How was he treated for the cancer in 1998?
Whats is His PSA level now ?
Usually the progress of the prostate cancer depends on the stage at which the disease was diagnosed and the grade of the cancer and the primary treatment offered.If any one of them is not favorable the results of the disease is not very good and the disease can recur or spread.Bone scan in a prostate cancer is advised if PSA is above 20.So if the PSA was never very high,probably he may never be asked to do a Bone scan.That is the protocol of the prostate cancer.So if the cancer has come back it usually does in 8 years after treatment(that is after surgery or radiotherapy). But the efficacy of lupron is generally 18 months after which the cancer escapes its effect and come back along with spread to the bones.
So it is possible to have metastesis in the bones and not know it because the PSA was low? If it wasn't that he had complained of the pain in his head, the dr would never have ordered the bone scan. Im just baffled because even following protocol, one's cancer can grow and spread without warning. I just needed someone to explain how this could happen so suddenly without any warning.
Either the PSA has to be high or he should have symptoms to screen for bone metastases.Probably during the first presentation he had neither.Sometimes PSA can remain low despite advanced cancer and different variants like duct cell carcinoma/urothelial carcinoma and with osseous metaplasia etc.So the possibility is that he would having metastases even when the PSA was 1.4 and when symptoms appeared , it had spread to many places.Metastases just does not appear all of a sudden and become symptomatic.They slowly grow and when they are large enough, they cause symptoms.