MRI shows lesions. My last PSA was 0.34. What the f---.

[GFM887]

Last Monday ER visit for severe back pain which diminished in a few days. MRI on Thursday results were expected but not the lesions. Past and current MRI.

Current: A 9 x 8 mm enhancing T2 hyperintense lesion is present in the T8

vertebral body (series 18, image 7) and a 12 x 8 mm enhancing T2

hyperintense lesion is present in these T12 spinous process.

In the region of the T7-T8 facet joint on the left there is T2

hyperintensity with associated enhancement (series 6, image 2) and

(series 18, image 3), worrisome for an additional smaller lesion in

this region.

Jan.8 2018

Multiple small foci of decreased T1 signal involving several lower thoracic vertebral

bodies including T9,T10,T12 of concern for metastatic disease.

Equivocal lesion of T8. Metastatic disease is not entirely excluded.

My results will be forwarded to MO tomorrow. Am I a 2%. If so what treatment would you think is next. Thanks Warriors

[Tall_Allen]

What do you mean by "a 2%"?

Since you are BRCA2+, next steps might be a taxane+carboplatin followed by maintenance with a PARP inhibitor (Lynparza or Rubraca).

[GFM887 in reply to Tall_Allen]

Hello T. A. I was thinking because my PSA is almost zero that it might be some form of small cell. Does all normal Prostate cancer produce PSA? Thank you

[Tall_Allen in reply to GFM887]

No- there are low PSA subtypes that are normal acinar adenocarcinoma (in fact, that is much more prevalent than neuroendocrine).

[GFM887 in reply to Tall_Allen]

Thank God. Thank you for your wisdom, Sir

[Tall_Allen in reply to GFM887]

There is also a less virulent subtype of neuroendocrine PC called "treatment emergent" because it is only seen in men who have been heavily pre-treated. No matter which kind it is, a taxane (Taxotere or Jevtana)+carboplatin is a good next step. A biopsy of metastasis tissue can be stained with antibodies that will tell you which kind it is. There is a subtype called "double negative" (negative for PSA and the androgen receptor) that is in a clinical trial at SCCA.

[Hidden]

Here's a good article that covers the chemotherapy spectrum in CRPCa including those with small-cell features.

ncbi.nlm.nih.gov/pmc/articl...