Positive Bone Scan without elevated PSA

Hello H&P
Welcome to HW

I'm not in the same situation as the love of your life, but it might help folk here if you were to explain his stats a bit more.
You have explained a lot but the overall picture will make more sense if we can understand the sequernce, for instance:
What was his PSA in the past?
When were the biopsies? And what Gleason/Staging did the biopsies give?
When was the surgery?
What was the post-op Gleason stage etc
When was the bone aspect found and how?
When was his PSA tested after suergery and what was it?
When did the HT/Lupron etc start?
How old is he now?

Sorry if this first response is all questions rather than answers, but I hope it will steer things the right way.

With best wishes to both of you

Alfred

Thank you Alfred and bbfan for your quick responses! I am going to get Dr. Meyer book. Alfred-Thank you for your questions which you are correct, are helpful.

What was his PSA in the past? 11/09-51.3; 1/13/10 after surgery 23.15; 2/8/10 .37 and 3/18 and 5/14 <.05
When were the biopsies? And what Gleason/Staging did the biopsies give? biopsies 11/09 11 of 12 were positive. Gleaseon 4+5 and confirmed after surgery. Left nerve and lymph invasion. Bladder invasion as well. I think left neck. Tumor pierced the capsule.
When was the surgery? Da Vinci Surgery was on 12/31/09
What was the post-op Gleason stage etc. confirmed. 4+5
When was the bone aspect found and how? There was a bone scan done on 2/10 which has uptake at right anterior acetabulum consistent with mestastisis as well as T3 and iliac crest. We just got confirmed report today from bone scan taken yesterday showing new intense uptake at right medial acetabulum consistent with metastisis which did not show on 2/10 report. CT scan taken two days ago showed new spots on L3 and right femor but were not confirmed on yesterday's bone scan. So glad about that.
When did the HT/Lupron etc start? HT started on 1/4/2010, casedox and lupron.
How old is he now? He is now 45. PC dx 6 mos ago.
We have an appt with Sloan on Monday to discuss findings of new metastisis even though PSA is still <.05. We do not understand the new findings given HT but a bit relieved that PSA is still low which I hope means he is not already refractory.

Surgery for men with spread to bone must be considered rare. Has anyone on this board had such a treatment protocol? Spread from the prostate means metastasis is complete and further growth of tumor will not be affected by removal of primary site. This may not be completely true if spread is cT3, though for T4, the surgeon who will promote his service is rare. Dr. Samadi is obviously a risk taker and has recruited this man to join him in this process. Perhaps age of patient was an issue, as youth confers recovery for surgical patients and also this man has a long survival.
I assume the radiation is to the prostate area and lymph nodes. This is another departure from the standard treatment protocol. I hope the author finds other men with similar histories. I predict they will be few. Perhaps they are at Mt. Sinai alone.

Hope:  A couple of things, the removal of the prostate was probably an attempt to de-bulk the cancer meaning that the prostate was the place where the most cancer was and removing it might allow the Drs. to control the other areas more easily.  The Mayo clinic is known to use that process. 

Higher gleason scores can have a tendency to not be able to generate high PSA numbers because the cancer itself is badly diferentiated also there are a few types of prostate cancer that just flat out don't generate PSA such as small cell prostate cancer but that should have been caught on the biopsy pathology.

Make sure he is going to a prostate cancer specialist oncologist .

Good luck

David 

You have already been given a wealth of good advice and information. My heart goes out to you and your husband, and your family. I wish you only the best ahead ,and hope that things turn more favorable.

David in SC

Thank you guys! Really appreciate it. Your first reaction is to get it out!! I hope it was the right choice. He now has some regrets because of the ED but hindsight is 20/20. I think removal was good choice.
We just left Sloan with some hopeful news. Since the PSA is still low, the spots that showed up may be bone healing. Wont know until next week after running blood tests. If bloods show something funny, back for another PET scan. Also, did some research on MDV3100 which is going to Phase 3 trials at Sloan. We were told today that Phase 1 of a better version of MDV3100 is starting in July. Good news for the men that are refractory.

Alfred-- Good luck with your radiation as well. Hopefully no bad side effects. HT is going well so far. He does get more emotional and tired but not as bad as I thought it would be.