Update liver & lymph biopsy

[spw1]

Those of you who have followed my husband's journey with PCa might remember that we were looking at Crescendo trial Ph1. We were told in the UK that his disease was PSMA positive and that he could be eligible for Lu177. We did not wish to wait given the increase in clinical symptoms and decided to fly to India for Lu177 treatment. The FDG PET and GaPSMA scans carried out in India showed considerable discordance with most cancer being FDG positive and extensive marrow involvement. We were advised against trying Lu177 given these facts. Instead, my husband underwent a biopsy of the new liver met the FDG PET identified and one of lymph nodes.

This was to rule out neuroendocrine element. Fortunately, the biopsy did not indicate neuroendocrine disease and his blood test showed CgA of 52.9. In the past it has been 59 and 32.8. The biopsy results show poorly differentiated PCa and the lymph biopsy indicated strong expression of NKx3. The lymph met showed Gleason 9 (this was a note that despite it being a met it had a Gl9 score). As there are no particular indications of why the adenocarcinoma did not respond to the chemo at all, we are left with no particular guidance as to the treatment to be followed next. Abiraterone was never prescribed yet and it is worth a try.

The liver biopsy states, 'CT guided biopsy from FDG Avid left lobe liver lesion shows deposits of Adenocarcinoma.There are atypical cells noted in clusters & sheets. Cells show high N:C ratio, prominent nucleoli & clear cytoplasm. Few mitotic figures are also seen.Background liver shows mild chronic inflammation'.

And the other one: 'The tumor is composed of round to oval cells with pleomorphic nuclei and eosinophilic cytoplasm, arranged predominant in a solid pattern or in an illformed glandular ( acinar ) pattern. Some of the cells show prominent nucleoli. There is no definite intracellular mucin or signet ring cell morphology. There is no well formed papillary pattern seen. There are moderate mitoses seen. Focal area of tumor necrosis is seen. There is no definite evidence of e/o Neuroendocrine differentiation. There are no epithelioid cell granulomas.IHC Result:# Immunohistochemistry Results ( A3 ) :* The tumor cells express NKX-3.1 ( strong ) and are negative for Synaptophysin* The tumor cells negative for Synaptophysin ( No e/o Neuroendocrine differentiation )Final Diagnosis:# Right Inguinal Lymphnode - CT guided Trucut Biopsy (*) In a Known Case of Adenocarcinoma of Prostate on therapy )*  Nodal involvement by Metastatic Deposits of Poorly differentiated Adenocarcinoma Consistent with a Known Prostatic Primary ( ^ Please see note )*  The tumor cells express NKX-3.1 ( strong ) and are negative for Synaptophysin.'

Any thoughts about what next? Is liver met something to be dreaded? Mobility is worsening slowly and oedema too. So far bloodwork is okay.

[tango65]

Some info about treatment of the cancer with liver mets:

pcri.org/insights-blog/2015...

[spw1 in reply to tango65]

Thank you 🙏

[tango65 in reply to spw1]

The microspheres are approved by the FDA and used mainly with colon cancer mets but they will kill any cancer since it is beta radiation. Some info:

youtube.com/watch?v=YndyQkS...(Not working as expected?)

accessdata.fda.gov/cdrh_doc...

I believe the injection is done by nuclear medicine along with interventional radiology. It is not done by the oncologists, but they could order it and coordinate the treatment along with chemo and possible carboplatin or similar.

I wish you the best of luck.

[spw1 in reply to tango65]

Thank you. I have not heard of these before and will ask the UK RO about them.

[Spyder54]

your story is so far above almost all cases I have read in these past 26 months since ny own diagnosis. I find it amazing that Tango65 is consistently here trying everything to help you. I saw where Tall Allen suggested adding Cabazitaxel and Carboplatin, when Docetaxel was failing your husband.

This has to be so frustrating for both of you. As a side note Xtandi failed me but Zytiga+ Prednisone put me back on track to lower PSA levels. I have read some guys who had exhausted most everything added some of the “MAB” drugs, in particular Pembroluzimab for last ditch spectacular results. In reading his Bio, it is shocking how most everything has failed you.

It seems there must be something that buys you time and reduces the pain you have both endured. Gosh, I hope you find something. Persistence is sometimes your greatest ally. Our very best to you both, Mike & Barb❤️

[spw1 in reply to Spyder54]

Thank you. What is odd is that apart from cancer, my husband is relatively healthy. UCL hospital London told us that he is unlikely to have MSI high as it tends to come with more than one type of cancer. At least we now have the material from the biopsy to test for genetics. We also have Zytiga started which may well help to shrink lesions. He has got a persistent mouth ulcer that has grown recently which worries me no end. I do not know who gives the SIR spheres treatment here in the UK but will ask the RO. The journey to India was tough and we would like to keep the travel to the minimum.

[Seasid]

They should ask for a liquid biopsy guardant 360 for you to see if Olaparib or Keytruda could be useful.

[spw1 in reply to Seasid]

Will look into it. It is very expensive done privately - so far the lowest quote was GBP 3000 in India. There is a more targeted Indian version the we might do which looks only at actionable genes.

[Seasid in reply to spw1]

I don't really know, just simply believe that if I would have your situation in Sydney, Darlinghurst Australia I could solve it with 2200 US dollars.

I would get a Guardant 360 liquid biopsy and a tissue biopsy for that price if I can believe to the information from my oncologist registra from 10 days ago. She said that Guardant has a special offer for that tests. Maybe you could ask someone in your country. I personally would not jump to go to India or Turkey etc.

[spw1 in reply to Seasid]

I will enquire again but UK prices might be high compared to Australia.

[MyDad76]

Unfortunately, I do not have any useful information / knowledge, I would just like to say that we are all rooting for you! My heart aches when I read how though battles some man fight so early after diagnosis.

[spw1 in reply to MyDad76]

Thank you. 🙏