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is a mixed lytic/blastic tumour on spine always small cell PC?

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Posted 2/22/2017 10:42 PM (GMT 0)
hi all,

my dad was diagnosed in early 2010 with gleason 7, updated to gleason 8 post surgery. he had an RP followed by radiation and hormones. he responded well and PSA went to zero. in January 2016, he had chemical recurrence which slowly started to climb until PSA went up to just above 1 in october 2016. He wasn't on any treatments during this time.

Recently he began experiencing back pain and one mixed blastic/lytic tumour was discovered on T6. All soft tissue and other bones were clear.

Strangely, his PSA level came down to 0.45, this is BEFORE he started casodex (which was prescribed after finding the tumour) so it appears to have gone down on its own.

Right now we aren't sure what is happening and neither are doctors. The site is apparently too risky to take a biopsy. The tumour has now entered the spinal canal and is at the early stages of spinal compression so he is getting surgery to avoid compression.

Has anyone experienced anything similar? Should the mixed tumour be of concern, as most PC bone tumours are blastic? Could this be the small-cell variant? Or can you have a mixed tumour and it still be "ordinary" met instead of small-cell?

He is in otherwise great health, no fatigue etc.

Just really scared the combination of things here - distant tumour at an unusual site, mixed blastic/lytic tumour and low PSA are indicating the worst sad

Post Edited (snowcake) : 3/2/2017 10:13:13 AM (GMT-7)

Posted 2/23/2017 1:20 AM (GMT 0)
May I ask why he isn't getting SBRT to the spinal met, which is known to be effective in avoiding spinal compression, and is not at all invasive? Are they proposing kyphoplasty/vertebroplasty? Those can be done together with radiation. Radiation is necessary to achieve local control.

It may be small cell or any of a number of other variants. Was he positive for chromogranin A? What happened after Casodex - did the tumor shrink?

A assume you're working with an MO - what does he think?
Posted 2/23/2017 1:41 AM (GMT 0)
Hi Tall Allen,

Thanks for your reply. I'm not sure why they didn't go for SBRT in lieu of surgery, I know the doctors said something about it and it may have been becasue there would be a delay and also they may have had to do a biopsy to get it which wasn't possible. This is an emergency surgery as he started showing symptoms of early compression and the MRI today showed the tumour had gone into the spinal canal. I guess the doctors felt it was urgent and couldn't wait.

They are going to remove as much of the bone tumour as they can and then handle the rest with radiation - is that a good way to go?

I will ask about the chromogranin A, thank you so much for that suggestion, as I didn't even know what it is or to ask about it.

He only started the casodex about a week and a bit ago so not sure if it has shrunk the tumour or not...his pain hasn't subsided due to it as he is still on painkillers.

All of this has happened very suddenly over the last week/week and a half or so and started off in the emergency room after back pain, so it's been a bit chaotic. We don't have an MO yet but I believe they are talking to one today. I sadly had to come back (they're in Canada) so can't be there right now but am planning to go back again in the next week or so. My sister is there and is handling this side of it so I will pass all this info on to her. I appreciate it so much!
Posted 2/23/2017 2:54 AM (GMT 0)
"They are going to remove as much of the bone tumour as they can and then handle the rest with radiation - is that a good way to go? "

Yes, that's fine. You didn't mention the radiation part, which is essential. I hope it is successful.

If they are removing some of the bone tumor, they will get a pathology report afterwards, I assume. That should definitively tell you what you want to know.
Posted 2/23/2017 3:16 AM (GMT 0)
Thank you again for your help and input! I guess I'm just impatient and trying to prepare for what it could be. The docs are baffled and I'm scared it's the extra nasty type of PC cancer I've read about sad The cancer was gleason 8 and stage 3 and kept at bay for 7 years. It feels so awful right now that it seems to be back and if it's the small-cell kind options are so limited. Hoping it's a benign growth but not sure if that's me giving myself false hope or not sad
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