Help me

[Chris52981]

IMPRESSION

Findings consistent with osseous metastatic disease in the left iliac crest, right anterior 4th and left 10th ribs, T5 spinous process and L3 vertebral body.

Narrative

EXAM

PET CT, SKULL BASE TO MID THIGH, AXUMIN-8/6/2020 3:42 pm

HISTORY

biochemical recurrence prostate cancer

COMPARISON

CT ABDOMEN /PELVIS WITH IV CONTRAST WITHOUT ORAL dated 7/6/2015; BONE SCAN INJECTION dated 7/6/2015

TECHNIQUE

PET-CT from the pelvis through the skull base was performed 4 minutes following intravenous administration of 10.56 mCi F18-fluciclovine. Non contrast CT images were obtained for localization and attenuation correction.

FINDINGS

PROSTATE BED: There is minimal low level uptake in the prostate gland centrally with SUV max of 3.57.

PELVIC AND RETROPERITONEAL LYMPH NODES: No abnormal uptake.

BONES: There is abnormal uptake in the left iliac crest, right anterior 4th rib, T5 spinous process. There is a sclerotic lesion in the left T10 rib without abnormal uptake concerning for metastatic disease. There is a sclerotic density in the L3 vertebral body with slight increased uptake concerning for osseous metastatic disease.

OTHER PELVIC FINDINGS: Bladder is within normal limits.

HEAD AND NECK: No abnormal uptake. No enlarged cervical lymph nodes.

CHEST: No abnormal uptake. Mild physiologic myocardial uptake. No pericardial effusion. There are several tiny pulmonary nodules in the lingula and right lower lobe ranging in size is from 3-5 mm. Coronary artery calcifications are present. No focal consolidation or pleural effusion. No mediastinal or hilar adenopathy.

ABDOMEN: Physiologic uptake in the liver and pancreas. No focal adrenal nodules. No hydronephrosis. No acute findings in the bowel. No other abdominal lymphadenopathy.

MUSCLES: Mild diffuse physiologic muscle uptake.

[Tall_Allen]

Next would be docetaxel + Lupron, followed in about 4 months by Lupron + Zytiga. He could do it the other way around, but I think doing docetaxel earlier is better.

[Chris52981 in reply to Tall_Allen]

Is common and successful to treat

[Tall_Allen in reply to Chris52981]

Yes, those are the standard of care. He should also get one of the bone metastases biopsied. There may be something there that can enable him to benefit from a tailored therapy.

[Chris52981 in reply to Tall_Allen]

My dad actually fell

And broke ribs when he was young and on x rays in past there was post trauma to those ribs can that be shown on there

[Tall_Allen in reply to Chris52981]

They would show up on CT, but not Axumin.

[Chris52981 in reply to Tall_Allen]

Curious as to why he would need chemo if Lupron would work. Not sure just asking ?

[Tall_Allen in reply to Chris52981]

Lupron is only one ingredient. He needs both. Two major clinical trials found that survival is longer and time to castration resistance is longer too whn both chemo and Lupron are given at the same time.

[Chris52981 in reply to Tall_Allen]

He had open heart surgery years ago

And takes things for blood pressure and angina - I just am

Wondering how the chemo

Will effect his heart ?

[Tall_Allen in reply to Chris52981]

Ask the oncologist.

[Chris52981 in reply to Tall_Allen]

Also are these spots that he has or the whole area - how big are they

[Tall_Allen in reply to Chris52981]

The sizes are on the detailed report.

[Exrunner in reply to Tall_Allen]

Survival may be longer but what is the quality of life during that time? If the treatment side effects are so debilitating that life cannot be enjoyed what is the purpose of surviving longer? Hoping for a cure.

[Tall_Allen in reply to Exrunner]

Most patients enjoy an improvement in their quality of life because of the treatment. It is important to use actual facts, and not imagination, drive decision-making.

[Chris52981 in reply to Tall_Allen]

Once you have bone Mets - is it possible to still do intermittent Lupron

[Tall_Allen in reply to Chris52981]

Yes. Anything the patient wants is possible if he needs a break from the therapy.

[Chris52981 in reply to Tall_Allen]

Can the Mets actually go

Away and the patient be in remission with once it his bones

[Tall_Allen in reply to Chris52981]

The VISIBLE metastases can shrink, but that doesn't get rid of all of them. Remission just means the cancer doesn't seem to be expanding for now.

[Chris52981 in reply to Tall_Allen]

Ok so because my dad stopped taking Lupron and now it metastized that doesn’t not mean Lupron will not work- he could have had the Mets for years but the scans maybe weren’t sensitive enough to show

[Chris52981 in reply to Chris52981]

The dr had him use it for two years or 18 months and then was watching psa bc it was undectable once it went 2+ nadir he got the Axumin- this is more

Sensitive to seeing Mets than the CT and bone - is that correct

[Tall_Allen in reply to Chris52981]

Yes, Axumin PET/CT is more sensitive than bone scan/CT

[Tall_Allen in reply to Chris52981]

Lupron always works- it prevents the testes from manufacturing testosterone.

[Chris52981 in reply to Tall_Allen]

So u think it may have been possible he had them

Always

[Chris52981 in reply to Tall_Allen]

I get reassured and then someone else’s opinion makes me think other-

[Schwah in reply to Tall_Allen]

Question Tall Allen. When I was diagnosed with 3 mets, I did chemo and lupron and quickly added Zytega. If I remember correctly, you seemed reticent For me to do all three because no studies proved it to be a benefit. Has your thinking changed or did I misunderstand you last time?

SchwaH

[Tall_Allen in reply to Schwah]

I think what I said was the benefit of combining chemo and Zytiga has not yet been established in the mHSPC situation.

[Schwah in reply to Tall_Allen]

Gotcha.

[V10fanatic in reply to Tall_Allen]

My MO Dr. Scholz went with Provenge at the beginning, Followed with Lupron/Zytiga, SBRT to the mets, with the Docetaxel coming approximately 6 months after my last infusion. FYI- My insurance company is Anthem Blue Cross/Blue Shield, and they approved the Provenge without a need for appeals.

[Tall_Allen in reply to V10fanatic]

Scholz has a way of getting things approved - I never ask him too many questions.

[V10fanatic in reply to Tall_Allen]

It was actually my local MO here in Colorado Springs- Dr. Scholz was actually pleasantly surprised.

[Tall_Allen in reply to V10fanatic]

Sometimes MOs have good relationships with insurers or they know how to write it up so that it gets approved.