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
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Noel91
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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.
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.
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.
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
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?
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.
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.
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?
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