Two nodules in Lungs

[Noel91]

Hello everyone, I have been in this group since my father was diagnosed in December 2017.

You have always been a great source of help and support. I have not been writing for a long time because my father has remained stable and undetectable until now and got really depressed with muy father's illness. His treatment these years has been Zytiga, Prednisone and Lupron every 3 months.

Today we have been told that PSA remains undetectable and there is no progress in bone metastasis.

However, two small nodules (less than 5 mm) have been detected in his lung. The doctor said that they may be metastasis or something else, but that those are very small and that is why the PSA has not increase(less than 0.02)

Do you have any experience on this?

Thank you all very much for the help from Spain

[Hidden]

The nodules in his lungs might be a type pf prostate cancer called neuroendocrine that often metastasizes to organs and soft tissue. This type of PCa does not make PSA. The treatment for it is usually a combination of chemotherapy including a platinum-based chemotherapy drug.

[Noel91 in reply to Hidden]

Thank you very much for your answer Gregg.He was diagnosed with an adenocarcinoma, is it possible that he has changed to neuroendocrine cancer?

thank you

[Hidden in reply to Noel91]

It can change due to successful androgen-based treatments that don't effect these cancer cells. That's why it's known as "treatment emergent" NEPC.

He'll just have to keep an eye on the "mets" as long as they are small. I would also be getting imaging for organs, especially the liver. He has had imaging?

At some point he may need to have a biopsy to determine the best course of treatment.

[Noel91 in reply to Hidden]

He had imaging. There was just these two mets in the lung.The two mets in the Bones remain indetectable

Thank you very much

[Hidden in reply to Noel91]

I also had quite a few small nodules at diagnosis, my doctor didn't think they were cancer, but we did have a discussion about that and also the possibility of lung cancer. I said "Well I'm doing chemotherapy so let's see what happens." She said, "It's not first-line chemotherapy, but it is second-line so OK."

Turns out the nodules went away after chemotherapy so we don't know. I agree that a lung biospy should be avoided if possible, only done if you really need it and there is no other option. Hopefully nothing shows up on his liver, but if it does it's a much safer location for a biospy.

[Noel91 in reply to Hidden]

thanks Gregg, if the mets reduce its size with chemotherapy, does that mean they were related to cancer?

Thank you very much

[Hidden in reply to Noel91]

That's what I thought although they said at diagnosis the nodules were very small and didn't look like cancer. Guess it will remain a mystery.

[Magnus1964]

I had the same experience. I went on Provenge. The nodules reduced in size and stayed dormant since then. That was 5 years ago.

The lungs are a tricky spot. Biopsies are not recommended.

[Noel91 in reply to Magnus1964]

Thank you very much Angus, I'll talk to the doctor about this. Is it your type of neuroendocrine or is it an adenocarcinoma?

thank you very much for the help

[Magnus1964 in reply to Noel91]

My cancer is the adenocarcinoma type.

[Tall_Allen]

Benign lung nodules are common. Best to biopsy one if it is accessible.

[Noel91 in reply to Tall_Allen]

Thank you Tall Allen. Doctor said to wait two months to check if the nodules grew. Not sure if that is the best solution,I Will ask him about the biopsy too

[podsart]

What type of scan was done with such a low PSA ?

[Noel91 in reply to podsart]

Thank you for your answer Podsart, he had a Tac and scintigraphy to check if there is progression.

Not sure if those are the correct names in english, sorry about that

[wagscure259]

I can only report that I have had a Right Lower Lobe “nodule” which has been suspected to be a granuloma which has not changed in 7 1/2 years. Was there a smoking history.? My parents were heavy smokers and I commuted by vehicle to NYC for over 20 years and may be the etiology of my nodule. If nodules are easy biopsied that may be indicated. Are the radiologists unsure what these small nodules are ? Does this represent a radiological change?

[Noel91 in reply to wagscure259]

Thank you very much for your answer. My father has never smoked.

In the initial history he said that there were small points in the lung of dubious pathological significance so MO did not Pau attention at the beggining but now the report said nodules. We are scared because the oncologist who has his medical histology has given importance, but we will Talk with MO Next week.

thank you

[j-o-h-n]

My lung melanoma is being treated with Keytruda and it's working.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 07/11/2020 2:59 PM DST

[Noel91 in reply to j-o-h-n]

Thank you John, Did you have It at diagnosis or came after?

[j-o-h-n in reply to Noel91]

Many years later..... It was from a tiny melanoma (skin cancer) metastases on my neck. But they are using Keytruda for lung cancer and it is working. Immunotherapy. Ask your M.O.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 07/11/2020 9:15 PM DST

[Noel91]

Thank you very much for your help,really. The report only says adenocarcinoma. My father reacted quickly to hormonal treatment by lowering his PSA from 8 to nadir. Is it possible that the initial autopsy did not detect the neuroendocrine type or that it has appeared now?

Next week we are going to the MO so I will ask you to review those parts and the test.

If It is finally neuroendocrine, would he have to stop zytiga and start with docetaxel?

thank you very much