Liver cancer or Liver mets

[Blair77]

Recent CT scan after PSA rise ( from 2-3.5) shows large amounts of skeletal lesions. Then CT shows possible liver cancer??? The ct scan suggests a biopsy of the liver. But the kicker is the doctor is still out till next week to make a decision. I’m not sure whether to think it’s liver cancer or liver metastasis?

[tango65]

In a patient with metastatic prostate cancer with large number of bone metastases and rising PSA, new lesions in the liver most probable are caused by prostate cancer metastases.

[tango65]

If there were prostate cancer metastases they could be treated directly with SIR microespheres. Other possible treatments could be Zytiga, Xtandi, or chemotherapy with Taxotere, Jevtana or Carboplatin,

[BarronS]

Why does he have a higher burden of mets with such a low PSA?

[tango65 in reply to BarronS]

The cancer could have mutated to neuroendocrine or small cell PC which may produce little PSA. An increase in chromogranin A and in neuron specific enolase may help to do the diagnosis or NE PC. The liver biopsy will be the main factor to have a final diagnosis.

[Blair77 in reply to tango65]

Are those blood tests?

[tango65 in reply to Blair77]

Yes

[MichaelDD in reply to BarronS]

I have lung metastasis. Lungs only --more then 10 nodules. LOW PSA. I have blood work monthly and scans every 3 months. PSA is not my driver but it can be an indicator if my ADT is failing. Next week and the following I have multiple visits to UCSF. My PSA went from February .002 to .010 in March (not sure on April asked for month break). Been on Zytiga 5 months. Last February scan showed no shrinkage on the two biggest nodules the CT scan could see. But not growing either. MO's would not be so concerned had PSA rose to .003 or .004. Here they see a 5x increase in a month. To most here on this site those numbers are good...me not so much.

[Blair77]

I don’t know.

[Hidden]

He needs to have a liver biopsy ASAP!

[George71]

I would see about gene testing for mutations -- it is highly likely he has mutations and immunotherapy can be very effective if he does. Ask doctor to get Foundation 1 gene test asap

[Blair77]

Is that a blood test?

[ctarleton]

If you are considering new biopsied tumor tissue testing at UCSF, you might want to ask them about the pros and cons of these options.

labmed.ucsf.edu/labmanual/d...

foundationmedicine.com/geno...

Charles

[vandy69]

In September 2017, scan indicated suspicious activity in my liver. Only way to know for sure was Interventional Radiologist CT guided biopsy of liver lesions. Answer was prostate cancer mets in liver. MO said liver cancer had a better prognosis than prostate cancer mets, but mine responded to 12 infusions of Docetaxel/Carboplatin chemo. Have MRI of liver every 2 months.

Best wishes. Never Give In.

Mark, Atlanta