Brain metastasis update

Jeff has 3 masses in his brain in 2 different places. One tumor is on top of the other, a much bigger one is coming from the dura and pressing into Jeff’s brain. The radiation oncologist will target said masses via radiation which should stop them from growing/spreading, but unfortunately radiation won’t get rid of it.

We will meet with neurosurgery Thursday. As the cancer is in 2 different places, it’s doubtful that surgery will be recommended, but RO wants a consult.

Radiation treatments will be scheduled pending neurology visit.

Zytiga should also help combat the cancer in his brain.

RO said when doctors try to put a number on life expectancy they are usually wrong. He said the most he tries to do is narrow it down to weeks, months, or years.

With cancer such as Jeff’s, it’s considered aggressive, and we are likely looking at months left.

~ Stephanie

So sorry to hear this.
We often beat the odds and staying positive is of course important.
I lost my brother to lung cancer that had infiltrated his brain.
We had good quality time together and I am happy to say he was aware and appreciative of this.
It was months but just short of 3 years from initial diagnosis.
I can only offer my best wishes and prayers

Glen Heinsohn

Stephanie,

That PSA sounds like it’s going in the right direction. Keep us updated on his next bloodwork. These systemic drugs are usually quite effective…and the radiation and other therapies are also effective…and it also helps with pain.

I don’t know if you’ve been following the Lu-177/PSMA therapy that might prove useful down the road…it should be available to hormone resistant patients soon once it is officially FDA approved:

https://www.pcf.org/blog/psma-targeted-therapy-trial-results-new-hope-for-men-with-prostate-cancer/

“ There is incredibly hopeful news on the horizon for men with metastatic castration-resistant prostate cancer (mCRPC). Today, promising results were released from a clinical trial of a revolutionary new class of therapy for mCRPC: a radioactive molecule called 177Lu-PSMA-617 that hunts down and kills prostate cancer cells wherever they are in the body. More information will be presented during the online 2021 American Society of Clinical Oncology (ASCO) Annual Meeting this weekend.”

It’s natural to ask questions about life expectancy…but over the last 12 years I have tried to avoid all of the stats, etc…when I first was diagnosed I drove myself crazy and there wasn’t much positive news for gleason 9, mets guy like me in any of the numbers…that’s when I decided not to bother with that type of “googling” and focus on throwing the kitchen sink at it…

I understand also how you two might feel being so young….I was 44…hang in there…

Keep us updated and let us know how we can help…feel free to email me as well..

Take care,
Jerry L.

Post Edited (Jerry L.) : 8/17/2021 4:43:40 AM (GMT-6)

JNF,

No…you didn’t miss anything…I just wasn’t clear…I changed it above…

https://www.onclive.com/view/177lu-psma-617-receives-fda-breakthrough-therapy-designation-for-mcrpc

Thanks for clarifying…
JL

Post Edited (Jerry L.) : 8/17/2021 4:47:44 AM (GMT-6)

This is the actual radiology report if you prefer the more technical side of things. I always have to have the doctor dumb it down for me. 😂🤷‍♀️

“ Reason for Exam
AMS, CT showing mets vs bleed; Brain/CNS neoplasm, staging; Metastatic disease evaluation _____________________________________________________________________________
IMPRESSION:
Findings consistent with diffuse osseous and dural metastases in
setting of known metastatic prostate cancer, with dominant dural/calvarial masses involving the right parietal and occipital regions as described. No convincing evidence of parenchymal invasion.
EXAM: MR BRAIN WITHOUT AND WITH IV CONTRAST COMPARISON: CT head 08/07/2021

FINDINGS: Again seen is a mildly and heterogeneously enhancing dural-based mass overlying the right parietal convexity, measuring approximately 3.2 x 5.2 x 2.5
cm (obliqued AP x TR x CC). This mass demonstrates marked heterogenous internal diffusion restriction and peripheral-predominant intrinsic T1 hyperintensity and magnetic susceptibility which could represent small amount of hemorrhage and/or developing calcification. Moderate local mass effect on subjacent sulci without definite parenchymal edema or enhancement to suggest parenchymal invasion. Smooth thickening and hyperenhancement of the adjacent dura, thickening of the overlying calvarium and mild thickening and hyperenhancement of the overlying periosteum. Additional dural based extra-axial mass overlying the right
occipital lobe with similar imaging characteristics, measuring approximately 1.6 x 2.7 x 2.9 cm (AP x TR x CC).
Diffuse calvarial and upper cervical spine heterogeneous enhancement and marrow T1 hypointensity compatible with metastatic disease. A few additional focal
areas of calvarial expansion with subjacent dural thickening and hyperenhancement are seen in the right temporal and left parietal regions. Focal osseous expansion with possible calvarial inner table and/or dural invasion in
the left medial occipital region extending across midline displacing and compressing the posterior aspect of the superior sagittal sinus as well as the torcula menses for example series 900 images 55-63). In addition, there is extensive asymmetric enhancement and marrow signal abnormality involving the right mandible with extraosseous extension of soft tissue, compatible with metastatic disease. This is well seen on comparison CT where there is associated periosteal reaction as well as a focal pathologic fracture involving the right mandibular ramus (for example series 7 image 32). Additional foci of osseous metastatic disease involving the left mandible, clivus, and skull base.
No parenchymal diffusion restriction. Minimal leukoaraiosis. Major intracranial vascular flow voids are maintained. Paranasal sinuses are well aerated. Right greater than left mastoid effusions.
Electronically Signed by: Alex A Nagelschneider, M.D. on 8/7/2021 10:36 AM”

This sounds so very, very difficult. I think you need to hang in there and see what the surgeon says and also to find out if the Zytiga is having any effect. I've always felt that it's important to have hope while there are still options on the table. I'm so glad that you're in there advocating for Jeff.