Husband is Stage IV Metastatic to Bones with Rising PSA

My husband was diagnosed in February with Advance Prostate Cancer metastatic to the intrapelvic lymph nodes. Biopsy showed 12 out of 12 cores Gleason 10. PSA was 31.8 on 1/29 after 13.1 on 12/8. He was put on one month of Casodex and received his first Lupron shot on 3/10 and started RT on 3/22. We were told surgery was out because it had spread so much. We met with oncologist who set up chemo for after radiation. Dan breezed through radiation with no side effects and had no side effects at all from the Lupron either. Here's where the story gets confusing. During last 2 weeks of RT, he had to be replanned because his prostate had shrunken so much things had shifted. Great! Doctor even said the word remission. On scan reports after RT it mentioned progression of previously noted bone mets (WHAT?) plus several new ones. At no point was this ever mentioned, and was not referred to in his diagnosis. PSA on 5/25 was 3.6 and 6/6 7.4. Already doubling! T was <12. Met with Med. Onc. who was very grim, but will not think outside the box. Dan had his first chemo yesterday and we are going to Vanderbilt on Monday to get a second opinion. Any advice or treatments I should ask about at Vandy? I'm really unhappy with our situation at the Pratt Cancer Center in St. Louis. At the moment he's feeling no effects of anything, but every ache makes him think the cancer is spreading. This is the first forum I've found with many Gleason 10 guys and it's very encouraging. Thanks in advance for your thoughts. Mary

Spouse DX 2/16

age 58

PSA 8/14 1.4

PSA 12/15 13.1

PSA 1/16 31.8

2/11/16 Biopsy 12/12 Gleason 10

2/23/16 CT & MRI Pelvic Nodes Enlarged

2/29/16 Casodex

3/10/16 Lupron

3/22 - 5/20/16 43 IMRT sessions

3/24/16 Meet with Medical Onc.

5/25/16 PSA 3.6

5/31/16 CT/MRI bone mets

6/6/16 PSA 7.4

6/8/16 Taxotere PSA 9

6 Replies

  • I found out after 8 years with a somewhat controlee psa of 5 or less and gleason of 9 that my psa jumped to over 2000 in three weeks and liver emzymes to over 2400. Doctor started me on texderm and psa drop to 800 after first dose. Now at 6 after 3 doses. Sorry was for in march 2016. The cancer had spread to loungs and bones including spine and all bones below the waist. So guys there is hope for a good recovery. Get a good support group and stay positive. OH by the way I am always tired and have had some major paid and blistered feet. Small price to pay for a possible normal life. Looking ahead to years of life instead on average of one. I wish you all well. My age 64.

  • Hello. I was diagnosed in January 2014 with a Gleason 9. I was 51 yrs old. I had one positive lymph node. I had surgery in Orlando with Dr. Patel. However, my PSA did not lower very much at all. I went to every major cancer center and decided to treat with Dr. Drake at Johns Hopkins. I had radiation and provenge. All paid by insurance. I had two years of hormone therapy (Trelstar). I discontinued that in April. My PSA is now undetectable. Keeping fingers crossed and praying. Dr. Drake was given close to $200 million grant recently for his immunotherapy research. He is an out of the box thinker. There are several clinical trials going on m associated with immunotherapy at JH. I believe 100% I woukd have never achieved this result anywhere else. If you're looking at places to treat, its worth an appointment at Johns Hopkins to see what they might have available for your husband. God bless.

  • I was diagnosed in August 2012 with PSA of 29, Gleason 9/10 in all cores. Surgery not an option. Under care of Dr. Charles "Snuffy" Myers. After Feraheme MRI, confirmed numerous mets in pelvic and abdominal lymph nodes. Radiation not an option. Have been on androgen deprivation therapy. Currently take 10 prescription drugs. At various times, have had Lupron, Firmagon, Casodex, Avodart, Zytiga, Metformin, Leukine, Xtandi, etc. Lowest PSA was .041, now rising slowly to 1.070.

    Myers is a strong believer in hitting aggressive cancer from all sides at once, with multiple drugs. Ask Vanderbilt about a similar approach. To find out what is going on, Mayo uses C-11 Cholene PET/CT and Phoenix Molecular Imaging uses C-11 Acetate PET/CT.

    I am going to Phoenix when my PSA rises to 1.5-2.0 (it hurts me to say that I actually am looking for a PSA increase, but that level insures a more accurate scan result)!

    Bottom line, buy time with aggressive treatment to aggressive cancer. New drugs (checkpoint inhibitors) are coming which may save us. Stay strong and never give in.

  • I've been at Vandy for at least 18 mos. Great experience with Dr. Shinahara. You are welcome to call me.

    Bob Chanin


  • Mary,

    You are on the right track at this moment. Chemotherapy and a second opinion are your current best course.

    However, if it were me, given the very aggressive nature of his disease, at this time I would personally also get a third opinion. Insurance will probably cover the cost and I am a firm believer that more heads (all who have had different experiences) will always come up with a better plan. If you go this route you will have to be the person to merge the thinking and develop the plan.

    I have 5 different cancers, including advanced prostate cancer and when I was diagnosed with a rare cancer I followed this path and actually had 5 consults before I decided on a treatment path. All 5 of the recommendations were different and I ended up carving out my own personal conglomeration of what I learned. You will need to do the same.

    As I know you are aware that his disease is very aggressive and as you have been doing, you need to answer it in a similar fashion.

    When you go to Vanderbilt and if you decide to have additional consults I would ask specifically about the possibility of a clinical trial, maybe one using a PARP Inhibitor. These inhibitor are the most recent newer investigational drugs and have in other cancers had an impact. It is totally experimental, but worthy of consideration.


  • Following are a few papers for your review, consideration, and discussion with your treating physician. With advanced, high grade, and particularly known metastasis at diagnosis, a more aggressive treatment protocol is important early-on. In the following you will find some repetition in consideration, but each paper is intended to provide the patient aggressive treatment considerations.




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