Dad with nearly daily low grade fevers

[dunde8889]

Hi all, as I posted previously my dad has metastatic cancer. He was started on lupron in 2017 and at the end of 2017 zytiga was added. PSA never went below 4. He did not have surgery or radiation at that time. Earlier this year he started to have blood in the urine. They found out the prostate was much larger and also blocking the kidneys so they put in two stents. They also scraped out the prostate. The biopsy now shows Gleason 10 in 99% of the scrapings. Zytiga was stopped at that time since it was not working. The PSA went up to 35. Just before they placed the stents he started having low grade fevers along with weakness nearly everyday and he takes Tylenol which helps. They checked for infections but all tests are negative. He is currently getting radiation to the prostate and the bone metastasis in the right hip bone. He had an axumin scan which showed cancer in the right acetabulum, right pelvic bones, a soft tissue mass in that area and the lymph nodes in the pelvic area. The doctor has no explanation for the fever other than cancer. But he also said prostate cancer usually doesn’t cause fevers.

Reading here I am concerned about neuroendocrone cancer. Is that still possible even though the biopsy showed Gleason 10? His original biopsy in 2017 was Gleason 8-9.

Any other reasons for the fever? They plan on starting chemo after radiation is done. I’m hoping that will help.

Thanks for your input.

[HOPEFULSPOUSE]

Have they done a urinalysis to see if he has a UTI (urinary tract infection)? Typically it’s associated with pain but not always. It can be serious in cancer patients and develop into other issues.

[dunde8889 in reply to HOPEFULSPOUSE]

Yes they checked it many times and the test and culture never showed anything. He has been having the fevers for 2 months now.

[Hidden]

There is something I believe I had called systemic inflammatory syndrome. It causes fevers and is not often recongnised by doctors. My doctor said it couldn't be caused by the cancer, but went away when I started treatment. Here's a link to my post, there's an article about it linked there. There are 2 blood tests that help determine if you have inflammation: ESR and C-reactive protein. Mine were high in both cases. They are non-specific indicators of inflammation, but useful in determining if you have this.

healthunlocked.com/advanced...

As far as your concerns about neuroendocrine cells, I would think that would have been seen in the biopsy. It's generally mixed with other types and as far as I know would not directly depend on Gleason score.

How are his white counts and neutrophils? that's another thing to look at, but would imagine that's been looked at.

Wishing the best for your dad. Please keep us posted on what they find, treatment, etc.

[dunde8889 in reply to Hidden]

Thanks I’ll ask them to check the ESR and C protein. Hopefully his improves once they start treatment. His white cells are normal.

[CantChoose]

If his kidneys were blocked, inflammation there can cause fever and malaise. Takes time to heal. Cultures may not show infection, as it's not always bacterial. Is his creatinine up? Make sure you are pushing LOTS of fluids.

[dunde8889 in reply to CantChoose]

Yes his creatinine is up and improved after they put the stents but not normal yet. Is is possible for an infection to linger for 2 months since he has fever the last 2 months? All cultures are normal.

[CantChoose in reply to dunde8889]

It''s not an infection but an inflammation. Now that the stents are in, it will hopefully get better but it takes time:

aafp.org/afp/2003/0615/p252...

[elainea53]

My husband also had low grade fevers. Mo said as long as not over 100 not a problem

[dunde8889 in reply to elainea53]

Does he become fatigued when the fevers come on? My dad gets really fatigued and just sleeps when the fevers come on and he may sleep for hours during the day and not do much. At times when he does not have the fever he is his usual self.