Shoulder Pain

[deano58]

Hey fellas, looking for a bit of advise please.

I have extreme constant shoulder pain for 7 weeks now.

Recent x ray reported degenerative bone disease probably arthritis.

I've been on ADT on and off for 3 years, PSA has suddenly gone from 0.70 to 0.82 in 3 months. ALP is 89.

I'm not due to see my MO for another 3 months. ( last consult in August, he said that I didn't have to see him for another 6 months)

I know bone mets can look like Arthritis on a simple xray.

With all things considered, should I race back to MO., or wait another 3 months?

I was considering another PSA in a couple of weeks to see if there is another rise.

Many thanks,

Mark

[Mkeman]

Most clinics have a triage desk or nurse you can call when you have concerns between visits. I would share your concerns with your clinic or MO’s staff. Having a good orthopedic doctor look at your X-ray might also help.

[deano58 in reply to Mkeman]

Thanks Mkeman.

It might be worth a phone call to the MO's office.

[Tall_Allen]

Is PSA rising while taking Lucrin (and testosterone is presumably at castration level)? Maybe it's time to add Zytiga (whether or not your shoulder has a met). Let's suppose it is a met in your shoulder -- what might you do differently?

[deano58 in reply to Tall_Allen]

Thanks for your reply Tall_Allen

I didn't get a T test done last time. Maybe it's not at castration level. I think I'll take the advice from Nalakrats and get a PSA and T test in 30 days.

[tango65]

Perhaps you should consider to get an earlier appointment with your MO and discuss the possibility of doing a PET/CT preferible PSMA based (GA68 or 18 F DCFPyl, there are clinical trials for these studies). These studies will determine is there are metastases and their location. If there were metastases you could start therapy with the new antiandrogens or with chemo or with Lu 177 PSMA (there are several clinical trials in the USA).

I am in a similar situation. I am having a Ga68 PSMA PET/CT when the PSA reaches 0.3-0.4 and if there are metastases I will try to get Lu 177 PSMA treatment in the USA or in Munich and see what happens.

[deano58 in reply to tango65]

Thanks tango65,

I'm in Australia and the GA68 PSMA scan is easily accessable ( and affordable)

I had one 1 year ago which showed a rib met and several pelvic node involvement.

I'll look into getting another one now.

[tango65 in reply to deano58]

You are welcome. If there are metastases you could get Lu 177 PSMA treatment and it could help. The idea is to delay as much as possible the use of the new antiandrogens and chemo. Best of luck.

[deano58]

Thanks Nalakrats,

Sensible advise!

Cheers

[Drcrunch]

Let’s keep this simple. If the lesion is not in the joint , then it can be considered a metastasis. If the lesion is in the joint, where the bones meet, then it is usually degeneration. Degeneration means arthritis.

[Gleason4042]

deano58, The shoulder pain sounds a lot like my experience. I also have high grade cancer and was worried that my arthritis might be cancer. IT turned out to be torn tendons and bone spurs caused by arthritis. A X-ray and a MRI showed conclusive evidence of the problem. I suggest you check this out. I am now waiting on surgery on my shoulder that is being held up due to a heart issue. Ejection factor of 40 to 45% which I think should not be a reason to delay surgery since I had a knee replacement with the same numbers.

[stangoldberg]

Statistically going from .70 to .82 is insignificant. I speak as someone familiar with statistics not as a medical doctor. STATISTICALLY, two things are important. 1) the trend line over a period of time (for the past 15 years I look at least 3 readings) and 2) does a lowering of testosterone correlate with a reduction in PSA.

If you haven't already tracked your PSA and testosterone levels following each Lupron injection, start now. If you don't have the data, your oncologist should.

[j-o-h-n]

You need a shoulder to cry on...make it your MO's asap.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 11/23/2018 10:19 PM EST

[JimVanHorn]

My opinion (and it is only an opinion) is that 3 months is accurate for a PSA. The PSA changes up and down 0.1 all the time and this is normal. Also the tester may not always be "perfect". So we must look at it as a range. PCa grows slowly and 3 months is not that long. I was taken off all therapy in June 2018 and my PSA was 0.00. I could not wait 3 months so my urologist did a PSA after 6 weeks, so I know how you feel. My PSA is still 0.00 and I wish you well in the future. Oh, and keep truckin'.

[England1]

How are you doing ,hope all is well.