I can say from my husband's experience that aggressive prostate cancer does NOT always take years to metastasize to the bones.

Routine PSA screening wasn't the standard recommendation for many years, as a knee-jerk reaction to overtreatment of low-grade PCa 20+ years ago. I've still had smug jerks explaining to me online why it isn't necessary, based probably an outdated example from their intro stats class. 😕

Fortunately, many doctors kept ordering the test anyway, and now the recommendation is starting to shift back after the predictably-disastrous consequences.

I insisted on yearly PSA screening. I missed one when covid hit and during the 17 month interim between testing my PSA jumped from 2.1 to 12.2 and I was diagnosed with Stage 4, Gleason 9, w/mets to RT iliac and local lymph nodes. It can happen quite quickly. I truly believe PCPs and Urologists should go back to doing digital rectal exams routinely during exams.

My husband had a psa that went from 2 to 4 in a few months. Our GP referred him to a Urologist a month later who did I biopsy with a Gleason of 9 Grade 5. He has metastases in seminal vesicles and nerve bundles. This all happened within 4 months. So yes, it can happen. He immediately started radiation for 3 months. Prior he had Decipher test with results .99 which is very high which led us to add another doctor to the team who prescribed Abiraterone/prednisone and he also gets Lupron shots every 3 months for 2 years. We are 3/4s of the way through the therapy. We shall see what happens.