Recurrence

My husband just got the results of his bone scan--not good. His PSA had been rising from .05 in Nov. 2017 to .95 five months later. So his excellent urologist ordered a bone scan before he got to 2. We do have an appointment with his local onco in two weeks and another at Mass General the third week in July with the oncologist we met with back in early 2015.

Findings:

Progressive increased activity is evident in multiple sites in the skeleton. There is a new lesion in the proximal right femoral diaphysis with increased activity evident in the sacrum bilaterally. Also evident is increased activity in the upper thoracic spine to the left side and in the right scapula.

Pelvic: Questionable 1cm. right pelvic sidewall internal iliac lymph node versus vascular structure.

Urologist said Lupron is likely and to ask MG onco about intermittent Lupron if that's what's recommended this next round . But we still have two oncologist visits to go.

Also, does this seem like a lot of mets or "average" Gleason 9 recurrence? It seems like a lot. Due to some rushing to start treatment back in 2014, there were some options we didn't explore early on. If anyone has thoughts and suggestions about these results and new options to consider, questions to ask, specialists to see, etc. we'd welcome the input. BTW, he never got radiation to the pelvis the first go 'round since that wasn't the standard back then.

Spouse21:

First of all I'm sorry to hear about your husband's progression. It's a worry we all have. My thoughts and prayers go out to you both.

Regarding the scan, I am very surprised that they were able to find mets when his PSA is so low. What type of scan did he have?

My husband's stats are similar although we aren't aware of any mets beyond the nodes yet. (I've tried to update my profile but don't know if it will show correctly yet). But since he was diagnosed 3 years ago as a G9, he's had chemo, radiation, and Lupron. He stopped Lupron for a year. After 5 progressions in a year -- from .19 to .80 -- his Onc said he was recurrent and put him on Xtandi monotheraphy. Since starting it four months ago, he has gone from .8 to .2.

So I guess my advice is to check out Xtandi or Zytiga. Doc says if my hubby continues progress and gets to undetectable for a good length of time he may be able to take a vacation from it.

I wish you well.

Thank you Peanut, Fairwind, and Wilderness. I follow you all and always have my fingers crossed that you'll maintain consistent and enduring, low PSA numbers.

Peanut, my husband had a full body nuclear medicine scan at our local hospital. One thing he's about to do is get digital records of this current scan to send to Mass General and Dana Farber along with an older scan. We believe one or two areas mentioned--scapula and sacrum were on an older scan from old injuries sustained decades ago. So we're going to have them read at Mass General. But, yes, unfortunately there are some new areas of serious concern, and the PSA began to rise very quickly after the effects of Lupron ended. Something is going on. He had a high Gleason, low PSA combo at dx--very unfavorable--though unlike some men with that unusual combination, he did respond well to Lupron, or so we thought. Now we're wondering if Lupron killed off all the "easy" cells and now the much-harder-to-kill-off cells remain.

Fairwind: Yes, we will be consulting with prostate cancer oncologists at Mass General and Dana Farber. Dr. Matthew Smith, whom Wilderness mentions, will be one of them. He's done a lot of research on bone mets in prostate cancer patients.

Can anyone out there recommend an prostate cancer oncologist at Dana Farber? We'd seen Dr. Taplin years ago but would like to try someone else. We'd heard Paul Nguyen was great, but he's a radiation oncologist. Any and all suggestions are welcome. Thank you again.