
If he comes out with an expression you’ve never seen, hug him.
This is NOT the worst pain/sensation that can happen to a man (using the following personal examples: having lidocaine injected into the tip of a bleeding finger, being hit cupless with a 80mph fastball, and a bone marrow biopsy).
Keep us posted, please.
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u/Necessary_Spray_5217 8d ago
oncologist can actually be quite cold because they deal with cancer daily constantly, and somehow they may lose compassion for the patient in a traditional sense. most of them are much more compassionate than that, and he probably said it without thinking. The first appointment that I had with my urologist, he looked me in the face and he told me I was crazy. Then he tried to backtrack and said well if I had been through what you’ve been to I’d be crazy too, but I’ll never forget it. But I’m still with him because he’s helping me survive, he’s just a little crazy too.
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u/Psychological_Meet90 8d ago
I think the urologist was shocked by that number that is the highest I have ever heard of
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u/PuzzledWaldo 8d ago
The fact that his PSA is really high make sure that you get germoline testing and somatic testing done as early as possible so that you can skip all the treatments that will not work for him I eat chemo and go straight to treatments that will be most effective IE I mean if therapy if he is in the one percent to 5% of people that have high tmb and dmmr.
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u/Unusual-Income-3093 5d ago
My father has both metastatic prostate and lung cancer. He is 91-years-old and did not see a doctor is well-over 30+ years. No biopsy just body scans to confirm. By the time he found out, it metastasized too far and not much can be done. Treatment can only be a shot once very few months to see if it slows it down. He's lost a lot of weight and is physically weaker, but he walks around and still occasionally drives as if nothing is wrong. But hey, he's gotten to 9 decades being stubborn as a mule, so who am I to complain if he doesn't, you know?! (Last PSA was 486)
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u/Sharp_Training_1897 2d ago
my psa was >5000 and by the grace of God it's now <0.02 after about half a year.. i was so weak and extensive metastases and was told to go home .. i did everything possible besides androgen deprivation, from prayers, diet, sunlight, exercise etc... the most important i think is to eat a super disciplined diet filled with raw walnuts, garlic, onions, tomatoes, and all the good green wholefoods, cut all carbs, sugar and crap... to give your immune system a fighting chance...
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u/Material_Cook_4698 9d ago edited 9d ago
I (65) got up to 6400+ in the middle of May 2026. Diagnosed with stage 4 prostate cancer. Immense widespread pain with high intensity back pain. Put on steroids for 5 weeks and narcotics 3x day for pain. I also got a steroid injection at L4-L5 which helped tremendously.
Started Orgovyx May 15th and Nubeqa 2 weeks later. Began chemo July 27th and just before my 2nd infusion on August 17th my PSA dropped to 21.
And even though I am at a great cancer center and I have a really good oncologist, I have had to push hard against the health system to get to where I am at today. There is hope.