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Can you have bone mets with undetectable PSA

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Posted 11/30/2010 11:08 AM (GMT -5)
Is it possible to have bone mets in the hip without a high PSA? I've started experiencing pain in my left hip lately, I had x-rays done by my by my orthopedic Dr. and he didn't see anything unusual.
Posted 11/30/2010 11:28 AM (GMT -5)
I do. And also to my lungs.
Posted 11/30/2010 11:51 AM (GMT -5)
Geez. I also have pain in my left hip. Thought it was arthritis, but I haven't see a doc yet.

DJ
Posted 11/30/2010 12:10 PM (GMT -5)
Ed: Brother Sonny of our ranks, had a bone met with very low PSA post surgery and post Radiation, so I would think it is possible, as they gave him additional radiation at the met to ease pain and further damage
Posted 11/30/2010 12:52 PM (GMT -5)
Some varients of PC are very agressive and produce little or no psa. These are rare, but do occurr. An expert pathologist if requested can do a complete analysis to discover varients.
JohnT
Posted 11/30/2010 1:21 PM (GMT -5)
I was waiting for Gordy to respond. And I hope he can add more details.

Gordy is one of two men that I know of that had recurrent prostate cancer with no PSA jump. But take it to heart, it is extremely rare.

Ed don't let those aches and pains drive you up any walls. I drove down to see family this past week and my hip was bothering me on the long drive to the Los Angeles area. And yea in the back of my mind was that i had a good PSA test a few weeks ago... but i chalk it up to a sore hip...

Tony
Posted 11/30/2010 1:36 PM (GMT -5)
Tony- I had a lung biopsy last Monday and have been (impatiently) waiting for results. After having been told definitely that my Pca is not small cell six years ago, now the thinking is that maybe it is. Hence the new biopsy.

Originally had one tumor on my acetabulum which was irradiated and earlier this year we discovered two new tumors nearby, on my hip. Those have been nuked, too.
Posted 11/30/2010 1:37 PM (GMT -5)
John T gave the best answer..Some, rare, forms of metastasized PC produce little or no PSA....Some forms of localized PC, usually Gleason 9 and 10, produce very little PSA, fooling doctors. The DRE spots it, and biopsy confirms it..

I once had excruciating hip pain. Thought it was an arthritis attack..But no, turned out to be a Sciatica attack...Originating in your lower back (I felt nothing there) the hip pain slowly turned into a spiral numbness down my leg. It took over a year to clear up completely..
Posted 11/30/2010 3:54 PM (GMT -5)

Gordy,

If you don't mind me asking, is your PSA undetectable?  Were these identified by a bonescan/CT/MRI?

Ed C. / All:

Since surgery I have had lower back/hip discomfort.  It is generally on the right side, but some days it hurts on the left and middle.  Normally feels fine after sleeping.  Running tends to work it up and sitting tends to make it hurt more, but it isn't consistent.  I do recall a large bruise after surgery at the point on the right and in fact it was more painful than the other areas from surgery.  It healed up, but the pain/discomfort didn't totally go away.  It is tough to explain because on a pain scale it is like 1 or 2 out of 10, and sometimes I don't even notice it. 

I got worried about this over the summer and had a bonescan, which came back ok.   Doctors don't seem as worried as I am.  I'm wondering if a CT scan, MRI, or any other test will show something different than the bonescan.   

What concerns me even more is that I had a relatively low PSA going into surgery.  I know you can't assume anything with this thing, but the rare cases that do happen - can we learn anything from the PSA before and after surgery....meaning if a person had a PSA between 4-10 (for example) before surgery can we assume that an undetectable PSA after surgery is trustworthy...I'm not sure if I made any sense there.  

Jerry L.

Posted 11/30/2010 4:11 PM (GMT -5)
Thank you all for your responses. My PSA prior to surgery was 3.8 and my Gleason was 8which was confirmed in the pathology report. I have had 5 PSA tests since surgery all of which were between .004 and .005. The last PSA was done on 10/9/2010. I'm in fairly good shape, I exercise regularly and I'm not overweight. I got worried because the pain started about a month ago after a long walk but has not subsided. I know that one of the first areas for mets is the hip and pelvis areas. Would mets show up on an x-ray?
Posted 11/30/2010 4:47 PM (GMT -5)

Ed C. said...
Would mets show up on an x-ray?

Ed,

The bone scan is used to diagnose bone mets.  Here's a link (below) to the bonetumor.org site on metastatic prostate cancer, which says:

PSA is also currently the most useful marker for assessing the level of bone involvement in prostate cancer. Diagnosis of bone metastases is accomplished by a bone scan.

While I'm no doctor, my understanding is that the most typical cases of bone mets had pre-primary treatment PSAs in the hundreds (not 3.8 ng/mL two years ago, like you).

 

http://www.bonetumor.org/metastatic-tumors/metastatic-prostate-cancer
Posted 11/30/2010 5:34 PM (GMT -5)
This thread just shows how unpredictable PC can be.

I have had tailbone pain since 6 weeks after surgery.

The doctors have all said don't worry about it (my PSA is 0.06; it was 4.19 just before surgery) as my PSA would be a lot higher is it was PC.

I also looked up stuff on tailbone pain and it often hangs around for months. My tailbone pain is finally starting to lessen quite a bit, after 9 months.

Had I not had PC, this pain would have been of almost no concern whatsoever.

Mel

Posted 11/30/2010 5:41 PM (GMT -5)
Jerry L - CT caught the lung nodules and bone scan found the hip lesions.
Posted 11/30/2010 5:48 PM (GMT -5)
Thank you Case, Mel and Gordy. I'm going to wait and hope the pain will subside. I started taking Advil and will continue to do lite exercising and stretching and see how that goes. Like Mel said, if it wasn't for PC and wouldn't have given it a thought.
Posted 11/30/2010 8:53 PM (GMT -5)
Ed. last week, 15 monts after RRP with a clean path report,  I now have a 1cm hot spot on my pelvis which is cancer confirmed by MRI.  My psa is 1.0 but - - I am a gleason 9 and as you probably know, Gleason 8-10 need to be watched closely.   I hope you do well.   The Old Sailor

Posted 11/30/2010 9:32 PM (GMT -5)
Oldsailor, Like you said Gleason 8-10 need to be watched carefully. I've fortunate so far with undetectable PSA after 20 months. I wish you good luck in your battle against this beast.
Posted 11/30/2010 10:15 PM (GMT -5)
Ed, if Sonny should pop in some time, ask your question to him, he had (has) a met, being a Gleason 7, and having underwent both surgery and radiation, with a rising but low PSA number after each treatment.
Posted 1/12/2014 2:41 PM (GMT -5)
I had my prostate removed 4 months ago...also had a lung collapse and repaired...now..I'm getting some really bad lower back pain..getting a little nervous here...only 55 yrs old..gonna see about another bone scan...

pain meds help ...but if I sit or stand to long ...whew..man it hurts really bad..

                       Jay

Posted 1/12/2014 9:01 PM (GMT -5)
Jay this was an older post but saw your statement. They can also radiate any mets, but since I don't see your stats under your signature I am not sure what all you have had done. Keep us posted on any news you might get from a new scan.
Michael
Posted 1/13/2014 9:31 AM (GMT -5)
Jay,

I had a lot of significant pain, but it turned out to be from Cialis. Adjusted the dose and it improved.

We tend to assign all of our aches and pains to PCa. When they finally found my bone mets, they were not in the area where I was having pain. But at the same time I had a PSA doubling time of 28 days. After surgery & RT.

Lupron drove them back a bit.
Posted 1/13/2014 3:17 PM (GMT -5)
Why did I read this post! LOL. Now every little ache and pain....and there seem to be more and more everyday, is going have me thinking the worst.
Posted 1/13/2014 8:31 PM (GMT -5)
wow...an old post and it seems I was better than Nostradamus at predicting my future...

I said 3 years ago, "What concerns me even more is that I had a relatively low PSA going into surgery. I know you can't assume anything with this thing, but the rare cases that do happen - can we learn anything from the PSA before and after surgery....meaning if a person had a PSA between 4-10 (for example) before surgery can we assume that an undetectable PSA after surgery is trustworthy...I'm not sure if I made any sense there."

Yes Jerry (me), you make complete sense...and as a G9 and low PSA, you can learn something from this combination...4 months after this -- bone mets were discovered with a technically undetectable PSA. I had this strange feeling even before surgery that I would not be the normal prostate cancer case...

However...I have absolutely no pain currently...any pain I complained about before has since taken care of itself...
Posted 1/14/2014 12:08 PM (GMT -5)
I saw this old post pop up so I'll update you. The pain in my hip went away few months after I posted. Apparently, it was a result of walking for 5 hours watching my grand son playing in a school golf tournament. I'm now almost 5 years since my surgery and my last PSA in October was <.002
Posted 1/14/2014 12:17 PM (GMT -5)
That is great Ed C....glad to hear that your pain went away and even happier to hear that it's been undetectable for a very long time...
Posted 6/13/2014 5:47 PM (GMT -5)
Jerry & Gordy, what was the explanation doctors gave you as to why you had mets with an undetectable PSA?
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