PSA "undetectable" but new mets? - Advanced Prostate...

Advanced Prostate Cancer
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PSA "undetectable" but new mets?

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Hidden

Hello All,

If the PSA is now "undetectable" but there are new mets... what is going on? My guy started taxatere treatment yesterday, Friday December 14th due to this new diagnosis... Has been on lupron since August 10th, and has now "stopped zytiga" due to the new treatment. Please give me some good news!!! I am so worried... MO has not given any info except to start chemo ASAP!!!

Thanks in advance!

Connie

21 Replies
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Not all metastases put out very much PSA. In fact, neuroendocrine prostate cancer, for example, puts out none. Before he starts on taxotere, it is prudent to check for chromogranin A, neuron-specific enolase, and synaptophysin with a blood test. If those are elevated, adding carboplatin to his chemo cocktail may be beneficial. There are other rare kinds of prostate cancer (e.g., ductal, squamous cell, sarcoma, etc.) that also put out little PSA but may be responsive to chemo. It is a good idea to biopsy one of those recent metastases for an immunohistological analysis to determine whether he has any of the many rare types.

Hidden
Hidden
in reply to Tall_Allen

He had a liver biopsy. From what I understood, the cancer is adenocarcinoma, same as what was found in the prostate biopsy. Does this sound correct?

Tall_Allen
Tall_Allen
in reply to Hidden

Yes. Sometimes even ordinary acinar adenocarcinoma puts out little PSA. If that was a recent new met, you have more assurance that docetaxel may be beneficial.

Hidden
Hidden
in reply to Tall_Allen

His first scan was in August. No mets in liver at that time. Scan a few weeks ago showed sign of mets in liver and the pelvis lymphnodes have grown. He had to have stents put in between kidneys and bladder as one of the kidneys was inflammed. Would this kind of cancer growth show no increase in PSA? This is all so frightening!!!

Tall_Allen
Tall_Allen
in reply to Hidden

Everyone's cancer is unique to them in some ways. If his puts out little PSA, that's just what his type of prostate cancer does.

Hidden
Hidden
in reply to Tall_Allen

His PSA at the end of July was 56. One week later, it was 95. He was diagnosed with advanced stage PC on August 10th. Mets to bones and lymphnodes and small spots to lung... So, he has shown signs of high psa...

Hi Connie. Your ‘guy’ is not alone; my husband’s PCa has been this way for over a year, and he will likely be starting taxotere & carboplatin in Jan. As Tall_Allen mentioned, we recently had those tests done to rule out any mutation, and we are awaiting one last bone biopsy test result to confirm his “cocktail”. I would encourage you to ask the MO about the additional blood work.

Hidden
Hidden
in reply to NurseRatched

Why is your husband having to start chemo?

NurseRatched
NurseRatched
in reply to Hidden

Because he also has new mets with an undetectable PSA, which means his PCa is both out of remission and castrate resistant. So it’s time to pull out the big guns.

Hidden
Hidden
in reply to NurseRatched

Hello NurseRatched,

How is your husband doing? We are starting second round of chemo (jevtana) tomorrow, July 19th...😪

NurseRatched
NurseRatched
in reply to Hidden

Good luck! We are probably not far behind you. Hubs finished 6 cycles in May, and his AlkPhos is already climbing.

I read Tall_Allen's response--most correct--get those blood tests---as for the Adenocarcinoma in the liver biopsy---we do not all give recognition to a fact that 2 cancer pathologies can be active at the same time--I.E your man could have both Adenocarcinoma, and Neuroendrocrine at the same time--it is usually NEPca that goes to soft tissue before Adenocarcinoma. So Allen's suggestion of the adding of a Platinum Based Chemo, to our usual Chemo's and making a cocktail makes sense.

If you have the will and time--I would suggest Gene Mapping, to provide any Gene Mutation Info---as today's rush on Immunology drugs is moving at a fast pace. Targeted Gene Therapy Drugs may also be something for use--later.

Nalakrats

Hidden
Hidden
in reply to Nalakrats

Please explain gene mapping... I am new to all of this... many thanks!!!!

Nalakrats
Nalakrats
in reply to Hidden

Gene mapping identifies mutated Genes in your DNA, that if they can be repaired with certain Immunology drugs offers a chance for a blockade against the advancement of the disease, sometimes the disease recedes. For more direct information call 800 number for Foundation One--you can get # on their web site--an advocate will walk you thru, and explain the reasoning--I can go into deeper detail--but best to get it from the source.

Nalakrats

Hidden
Hidden
in reply to Nalakrats

Will the taxatere kill the cancer in the liver? I know small cell cancer requires a different kind of chemo??? Thanks in advance!

Nalakrats
Nalakrats
in reply to Hidden

Is the cancer in the liver small cell?--I thought it was plain old Adenocarcinoma.

Nalakrats

Hidden
Hidden
in reply to Nalakrats

We were told the cancer in the liver is not small cell. it is adenocarcinoma. Will the taxotere take care of it?

Hazard
Hazard
in reply to Hidden

I had PSMA scan last year which showed 5 avid lesions in my liver. After 9 cycles of docetaxal I had another scan and no avid lesions were identified. So yes, chemo can definitely help liver mets.

You should discuss the possibility of treating the liver metastases directly with SIR micro-spheres.

sirtex.com/us/clinicians/ab...

verywellhealth.com/sir-sphe...

pcri.org/insights-blog/2015...

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