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Despite reduced testosterone levels, metastatic prostate tumors eventually continue to grow – manifested by rising blood PSA levels, and metastases to nearby bones. [ 62 ] [ 63 ] This is the most advanced stage of the disease, called castration-resistant prostate cancer (CRPC).
Prostate-specific antigen. Prostate-specific antigen (PSA) is secreted by the epithelial cells of the prostate gland and can be detected in a sample of blood. [14] PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer or other prostate disorders. [15]
PSA levels between 4 and 10 suggest you could have about a 25 percent chance of prostate cancer, and levels over 10 signal that your chance of having the cancer is more than 50 percent.
Injections of certain radioisotopes, such as strontium-89, phosphorus-32, or samarium-153, also target bone metastases and may help relieve pain. For men with prostate cancer and bone metastases zoledronic acid (a bisphosphonate) and denosumab (a RANK-ligand-inhibitor) appear to be the most effective in preventing skeletal complications. [85]
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The highest levels of acid phosphatase are found in metastasized prostate cancer. Diseases of the bone, such as Paget's disease or hyperparathyroidism, diseases of blood cells, such as sickle-cell disease or multiple myeloma or lysosomal storage diseases, such as Gaucher's disease, will show moderately increased levels.
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