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Is anyone else oligometastatic with low PSA, post surgery?

Prostate Cancer | Last Active: 3 hours ago | Replies (12)
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@jeffmarc

There is a lot of literature about the fact that even though PSA is undetectable metastasis can occur.

NIH and Scirntificliterature said the following

A patient with Gleason 10 adenocarcinoma achieved undetectable PSA after radiotherapy and androgen deprivation therapy (ADT) but developed spinal cord compression and liver metastases within six months. Biopsy confirmed poorly differentiated carcinoma of prostatic origin, highlighting the disconnect between PSA and tumor burden

Prostate cancer progression and metastasis can occur even when prostate-specific antigen (PSA) levels are undetectable or extremely low, particularly in aggressive or atypical tumor subtypes. This phenomenon, though rare, is documented in multiple clinical studies and case reports. Below are the key findings and implications:

In a study of 46 patients with metastatic prostate cancer, 10 patients (22%) developed metastases despite undetectable PSA levels (< 0.1 ng/mL). Eight of these cases involved small cell carcinoma, an aggressive histologic variant.
• High-risk features were common:
• 85% had Gleason scores ≥7
• 63% had locally advanced tumors (T3/T4)
• 46% exhibited atypical histology (e.g., ductal, sarcomatoid, or small cell).

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Replies to "There is a lot of literature about the fact that even though PSA is undetectable metastasis..."
northoftheborder | @northoftheborder | 1 day ago

Thanks, Jeff. That is very useful information.

For others reading, note that all of the cases Jeff mentioned were based on the regular PSA test (< 0.1), not the newer ultrasensitive PSA test (< 0.01) — probably because uPSA wasn't widely available yet when they were collecting the initial data — and also that 8/10 of the cases involved involved small cell carcinoma (the "neurodendocrine cancer" that I mentioned in my post), rather than the more-common adenocarcinoma.

So for the vast majority of us, especially those being monitored with uPSA, as far as I know there's no evidence ... yet ... that progression without a corresponding PSA rise is a significant risk. I'll keep watching developments.

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