Advanced Prostate Cancer
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Bone Mets and rising PSA

My husband just had new scans done and it mentioned something about 2 new foci at left base of skull and then now sites of abnormal uptake in several ribs and scapulae and mannubrium and thoracic and lumbar spine besides the pelvic area. His PSA rose from 373 the end of April to 657 on May 30th.So far he's had no bone pain whatsoever thank goodness. Does anyone here know exactly what this all means? It's all so confusing. I'm most worried about it mentioning the skull and is it possible to spread into his brain next? He just had sipulucel-T Provenge treatments that ended on April 15th. He's scheduled to get a port and start Jevtana chemotherapy next Thurs. He had docetaxel 7 treatments from Dec. 2016 to April 2017 and then he had Zytiga from Aug. 2017 to Feb. 2018 because it quit working and PSA has been continually rising since then. Please any advice anyone out there has would be greatly appreciated. His doctor doesn't like to mention any time frame.

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Do you have a MO at a Center OF Excellence, where the MO only treats Prostate Cancer? A Facility that does Research and Clinical Trials? If not you might consider. Where is your Husband going now? Where do you live?

I cannot provide answers or advise as I am not a Doctor. Other than getting second medical sources involved.

Nalakrats

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He goes to the VA in Asheville NC.

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So we are neighbors. I go to the Levine Cancer Institute in Charlotte--I drive the 2 hours for my appointments. They Do Clinical Trials and Prostate Cancer Research. I use Dr. Earle Burgess, MO---head of Pca research.

Do you live in Asheville?

Nalakrats

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Actually we live up in Spruce Pine.

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It is almost unheard of for prostate cancer to spread to the soft tissue of the brain. It has a predilection for bone, which is why it hits the skull. I hope Jevtana works for him. Xofigo would be a good option as well.

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So if it hits the skull it most likely will not go to the brain? I remember the dr telling me it won’t go to brain but when I kept reading about the skulls I was worried. Thank you for clearing that up!

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I would say first, that without a biopsy they can not really know what it is. I have had lots of uptake that was found to be an unrelated benign event. Could it be from an old injury? On my recent Bone scan the picture taker put the machine sideways to my head for an extended period of time, something they had never done in the 20 or so BS I have had, they did see some uptake in skull, of which I discount as they do not really know what it is if anything, and they had not taken that view before, not to mention the motorcycle,ski, jumping off bridges accidents I have had in life, that could be what they see.(see pictureMaui 76).

I just finished 6th jevtana, scans showed marked decrease in bone metastatic disease and also in Soft tissue. I am on Nuelasta and taking claritin and aleve for bone pain that is caused for 2 or 3 days following Nuelasta. I found jevtana less bothersome than docetaxol. I wish you the best,please keep us posted.

Dan

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That's good to know about the Jevtana and the decrease in bone mets. We have the Neulasta here ready for him the day after chemo next week. He had to take it also when he got the docetaxel and I hated to give it to him because I didn't want to cause him any pain. Thank-you for mentioning the Claritin and Aleve for the bone pain.

No old injuries ever to neck or back in his life. Thank goodness he hasn't experienced any pain in his bones as of now.

Best wishes to you also.

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I agree with Dan on the aleve after neulasta. My onc. gave me tramadol for pain and it was useless, plus it's an opiod.

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I take the claratin day before nuelasta and for a few days after ,and aleve as needed up to 2 a day.

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That's good to know. It's just worrisome because I had read that it could spread to brain somewhere and it scares me. We will mention the Xofigo to oncologist on next visit also. Thank-you for the info I appreciate it.

Take Care

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If your husband begins to have any ear pain, go right to your oncologist. My husband, diagnosed 8/16, showed some left skull involvement in a bone scan 10/17. Oncologist didn't seem concerned. In late December 2017 he experienced left ear pain. We thought he might have an ear infection. Went to PCP who prescribed antibiotics. In January still had ear pain and hearing loss. Mentioned it to oncologist who ordered brain MRI. It showed diffuse disease in the skull base. Saw a neuro oncologist who recommended 14 radiation treatments to the skull. During the time it took to get this recommendation, my husband suffered extreme cranial nerve damage on the left side. Now left eye won't close or blink and his mouth is drooped. He needs to drink out of a straw. He finished radiation in 3/18 but is already showing more disease in the skull. He is quite debilitated by this. His thought process is bizarre, has no appetite and is confused. I'm not trying to scare you, but please watch for ear pain. I would hate to see someone else go through this. Take care.

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Thank-you so much for all the info I really appreciate it. That's the same thing with us because oncologist suggested to my husband it is probably just arthritis in his neck. He doesn't have any kind of pain from it right now but it terrifies me how close that is to the brain.

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Hello sgrama,

I just had another bone scan (MD Anderson) after being on zytiga with lupron for a year. My PSA had started to rise again. The bone scan showed increasing activity (growth) in two of my met areas (medial right illiac and manubrium). I have mets in other locations, but these were the only two that showed growth from the recent scan.

My oncologist decided it would be best for me to drop zytiga and immediately start radium 223. I've had Provenge and chemo (docetaxel) earlier...before starting zytiga.

Has radium 223 been mentioned as an option for your husband ?

Take Care,

Monty

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Hello MontyB

The oncologist casually mentioned the Xofigo radium 223 but apparently he's not a fan of it. But he also wasn't a fan of the Provenge and the VA doesn't even offer it but we went outside the VA and he had it done. He just finished on April 12th I believe it was. We were so hopeful with the Provenge but for some reason the bone mets is getting worse and the PSA keeps rising. I guess we'll see what the Jevtana does and then go from there.

Thanks so much for the info.

Take Care

Sharon

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From what I have read, Provenge, like many other PCa treatments, is significantly more effective in earlier stages of treatment, while ADT is still effective, than later ones.

At this late stage, possible treatments I can think of include Xofigo, Lu-PSMA, and Keytruda. All of them are independent of ADT or chemo in that failure of ADT or chemo does not predict failure of those treatments.

Lu-PSMA and Keytruda have been spectacularly effective on a small minority of men (see pjoshea13's recent post on Keytruda) but they are still experimental in the U.S. and can only be obtained in a clinical trial or, in the case of Lu-PSMA, by traveling abroad to Germany or Australia.

Your husband's rapid PSA increase is discouraging. Jevtana sometimes works well when docetaxel has failed. It may help. Experimental treatments sometimes work well and may help. They may be worth pursuing. However, as a practical matter I also recommend getting financial affairs in order and investigating palliative care services in case they are needed. It is better to do these things and not need them than to need them and not have done them.

I wish the best for you and your husband.

Alan

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