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Advanced Prostate Cancer
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PSA "undetectable" but new mets?

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

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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.

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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?

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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.

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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!!!

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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.

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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...

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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.

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Why is your husband having to start chemo?

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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.

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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

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

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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

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

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

Nalakrats

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

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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.

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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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