- Psa<.05 And Still Spreading?

My Dad was diagnosis with prostate cancer at the beginning of the year, with Gleeson Score 9/10. It was not clear whether the cancer was spread or not at the time. He took radiation and Lupron injection. Now (7 months later) his PSA level has dropped from ~ 10 to < 0.05. He did a bone scan last week and the doctor says seeing a new spot and suspecting new spread. My question is, is that possible? Prostate cancer continue to spread while PSA < 0.1? Comparing the films with the ones he took before, I do see some kind of darker spot, but …

And, if it is really some kind of new developement, what can/should be done?

Please help. many, many thanks.

While there CAN be disease progression without a rise in PSA the fact his PSA went from 10 to .05 (usually considered undetectable) is telling.

I would suspect the scan is "over read" by a radioloigist who did not have all the information.  So I think it is a red herring but he should continue followup, but not change anything , until you know for sure.  In all cancers I am usually suspicious of "solitary" metatstatsis since every test has a significant false positive rate.

Is he taking calcium and vitamine D with his hormonal therapy.  Also he should excersize to reduce muscle loss.

I agree with the previous poster that a new metastasis at psa of <0.1 would be bizarre, though possible. More likely a misreading of the scan, either before or now or both times. A second opinion on scans can be pursued.

There is an aggressive prostate cancer that does not produce much psa, called neuro-endocrine cancer, and this can be detected by use of other tests for CEA and Chromagranin-A (CGA).

The response to hormones and radiation is a good sign and is much more significant that any possible ambivalent shadow on a bone scan. I assume he is continuing the hormone therapy. If not, then this is a subject for discussion with the doctor. If the doctor is not an oncologist, this would be a good time to find one who specializes in prostate cancer. This would reduce the possibility of misdiagnoses. A urologist or GP is not competent to treat this man at this point.

Thanks a lot for your kind reply, Doctor.

It just has been confirmed those are NE (neuroendocrine) cells. Unfortunately, hormone treatment has little impact on the cells.

As all malignant neuroendocrine cells are devoid of androgen receptors and the expression of neuroendocrine cells is not suppressed by androgen ablation, clonal propagation of androgen receptor-negative neuroendocrine cells may have an important role in the development of androgen-independent prostatic carcinoma. This has significant implications for the treatment of prostate cancer, because several of the hormones that are secreted by neuroendocrine differentiated, malignant prostatic cells are potential candidates for use in drug treatment. A limited number of hormones have been tested in this context, in particular somatostatin, bombesin, and serotonin.

Thank you, Thoosier. You are right on.

There doesn't seem to have good treatment exiting? Anyway, going to City of Hope and hope for the best. In LA area, what is the best place for this kind of cancer? UCLA? City of Hope?

On 11/19/2007 NT007 wrote:

Thank you, Thoosier. You are right on.

There doesn't seem to have good treatment exiting? Anyway, going to City of Hope and hope for the best. In LA area, what is the best place for this kind of cancer? UCLA? City of Hope?

 An excellent group for this is Prostate Oncology Specialists in Marina del Rey, CA