Does very high PSA when diagnosed predict long term outcomes?

Very high PSA doesn't even necessarily mean cancer. Have you been diagnosed with confirmed prostate cancer? (biopsy). If yes, then yes, a higher PSA level can (not always) indicate a poorer long-term prognosis, however, that is not the only determining factor. Case & point: Met a guy at my urologist's office with a PSA in the 600 range. Turned out that he had low grade (Gleason 3+3) cancer along with prostatitis. A course of antibiotics knocked his PSA to the normal range, and he is on active surveillance for PCa.
https://www.mayoclinic.org/diseases-conditions/prostate-cancer/expert-answers/prostate-cancer/faq-20058470
PS: Welcome and sorry you had to find your way here. Best Wishes!

Very high PSA doesn't even necessarily mean cancer. Have you been diagnosed with confirmed prostate cancer? (biopsy). If yes, then yes, a higher PSA level can (not always) indicate a poorer long-term prognosis, however, that is not the only determining factor. Case & point: Met a guy at my urologist's office with a PSA in the 600 range. Turned out that he had low grade (Gleason 3+3) cancer along with prostatitis. A course of antibiotics knocked his PSA to the normal range, and he is on active surveillance for PCa.
https://www.mayoclinic.org/diseases-conditions/prostate-cancer/expert-answers/prostate-cancer/faq-20058470
PS: Welcome and sorry you had to find your way here. Best Wishes!

Well, it is not a good place to start. I know people that have had it in the thousands that are still around after many years. At one of the Mayo Clinic monthly meetings one of the doctors mentioned they had patients whose PSA was as high as 20,000.

How high was your high PSA? How high was your Gleason score?

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

All of those things can be more important than a high PSA.

@jeffmarc Diagnosed with biopsy in 2017 (age 75) which indicted several spots of cancer in the prostate and indicated it had spread just outside the prostate. Highest PSA was 51. Urologist suggested radiation and ADT as the cancer was outside the prostate so removing it wouldn't eliminate all of it. Received 45 targeted radiation treatments and 2 years of ADT. PSA had remained near 0 until December 25 and suddenly started rising and is now up to 9.4. Started back on ADT last Wednesday and have a PSMA scheduled for Thursday.

@mjp0512 Diagnosed with biopsy in 2017 (age 75) which indicted several spots of cancer in the prostate and indicated it had spread just outside the prostate. Highest PSA was 51. Urologist suggested radiation and ADT as the cancer was outside the prostate so removing it wouldn't eliminate all of it. Received 45 targeted radiation treatments and 2 years of ADT. PSA had remained near 0 until December 25 and suddenly started rising and is now up to 9.4. Started back on ADT last Wednesday and have a PSMA scheduled for Thursday.

@grandpabolin - My PSA started rising again in December as well and got up to 15. PSMA PET scan showed increased activity on an L5 lesion. Received SBRT to L5 and PSA is on its way back down. Hopefully, it's as simple as that for you. Best wishes.

@grandpabolin
You could also ask the doctor about putting you on an ARPI. ADT alone can cause you to become castrate resistant. Adding an ARPI can extend the amount of time it takes before you become castrate resistant. Took me 2 1/2 years because I only had ADT.

I am on Orgovyx and Nubeqa, Both of which seem to have the least side effects. Nubeqa Has no side effects at all for most people.

I was diagnosed in 2010 and had surgery, 3 1/2 years later, it came back and I had radiation. It’s come back three more times since then, but various drugs have kept me alive, I have been undetectable for the last 32 months. I did have to have a metastasis zapped on my spine with SBRT radiation About three years ago. I have the genetic problem of BRCA2, which makes my cancer much more aggressive.

You need to get that PSMA pet scan to find out what’s really going on. Good to hear your doctors are doing that. If you have five or fewer metastasis, they can usually zap them and that can really bring your PSA back down. If you have more than five, then they usually want to do chemo or Pluvicto.

Prostate cancer is a chronic disease for almost all of us not a deadly disease.

@jeffmarc Thanks for sharing your experience and positive outcome. Your info is very helpful. Encouraging to know others had reoccurrences and survived. As far as gene testing, urologist hasn't recommended so wasn't aware of it.