Prostate Question

[Loughlin]

Hi all, this is probably best directed at Sheryl but I see so many members have had prostate issues or prostate cancer they may also have advice. 

 

Was diagnosed with very aggressive form of prostate cancer a few years back, had successful surgery at a private hospital here in Bangkok and despite post surgery biopsy showing signs of microscopic metastasis (plus a pre surgery psma pet scan showing a possible area of spread to bone) I've had an undetectable PSA since the operation. 

 

My question is - is it possible to have metastasis with lesions or tumours growing elsewhere but still have an undetectable PSA - post surgery. I've tried to research this online but can't find anything that covers it. My Thai doctor says it is possible but in extremely rare cases and only when the patient has been on hormone therapy, he is happy to continue with just blood tests. Should I be asking for a new pet or ct scan to check or is the PSA really the final word? 

 

Thanks in advance for any advice or suggestions 

Edited April 5, 2021 by Loughlin

[offset]

What is your PSA now I think that you have to trust your doctor if you are not happy with him go for a second opinion 

It seems like doctors here not worry until your PSA goes over 0.20 where as in the USA they worry over .0.10

[LosLobo]

Same light reading.....

 

Progression of Prostate Cancer Despite an Extremely Low Serum Level of Prostate-Specific Antigen (nih.gov)

 

Detecting recurrent prostate Cancer using multiparametric MRI, influence of PSA and Gleason grade | Cancer Imaging | Full Text (biomedcentral.com)

[BritManToo]

As far as I know PSA test is only a test for prostate cancer.

If you have any other cancer it doesn't tell you anything about it.

[Sheryl]

1 hour ago, BritManToo said:

As far as I know PSA test is only a test for prostate cancer.

If you have any other cancer it doesn't tell you anything about it.

He is not asking about unrelated cancers but rather about possible metastasis of the prostate cancer.

 

OP it is possible but very rare for there to be metastasis without a rise in PSA.

https://pubmed.ncbi.nlm.nih.gov/8625081/

 

As there was some suspicion of spread to bone on scan done pre-surgery I would certainly suggest a repeat bone scan.

 

Is the doctor you refer to an oncologist?  And have you had radiotherapy post operatively?

[Loughlin]

10 hours ago, Sheryl said:

He is not asking about unrelated cancers but rather about possible metastasis of the prostate cancer.

 

OP it is possible but very rare for there to be metastasis without a rise in PSA.

https://pubmed.ncbi.nlm.nih.gov/8625081/

 

As there was some suspicion of spread to bone on scan done pre-surgery I would certainly suggest a repeat bone scan.

 

Is the doctor you refer to an oncologist?  And have you had radiotherapy post operatively?

 

Thanks everybody for your replies. 

 

Thanks Sheryl, no my doctor is a Urologists / Surgeon, I think he's one of the better ones (based in the Private wing of Siriraj) the surgery was excellent and I've no complaints about that.

 

Once post surgery the PSA was undetectable and remained like that it was decided there was no need for any radiation or hormone therapy, these I was told will be an option in the event of a recurrence. But I'm still a little concerned about a spread going undetected and when I mention it to the doc he always points to the psa and general health. Not sure what to do.

 

I can't get a proper psma pet at Chulaborn Hosp without a doctors reference so in limbo, maybe I'm just overthinking it. Thanks for taking the time to read this and help. 

[Sheryl]

Consult an oncologist.