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This question was answered on Mon 31, Mar 2008 09:05am by Dr Heinrik M, MD

PROSTATE CANCER - PSA and Gleason score doesnt reveal spread of cancer to bones


    
Asked by user (Male ) on Sat 29, Mar 2008 07:51am

I WENT TO MY DOCTOR APPROX 5-6 MONTHS AGO BECAUSE MY LEFT SIDE NECK AND ARM WAS STIFF. MY DOCTOR SAID I HAD A PINCHED NERVE AND SENT ME TO THERAPY. ABOUT 3-4 MONTHS AGO I WENT TO MY DOCTOR BECAUSE OF SOME BACK PAIN ON THE LEFT SIDE AND HE SENT ME TO HAVE A CT SCAN WITHOUT CONTRAST AND STATED I HAD A KIDNEY STONE. TWO WEEKS LATER I WENT FOR MY ANNUAL PHYSICAL AND MY PSA LEVEL WAS 6.18 THE DAY OF THE DRE AND 5.77 TWO DAYS LATER. I NEVER HAD A PSA DONE BEFORE THESE. THE DRE WAS NORMAL. I WAS SENT TO A UROLOGIST AND THE BIOPSY CAME BACK POSITIVE. 4 OF THE CORES WAS POSITVE ALL ON THE RIGHT SIDE. 5% 10% 15% AND 90% OF EACH CORE. MY GLEASON SCORE WAS 6. I WENT BACK TO MY REGULAR DOCTOR TO ASK ABOUT MY ALKALINE PHOSPHATASE BEING ELEVATED AT 130.0 AND THE RESULTS OF MY CT SCAN. HE STATED THE ALKALINE PHOSPHATASE HAS BEEN ELEVATED FOR SOME TIME AND THAT THE CT SCAN DIDN'T SHOW ANY PELVIS LYMPH NODE PROBLEMS WHEN DOING THE CT SCAN. HE ALSO DID AN EXAM AND I NOTICE WHEN HE PUSHES ON THE LOWER LEFT SIDE ABDOMIN THERE IS SOME PAIN, BUT NOT ON THE RIGHT SIDE. I DIDN'T KNOW ANY SYMPTOMS OF PROSTATE CANCER UNTIL RECENTLY. I HAVE NOTICE URINATING MUCH MORE OFTEN. THE BIGGEST THING THAT SCARES ME NOW IS THAT I'M HAVING SOME LOWER BACK, PELVIS, THIGH AND HIP PAIN IS ABOUT A 1 OR 2 ON SCALE OF 10. HOWEVER I HAD THE LOWER BACK PAIN FOR ABOUT 3 MONTHS BEFORE THE OTHERS. I THOUGHT IT WAS FROM HELPING MOVING SOME HEAVY FURNITURE. SOMETIMES AT NIGHT MY LEFT SIDE ELBOW DOWN TO MY PINKY FINGER GOES NUMB. THERES ALSO GENERAL FLARE UPS THROUGH OUT MY BODY. I HAVE SEEN 2 UROLOGIST AND BOTH SAID IT'S VERY UNLIKLY THAT THE PROSTATE CANCER HAS SPREAD TO MY BONES BECAUSE OF THE PSA AND GLEASON SCORE. DOES THESE SYMPTOMS MEAN THE CANCER HAS SPREAD, OR COULD THESE BE SYMPTOMS FOR OTHER PROBLEMS. THANKS
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Answer by Dr Heinrik M, MD  on Mon 31, Mar 2008 09:05am:

Hi, The tests that are required during staging cancer are indeed based on the PSA and the Gleason score. For low levels of PSA and low grade Gleason, the chances of having bone disease is indeed low. These assumptions are of course predicated on a situation where there are no symptoms such as bone pain. Consider then if there is anything that can explain the pain (if the kidney stone is indeed on the side of the abdomen where the pain is elicited, this may indeed account for it; the numbness on the pinkie and the side of the elbow sounds like nerve compression, this commonly occurs without considering bone metastasis for example if you’ve ever banged your elbows and felt an electric like shock along with transitory numbness, this is because nerve that runs down the side of the pinkie is anatomically near the skin along the elbow; the pain in the lower back may indeed be due to moving furniture; the pain in the hip is a tough one to evaluate especially since bone metastases tend to involve these areas, the value of a thorough physical and neurologic examination may go a long way). If the symptoms are not adequately explained by findings on the examination which lead to other conditions independent of metastasis, then an investigation with a bone scan is probably the best way to go.

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