Last month we discovered that my husband’s normal looking blood tests were wildly out of sync with all the mets that appeared on the bone scans since last year. (He was high Gleason 9, low PSA from the get-go) Here’s the link to that question with the responses. healthunlocked.com/advanced...
The oncologist characterized the mismatch as a “conundrum.” He ordered the Guardant360 test to see what might be going on and said to arrange chemo for later this month.
The Guardant360 turned up nothing. Moreover, yesterday’s blood tests came back looking more stable, even improved (see updated profile)—totally in the middle ranges of normal. (We do know from some of your comments that some kinds of cells, particularly neuroendocrine, don’t express much PSA or other signals.)
My husband’s PSA has been .64 for the last three blood tests. The slightly elevated liver enzymes from last month (after the Zytiga suspension) are back in the normal range. He’s been off Zytiga for six weeks and is only on Lupron and 5mg. of prednisone now. All things considered, he feels “Lupron good,” with no notable aches or pains that he hasn’t felt before. (We just returned from a very active overseas trip with no problems.)
A couple of you suggested that a biopsy of met tissue might be a good idea to get a more accurate read on the nature of the cancer cells to tailor treatment. Should we ask for such a biopsy if the oncologist doesn’t suggest it? Are there other tests and/or scans that should be done to help guide the kind of chemo my husband should get? Last month, the oncologist said further scans wouldn’t be meaningful for three months (from last month).
What should we be prepared to ask (or ask for in the way of further testing?) How rushed should we be if we have to factor in possible biopsy and/or more imaging? The oncologist will probably come in with a plan that addresses some of these questions, but the appointments are always so rushed, we need to be better prepared than we were last month. Thanks so much in advance in helping us prep for next week's appointment.