Prostate cancer and bone mets with a low PSA?

I'm asking for a close family friend. He had locally advanced prostate cancer diagnosis a year and two months ago. A bone scan showed nothing there, but he had one lymph node tumour. He has had hormone treatment and radiotherapy. His last blood test showed his PSA was only 3.8. However, in recent weeks he has gone down hill rapidly. He has almost constant lower back and hip pain and now rib tenderness. He had night sweats last night and we are all very concerned. My query really is, would it really be possible for it to have spread to bones in such a short amount of time and would his PSA be that low? I feel like no matter what he says to the GP, he is fobbed off and despite speaking to 111 today and being sent to a walk in centre, he's been sent back home with basic pain relief. His oncologist is also not really doing anything in any hurry. 

  • Hello Vicki_76 and a warm welcome to the forum though sorry you have to be here. I too have LAPc, my PSA is 0.24 ng/ml. Like your friend i have had RT and HT and my cancer still spread, so it is possible your friends has, and you are right to be concerned about the pain in his hip, rib and back as any bone pain must be reported to your oncologist, they usually ask you to be informed. Does your friend have a cancer nurse specialist you can call, she will be part of the team overseeing treatment and is much easier to contact than the doctors, If you are unable to get in touch call PALS patient advice and liaison service at the hospital. take care.

    Eddie

  • Hi Eddie 

    Thanks so much for your reply and I'm sorry you are also in your situation. The person in question is my Mum's partner although they don't live together. I did read that a low PSA level doesn't necessarily mean anything and that spread can still occur. He is calling his oncologists secretary again tomorrow. They are already aware he had back ache and they did not seem concerned. They are very slow to respond or do much at all. Good advice re PALS. Thank you. 

  • Hi Vicki, you are right about PSA it is more an indicator than a diagnosis test, though it is still important, My PSA was 8 at diagnosis fell to 0.08 in 3 months then after my scan 3 months later still 0.08 but cancer still spread. I also know people with a PSA over a 1000 who have been cured, I can understand four frustration with the oncologist, i and many others have had these problems, I ended up contacting PALS. I hope you have more luck tomorrow, take care.

    Eddie

  • Eddie, thank you. You're so kind. I wish you well. X

  • No thanks needed, but appreciated, take care.

    Eddie

  • eddiel is very help full , i have PC treament in 2019/2020 , only 4 months HT {because it sent my blood pressure up} then 24 RT , my PSA was steady until late 2023 when it went from 0,03 to 0.05 then 2.5 for me this should have been the Red Flag for Urology but nothing was done , it took prompting from my GP to get PET scan and Bone scan done and now i have advanced PC and the only treatment i`am offered is Hormone Therapy , for me this is wrong as there are lots more types of treatment that could be done, I was taken off HT because of Blood pressure it causes now the same Consultant who took me off HT wants me back on it , I`am very angry at this stupidity by them , i like to try and keep fit but if back on HT i would not be able to exercise as that  takes the blood pressure up , add on the elevated blood pressure from HT and that`s in my opinion recipes for disaster leading to a major heart attack, I get the sense of ageism from Urology , Cost cutting  and some what Narcistic trates by one person 

  • Hello Stiga i have sent you the list you asked for but will repeat it anyway, Enzalutamide, Apalutamide, Darolutamide and Abiraterone with Enzalutamide being the most common. Like you i have advanced PCa and heart/ blood issues and the only treatment i can safely have is HT. You are right about your PSA once it gets over 2 action is needed, I don't know your consultant and i am not going to say our age and other health issues shouldn't matter, but they do matter as side effects from treatment may not be worth any possible benefit. Stiga you may want to research these options. Chemotherapy, Cryotherapy, Brachytherapy, Immunotherapy, HIFU and clinical trials, good luck and take care.

    Eddie

  • Yes thanks I looked at the list and replied ,  with HT it is the lowering of Testosterone that causes elevated blood pressure , this Consultant i have has not yet named the HT he thinks i should carry on with, { knowing he took me off it and the problems it caused } and now wants me back on it ,  I`am angry , i exercise quite a bit for my age and he the Consultant is mixing me a recipe for disaster,

  • Hello Vicky_76 and thanks for the post

    I am sorry to hear about your friend and the recent pain and other symptoms he is now experiencing.

    Unfortunately no one here can say exactly what may be going on or if it is related to his prostate cancer.

    It sounds like he has seen a couple of doctors about this and has been given some pain relief which hopefully in the short term will help ease things for him. In the mean time it is worth him speaking with his GP again and updating them about his symptoms so they are aware and in case they want to run some more tests to find out more.

    If your friend has a specialist nurse at the hospital I would suggest he speak with them in case they can reassure him and put his mind at ease. I am sure the oncology team will run more tests and investigate further if needed but do bear in mind this doesn't always happen straight away. The important thing for now is that the pain is managed whilst the doctors investigate the cause further.

    Please get back to us if you need any more information or support.  You may find it helpful to talk things through with one of the nurses on our helpline.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    Wishing you and your friend all the best and that he gets some answers and starts to feel better in himself soon,

    Naomi