IMPRESSION 1. A few enhancing marrow replacing lesions involving the spinal stenosis the T4 vertebra, left lamina and spinous process of the T1 vertebra and posterior aspect of the body of the T11 vertebra, likely representing metastatic disease. Please note that the T11 vertebra appears to have hemangioma and metastatic disease. 2. A mildly enhancing T1 and T2 hypointense lesion involving the L3 vertebral body, likely representing metastatic disease. 3. No evidence of enhancing epidural soft tissue component. 4. Multilevel degenerate is in the lumbar spine as described above, more pronounced at L4-L5 level with resultant mild-to-moderate bilateral neural foraminal stenosis at this level. No evidence of significant spinal canal stenosis.
Is this still treated systematically
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Chris52981
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Even if it's in the bone marrow, it will respond the same way to treatment. If he's hormone sensitive for example, the cancer everywhere will be hormone sensitive and can be treated just as well regardless of where it is located.
Xofigo is Radium 223, an alpha emitting radioisotope that is bone seeking. It provides short-range, high energy alpha particles that predominantly cause double-strand DNA breaks in cancer cells thus ending their reproduction. It is only useful for bone mets though so will not kill cancer anywhere else. It is short range (10 cell diameters) and theoretically should not reach the bone marrow.
The nice thing about combining Xofigo and Provenge is the increased antigens from the Xofigo synergistically combines with the enhanced dendritic cells of the Provenge. This kills cancer beyond the targeted bone metastases.
Have him get a full blast of chemo and do as many cycles as he can take. That's one thing I wish my Dad did when he first got diagnosed. That is the biggest thing I regret. If there are some lesions showing up on MRI, there are most likely micro lesions that are not visible on the MRI yet.
Then make sure he gets back on ADT and you could possibly save the zytiga or xtandi until it progresses. Hit with the chemo and get the cells that might be resistant to ADT and then hit it with the ADT. I'm convinced that is the best way to go based on studies and the hundreds of cases that I read on this forum.
Also look at his blood work and see if his HBG, RBC and Platelet count is normal. Bone marrow invasion could affect the blood.
Agree. My doctor was pushing me to do chemotherapy when I was first diagnosed, but I said no. But then I was really worrried about regretting that decision later so I went ahead with it. So glad I did it now.
in reply to
If his mets can only be seen on a PET scan, he's not technically metastatic though so don't think chemo will be an option at this point.
I've been trying to find an actual definition of non-metastatic which is kind of semantics since we know he has metastases.
So yes, apparently MRI is included in the imaging that can be used to determine whether there are metastases along with conventional CT and T99 bone scan.
So I'm wondering why they aren't offering chemotherapy, just second-line anti-androgens.
Given your Dads condition as you have described it I would base his treatments on his clinical condition and you and your medical advisers ( preferably a medical oncologist and radiation oncologist) need to discuss that. My guess is that would be hormonal treatment that is current and affordable (see above) and good pain control. Chemotherapy may be contraindicated because of the possible side effects; immediate - very common and delayed - such as peripheral neuropathy (10-40% of patients) - which may be disabling to him. His Quality of Life issues probably should dominate.
Chris, please be careful for what you hear on this forum. I am a practicing internist x 22 years and a current cancer patient. People try to be helpful, but they put in their own opinions which mean well but have minimal experience. Take it with a grain of salt. You need systemic for the places it has, and has not, developed yet. You have to assume it has seeded everywhere and must be treated. As for the spine, you have choices of conventional external beam radiation or newer proton beam radiation. This can be very effective and must be considered. You should see a radiation oncologist for options. Warmly, Dr Joel Silverman.
Yes I think lurpron with Zytiga or a different second line - radiology oncology said after they scan him after meds then they will see for radiation - he sees his med. oncologist Monday who was referred to us when we got his second opinion the first time. Thank you
Look, involve medical oncologist and cardiologist and get their approval for chemotherapy. It is the best systemic treatment sling with hormone injections available.
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Which MRI study to order
PSA Rising and MRI Negative 
Is another MRI needed? 
PSMA PET / COMBIDEX MRI 
MRI guided radiation 
