Finished upfront Docetaxel

My husband finished Docetaxel in August. His PSA has gone from 1044 in January to 6 at last test. CT scans show that all his lymphnodes in his pelvic area have markedly gotten smaller. However he is have increasing rib pain. We go today to review an MRI and speak with a radiation oncologist. Can PSA and soft tissue respond to treatment but bones not?

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  • I would be surprised if the rib mets did not improve along with the pelvis mainly because of the drastic reduction in PSA.

    A lot of people, including me, have various pains from chemo. I'm not exactly sure where they were coming from, but in my case it was the lower back. Every cycle they came and went. So the pain could be residual and related to the chemo.

    From what I know, the kind of prostate cancer that attacks the bones is generally the hormone sensitive kind and therefore a PSA response downward is associated with a reduction in the metastases there.

    Metastases that occur in organs and soft tissues are more associated with the prostate cancer cells that have neuroendocrine characteristics. Those cells do not have androgen receptors and do not express the PSA. So you don't get a response with androgen-based treatments to those cancer cells, but you typically do with chemo.

    Another indicator to look at is the Alkaline Phosphatase level in the blood. If that is also coming down, it typically shows a lower level of metastases in the bone.

    But the best way to determine the response is to look at the images. PSA is only one indication, but less is always better. If PSA it's going down in means the cancer is also going down and usually the bone mets are going down too.

  • Thanks. I'll let you guys know what we find out.

  • I would agree with comment above. Hopefully the pain is only from the Chemo. And please keep us updated!

  • Good morning. I went through very similar treatment. Finished chemo in early November 2016. The Docetaxel combined with ongoing ADT has stopped the advancement of the cancer and shrunk down the lymph node involvement. Even though my CT and bone scans continue to show a stable condition with no advancement, I still have pain in the Bone mets. Most recently this seems to have been brought on by my last Zometa shot. I know it's very easy to worry about these things but sometimes it just is what it is. A lot of these side effects are from the treatment and not the cancer itself. I have learned to get reassurance from my doctor and from the bone and CT scans. There's that old saying that the most powerful nation in the world is imagination. And this ugly disease certainly feeds our imagination with a lot of negative thoughts. But I just try and enjoy each day as it is and not focus on the future. Easy to say but hard to do. All the best.

  • So we met with the radiation oncologist. He mentioned that the pain could be a symptom that had been masked by the steroids Mikes been taking since March, and therefor not a new symptom. He confirmed again that the lesions were sclerotic but I'm still confused as to if this means the cancer is active in the bones or if it's " healing". The pain is definently coming from the lesions on the ribs and they have him slotted for 5 days of SBRT. Wish the consult had left me less confused but it didn't.

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