PSA levels in metastatic prostate cancer

Metastatic prostate cancer has spread beyond the prostate to other parts of the body. PSA may fall when treatment is controlling prostate cancer, remain stable, or rise when the disease is active, but the pattern can be affected by treatment timing and tumour biology. A PSA change must be considered with symptoms, examination, blood tests, and imaging. A lower PSA does not always mean every area has responded, and a temporary change does not establish the whole treatment outcome.

Attend the blood-test and oncology appointments arranged for you, and keep a record of results with treatment dates. Tell the team about new pain, urinary changes, fatigue, appetite changes, or treatment effects. They may combine PSA with scans and examination before changing treatment. Depending on the disease and previous care, discussions may include radiotherapy, targeted radioisotope therapy, bone-strengthening therapy, or other systemic treatment. Further information is available on Prostate Cancer.

Contact your oncology team promptly for new or worsening bone pain, difficulty passing urine, blood in urine, increasing weakness, or symptoms that appear after a treatment change. Seek emergency care for sudden leg weakness or numbness, loss of bladder or bowel control, severe breathlessness, confusion, or uncontrolled pain. These symptoms need assessment regardless of the latest PSA result.

Ask what your PSA trend means with your current treatment, which symptoms should be reported the same day, and when scans or repeat blood tests are planned. Discuss how bone health will be monitored and what findings would prompt a treatment review.