Looking Back

[dac500]

I start by wishing everybody a very happy 2020!

The last two years have been very eventful for me.

In 2018, my prostate cancer came back quite aggressively. After my Cyberknife and a short ADT for my extra-capsular recurrence in 2016/17, my PSA started rising quite rapidly with a PSADT of less than two months. A PSA of 0.2 in April 2018 rose to 4.48 by the middle of November 2018. A 18F-DCFPyL PET/CT scan at NIH in October found many abdominal and pelvic lymph nodes light up very strongly. A biopsy of a perirectal lymph node confirmed metastatic prostate cancer.

In 2019, I was on Lupron + Casodex and my PSA dropped sharply from 4.48 to 0.06 in November. Currently, I am on Lupron + Casodex vacation.

In 2020, I expect my PSA to remain low until my Testosterone rises from castrate level. If the change follows the same pattern as 9 month of ADT I had before and after Cyberknife, it could take up to nine months. Unexpected things can happen and I may find myself with castrate resistant cancer.

The brachytherapy I had in 2011 got rid of cancer from prostate gland as confirmed by a biopsy in 2016 and the above mentions PET/CT scan. The recurrent mass outside my prostate and attached to it has completely disappeared. So, why I have metastatic prostate cancer? To end up with metastatic prostate cancer from an initial diagnosis of Gleason 3 + 3 low volume cancer is very surprising for me.

Let us hope 2020 will not disappoint me.

[timotur]

The perirectal LN is not on the most common path for metastasis in the pelvis, and it could have been caused by the biopsy needle, or by more extensive ECE than thought. The mets to the abdominal region are distant mets that meets the criteria stage for stage IV. These could have been caused by circulating tumor cells that landed there. If you have less than five mets you would be Oligometastatic, which is considered curable. Did you have initial ADT with Brachy?

[dac500 in reply to timotur]

No I didn't have ADT with brachytherapy. The last biopsy I had was in 2016. So, how could the prerirectal metastasis be due to biopsy needle. At least 10 lymph nodes lighted up in the PET/CT scan.

[timotur in reply to dac500]

The needle passes thru the rectum to take a tissue sample of the prostate, and when it’s pulled out, some tumor cells may be left behind in the rectal lining. It’s not very common, but it can happen. I have a mesorectal LN met, and I suspect it may have been caused by the biopsy.

[Hidden]

That is crazy? But it just goes to show you that anything is possible with this dammed APC . At times It reminds me of playing pin the tail on the donkey ? Us guys respond differently .... no one path for all .. Take care

[SPEEDYX in reply to Hidden]

So true

[tallguy2]

I'm sorry, but with all those mets I would not personally choose an ADT "vacation." I am on ADT for life, and perhaps you should revisit this with your doctor.

[dac500 in reply to tallguy2]

Even with so many lymph nodes involved, my PSA was 4.48 and all the nodes were sub centimeter. My MO told me it is up to me, but suggested a vacation will lower the risk of cardiovascular and metabolism associated with long term ADT. I will restart ADT as soon my PSA increases sufficiently from 0.06. My PSA dropped from 4.48 to 0.17 three months after the first shot, and then to 0.1 six months later, 0.07 nine months later, and finally to 0.06 a year later when I skipped a Lupron shot.

I am more afraid of my cancer becoming castrate resistant. If my PSA rises by a small amount even when Testosterone is at castrate level, I will restart my treatment.