I just found out that my cancer has ' metastatic disease with innumerable liver masses'. I just send a note to my MO at MSK -- pain is pretty bad and I suspect the prognosis will not be a good one.
Ant thoughts/ideas would be appreciated.
Thanks, Ken
Hi Ken,
Sorry to hear you're experiencing pain. I'm sure I've heard here that platinum chemo is best for liver Mets but I'm sure someone more knowledgeable than me will be along to help soon.
Can I just ask what your symptoms/pain feels like? I'm worried my husband maybe showing signs
TY
After my liver mets were found in January I did 6 rounds of docetaxel. (For the second time, actually.) That shrunk them significantly.
Carboplatin is likely in my future because a biopsy of a liver met showed mutations in DNA damage response genes that hadn't been present in my original prostate biopsy.
Don't be afraid of the chemo if your doctor recommends it.
thanks, Rusty - little is scary me now, just found out today. How long have u had the liver mets?
They were found in the scan in January. There were none visible in the previous scan last April, so they probably started since then. They'd been growing a while, since they were quite large. The biggest was over 8cm. At the last scan in June the biggest one had shrunk to around 2cm.
My husband did six rounds of docetaxel for Mets. He told his dr no more chemo. He seems to not want to sustain that again. Right now in remission but you know how that goes .
Since you have been on only Lupron and off it for over a year, then maybe they could give you chemo---docetaxel or cabazitaxel--could be done in conjunction with SIR spheres--see below:
sirtex.com/us/clinicians/mc...
perhaps they can get a biopsy for testing...Have you had any DNA testing--germline or somatic...??? Some things to talk about with your MO...They did not put you on abiraterone, correct??
Good luck, brother.....
Fish
thanks, Fish - no abiraterone. best to you my friend...
The first step is a biopsy of a liver met. Depending on what they find on IHC analysis, your MO will probably want to start you on a taxane and/or carboplatin. He will take additional cores for genomic testing, to check for certain actionable abnormalities.
Allen - perhaps I mentioned this to you already, but that is exactly what the Dr is doing first, a biopsy. I'm sure what they saw on the CT is real and this is not for conformation purposes, ( false positive ) -- but you re telling me it will allow my MO ( MSK ) to best determine how to treat - could partial surgery along with radiation a path this could take? In the meantime, I do have some pain meds ( Tramidoil ) that is helping me along the way. Also, it would be a waste of time and foolish on my part to get a second opinion? How do you do that when you are in the best cancer center in the country. Do they all have new clinical trial information to them or only ones that are supporting their center? thanks
They stain the biopsy material with several antibodies that react with specific proteins (like PSA, PSMA, androgen receptor, Chromogranin A, synaptophysin, somatostatin receptor, MSH2, PD-L1, AMACR, etc.). All of those may lead to different treatment decisions - like PARP inhibitors, Keytruda, or some clinical trials. In addition, they probably send biopsy material for a full genomic analysis to Foundation One. MSK is a leader in the use of these tools.
It never hurts to get a second opinion. Once you have the IHC and genomic reports, you might want to send them to Paul Corn, Eleni Efstathiou, or Ana Aparicio at MD Anderson for a second opinion. Or Oliver Sartor at Tulane, or Celestia Higano at UWSeattle or Emmanuel Antonarakis at Johns Hopkins etc.
They will tend to promote their pet clinical trials at their own institutions, but they will also know about others.
They will probably not want to cut the liver, and if you have many widespread lesions, that would rule out radioembolization as well. Often, chemo does a good job of shrinking the tumors there.
Allan - I've already reached out to Anderson and set the stage for the 2-second opinion. My advantage care plan says I can ger 2 in total, and still, still stay with MSK and decide to switch at any time.
The Dr at MSK called Tues and said this prostate metastasis isn't following the usual path, despite all other organs that got scanned from the recent CT, were normal.
I have now learned just about anything is possible with cancer, but also was told or read, the metastasis to another major organ was not too likely. Thought 70% to 80 went to the bone, nearby lymph nodes, liver, lungs ( my base lungs on this CT and all previous full scans showed the lungs were clear.
My question - despite knowing anything is possible, how likely could have it gone somewhere else or is an entirely new form of cancer.
thanks..
thak
It is unlikely to be a new kind of cancer. I know a man who had a primary prostate cancer and a primary lung cancer, but that is rare. (The lung cancer was an incidental finding on his CT for prostate cancer - so he was lucky to pick it up so early.) The biopsy will tell you for sure.
thanks, Allen...
Rotten news. Hope you get some answers and pain relief.
Chemo with docetaxel, or jetvana or carboplatin have a role in the treatment of liver metastases.
These metastases may be treated directly with SIR micro spheres.
sirtex.com/us/clinicians/ab...
pcri.org/insights-blog/2015...
This could be another therapeutic possibility if chemo is not enough.
Genetic studies of the cancer it is important and they usually can biopsy liver metastases.
You could also consider the clinical trials for Lu 177 PSMA treatment:
That bites. But take the good advice and keep going. May I ask, can you be more descriptive of the pain you are feeling. Is it isolated to the right side? Any other areas affected? From 1-10, where is the pain? Is it constant?
actually left side to the middle of the stomach -- tramadol calmed it a lot.
Keep fighting.... My MO at MSK is Dr. Michael Morris..... I hope he's yours....
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 08/03/2019 12:57 PM DST
Hi Ken,
I was diagnosed with 20+ liver lesions in September 2017. CT guided biopsy of liver confirmed that these were prostate cancer mets in liver.
Immediately began chemo with Docetaxel/Carboplatin combo for 6 cycles and PSA declined (as I also have mets in lymph nodes) and liver lesions got smaller.
Have a MRI of my liver every 2 months.
When PSA began to rise, rechallenge with Xtandi bought me 5 months and then another 6 cycles of Docetaxel/Carboplatin combo. Now on second rechallenge with Xtandi and PSA has dropped 48, 30, 14 and now 3!
Best Wishes. Never Give In.
Mark, Atlanta
thanks, Mark -- just had a biopsy of liver yesterday ar MSK.. My Dr there said it was not likely to have come from my prostate ????
Did your chemo go directly into your liver?
Did you have surgery or any type of radiation treatment?
When did you get your PC dx?
When did the mets show up on your liver?
Best to you as well..Ken
very painful situation on top of this....
my profile tells you about me...
Hi Ken,
I was diagnosed with stage 4 PCa in August 2012 with mets in numerous lymph nodes—PSA of 29 and Gleason 10. For 4 + years had all available drugs, then proton beam radiation. Scans in September 2017 picked up 20+ lesions in liver, which CT guided biopsy confirmed to be prostate cancer mets in liver.
After the implantation of a port in my upper right chest, immediately began chemo with Docetaxel/Carboplatin combo for 6 cycles, 3 weeks apart. Chemo was normal, with nothing directly into my liver. Chemo worked, with PSA declining and liver lesions smaller and less defined.
Since then, I have had rechallenge with Xtandi, another round of chemo, and currently on another rechallenge with Xtandi. I have a liver MRI every 2 months.
Best Wishes. Never Give In.
Mark, Atlanta
Hi. Sorry about the scary report. Sounds like when I got the extensive bone mets report 2 and a half years ago. Wishing you well.
Hi Ken,
I am sorry you are experiencing pain. Is the pain in the liver area? Do you experience nausea or have to get sick? Have you lost appetite and/or weight? I am asking all this because those are the symptoms of mets to the liver, at least for most people.
Platinum-based Chemotherapy is what is most effective with liver mets. Have you spoken to your oncologist yet?
Best wishes, Mel.
Thanks, Mel --- yes, nausea but no vomiting. Have lost appetite and/or
weight, both.
best to you.
You may want to investigate Y-90. It is usually given for Mets of liver from lung or colon cancer but they are starting to give this for prostate cancer liver mets. Your liver enzymes especially total Bilirubin need to be certain levels. My husband has liver Mets too and was approved for the procedure but day of the procedure his bilirubin was too high so they cancelled it. This will only treat the liver but it might be worth investigating as an option in conjunction with other treatment. Here is a link: sirtex.com/us/patients/abou...
Elevated liver enzymes
Liver Damage after radiation? 
PC metastatic to the liver
Liver lesions
Spread to liver and lungs
