I was listening to Dr Scholz, he has many YouTubes, he is with the prostate cancer research institute. He describes a small category of men who develop cancers, mutated from their original prostate cancer, and this cancer manifests itself in other organs, and is not detected by PSA tests, etc.
I asked my friend ChatGBT to explain:
Ryne Sandberg’s case is a sobering example of how prostate cancer can evolve even after apparent remission — something many men and doctors are still learning to fully understand. A few key takeaways
1. Rare but Aggressive Subtypes Exist
Some prostate tumors can mutate into:
Castration-resistant prostate cancer (CRPC)
Neuroendocrine prostate cancer (NEPC)
These are often PSA-silent and spread quickly to the liver, lungs, or brain.

2. Genetic Mutations May Drive Aggression
Mutations in genes like:
TP53, BRCA1/2, PTEN, ATM, or RB1 are associated with treatment resistance and visceral spread.
In Sandberg’s case, the rapid return of cancer after remission strongly suggests one of these aggressive genomic paths.
3. PSA Alone Isn’t Always Enough
While PSA is a reliable marker in many men, some aggressive subtypes:
Produce very little PSA
Don’t respond to ADT, yet continue growing and spreading
Advanced tools like PSMA-PET scans, genomic testing (e.g., FoundationOne or Decipher), and liquid biopsies are often needed for early detection of these variants.
4. Monitoring After Treatment Is Critical
Even in remission, men—especially with high-risk or metastatic history—should:
Keep up PSA + testosterone testing
Consider genetic testing, especially with a family history or initial Gleason 8–10
Report any unusual pain, fatigue, or weight loss right away