Advanced Prostate Cancer
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Increase in bone Mets?

Today we met with oncologist after bone scan and CT.

Significant increase in bone Mets.

We knew something was off because of pain.

He has done Taxotere , Lupron, Xgeva and was entered into a clinical trial but got out of trial because he was so very sick.

Now Zytiga and PSA is down but increase in bone Mets is huge.

New lesions in ribs spine femur arms

Pelvis sacrum.

Anyone have this experience?

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Have you discussed Xofigo? He would have to come off of Zytiga first.

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I wanted you to know my oncologist added Xofigo with Zytiga . Someone on this forum posted the Bayer (maker of Xofigo)warning

on combining the two drugs.

Oncologist immediately took off Xofigo injection.

So only one dose went in combining the two drugs.

You would think they would know this!

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I'm surprised he didn't do it the other way around - take you off Zytiga since it is no longer working.

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The thing is..... PSA is down on Zytiga and bone scan showed increase in Mets.

The increase in Mets was enough that he felt Xofigo was warranted but he did not want to discontinue Zytiga.

I ended up on both!

Then warning was discovered.

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PSA is not the best measure of success when there are multiple bone mets - bone alkaline phosphatase and radiographic evidence are important too. If all other indicators are higher, but PSA is lower, it might mean the cancer is mutating into a form that doesn't put out a lot of PSA.

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We were given that as a possibility by PA.

Oncologist to call Monday.

Have you known others and what does it mean I wonder that Mets increase and PSA drops?

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Look closely at Xofigo. Anecdotally l had a poor outcome and so have many I've been in contact with online. My pain did not improve, my PSA shot up scans showed little impact on bone Mets.

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The radiologist told us that the mets are there for a long time before they are big enough to see in scans so its possible the growth occurred awhile ago and just now visable, hopefully. If the PSa went down, seems the meds have helped. Best wishes.

Charlean

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I was taken off Zytiga after PSA started to increase and scans showing a progression in some bone Mets. Next for me...my MO ordered Xofigo.

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The odd part is that PSA declined and Mets increased greatly.

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Yes, that is odd. How was the ALP ?

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ALP was also sky high.

How long did you take Zytiga?

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One year.

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Maybe mutated to neuroendocrine.

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I was wondering that too. Neuroendocrine cells do not express the PSA. He could check his Chromogranin A and NSE (blood tests). If that's the case, I'd want to look out for visceral mets.

Neuroendocrine prostate cancer (NEPCa) represents a minor population of PCa, yet NEPCa cells exists in the most advanced stages of PCa (6). Importantly, the population of NEPCa cells might increase during the current ADT with anti-androgen treatments (7). Different from most PAC cells, NEPCa cells express little androgen receptor (AR), thus they are inherently resistant to the ADT treatment. The common markers for these NEPCa cells are Chromogranin (ChrA), neuron-specific enolase (NSE) and synaptophysin (8).

Source: ncbi.nlm.nih.gov/pmc/articl...

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Best possible analysis.

Nalakrats

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Sounds like what happened to me. Hugh increase in bone mets was causing a lot of pain. MO started me on Xofigo two weeks ago (still on Zitiga as well.) About a week after the first treatment, I started getting relief from the pain! This stuff is really working well for me.

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They mentioned Xgofigo.

Please let me know side effects.

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Here's a link to the prescribing sheet which has the results from the clinical trial that was done prior to approval. It has all the details on side effects experienced by all the trial participants:

accessdata.fda.gov/drugsatf...

Good luck with your treatment, I will probably also be doing Xofigo next.

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Wow. So sorry to hear of the new Mets. That worry’s me as I get new pains Dailey. Hang in there and fight a good fight.

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How are your other liver enzymes such as ALT, AST and Bilirubin?

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ALT and AST high

Have not checked bilirubin

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Bilirubin is generally the slowest to be effected. How high are your AST and ALT? The high ALT and AST could be from Zytiga. Did they go up after you started Zytiga?

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Yes those tests did increase after Zytiga

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I had a few bone mets 14 mths ago, but 2 mths ago I had dozens. So scan is beginning to resemble dalmation dog, spots everywhere, but no pain yet.

I begin Decetaxel on 17th, 10 doses max, at 3 weeks apart.

I have no idea of taxotere will reduce bone mets but I can get Lu117 and maybe radium 223 within 6 weeks of ordering it. Nobody is talking about Xofigo here.

Psa is about 8 now, after Zytiga failed, rising fast. No visceral mets yet, just bones.

Cycling 200km a week still, and working in my shed doing craftwork.

Once Pca is in bones, relationship with Psa can get hazy, but most guys with high amount of Pca in bones have high Psa. If bone mets don't make Psa, a man can't get a fix with Lu117. Maybe with Radium 223, not sure, I think I have 5 years, onco says 8 years.

Nobody really knows.

Patrick Turner.

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