Liver Damage after radiation?

[Seabird12]

Regarding my previous post, I just wonder why my husband’s oncologist should have ordered for a Liver MRI? Is it normal to do so or MRI usually given if the damage is intensive? I googled the purpose of MRI and I came across few terms such as liver cancer , hepatitis , cirrhosis and Lesions that could be fatal !

Have you ever had such a issue during or after radiation?

He was on ADT+Zytiga+prednisone for last 9months, his PSA undetectable, PSMA scan showed the three mets gone , blood test every 2 weeks, everything was normal ! He started radiation therapy a month ago , had a blood test a week ago , liver showed abnormality , Dr.Scholz asked to stop zytiga and get MRI ASAP!

Can radiation To his prostate damage his liver so bad that MRI is needed ? Can it be liver met or even liver cancer ?

I would appreciate hearing your thoughts on this, please.

[Tall_Allen]

Radiation to the prostate does not affect the liver -- it's too far away.

Good idea to check for prostate cancer in the liver that isn't expressing PSMA. If the MRI is showing changes, an FDG PET may tell you more.

[6357axbz in reply to Tall_Allen]

Impressive response TA

[Seabird12 in reply to Tall_Allen]

Does it mean that although he has been under prostate cancer treatment for the last few months with good results as well as radiation , the cancer has silently spread to his liver ? Is it possible after all those scans , blood tests , treatments , etc ? I’m asking because I have zero knowledge about this disease and since I speak English as the second language I have hard time asking the right questions from his oncologists or understanding them when it becomes so specific, please tell me what is happening like you are explaining it to a 10 year old kid, please . One of the knowledgeable member of this forum told me maybe the combination of Zytiga and radiation was very harsh for the liver because of free radicals released during radiation. Can it be that ?

[Tall_Allen in reply to Seabird12]

It means exactly what I said. I can't say it any more simply than those two sentences.

I can't explain many of the eroneous things that other people post.

[Hidden]

Zytiga can cause liver enzymes to rise.

As far as I know, it's standard procedure to check the liver in this situation, but I don't think it's likely to be caused by cancer.

What was the abnormality in the blood test?

[Seabird12 in reply to Hidden]

Thank you Gregg for replying, I don’t know about the detail , the only thing I know is everything was normal till a week ago , I don’t understand this sudden change, and why the doctor didn’t rely on the blood test alone and ordered a MRI.

[Hidden in reply to Seabird12]

Do you have the blood test numbers?

[Seabird12 in reply to Hidden]

No , unfortunately I was not with him that day and he hasn’t the test result , I can remember , 9 months ago , when he just started zytiga, he had some elevated numbers but resolved after the third blood test . Could it be met ? A met that did not show up in any test ?

[Hidden in reply to Seabird12]

I'm fairly sure that liver mets can't be diagnosed with blood tests. I really wouldn't worry about, it won't help anyway and chances are good that it's not cancer causing the abnormal tests.

[Seabird12 in reply to Seabird12]

I find it out ! The ALT jumped from 25 in four weeks ago to 75 a week ago ,and normal range is 0-65 !

[Hidden in reply to Seabird12]

ALT levels of <5 ULN are conisdered to be mild elevations are not that uncommon. Mine went up over 90 during chemo and at >5X ULN they stop your chemo. My Oncologist was panicking, telling me I needed to immediately have an ultrasound on my liver. I said "This could be caused by the chemo, so let's wait a week and test it again." Sure enough it was down below 65 and they gave me chemo again. It kept coming down after that. When I later told my new doctor about this he was just shaking his head that my doctor didn't want to wait a week and check it again.

Here's an article on the subject:

aafp.org/afp/2017/1201/p709...

Keep this part in mind:

Mild, asymptomatic elevations (less than five times the upper limit of normal) of alanine transaminase and aspartate transaminase levels are common in primary care. It is estimated that approximately 10% of the U.S. population has elevated transaminase levels.

[Seabird12 in reply to Hidden]

Thank you so much , this comfort me a bit 🙏

[Hidden in reply to Seabird12]

It's good to have it checked out, but I definitely would not worry.

[LearnAll]

Seabird, the most likely possibility is that Zytiga has caused liver injury. The liver enzymes such as ALT ,AST and bilirubin are elevated which is telling that liver is under pressure.

Most of the time such liver damage is temporary and enzymes start becoming normal again if the drug is stopped or dose reduced to very low.

I do not think that there are liver mets..so relax...and wait for liver to repair itself.

[Seabird12 in reply to LearnAll]

Thank you dear but please let me ask you this , his ALT number in the last test is 75, while it was 25 a test prior , a huge jump ! The normal range is 0-65, what does it mean to you , please ?

[LearnAll in reply to Seabird12]

This does not mean much to me as a jump from 25 to 75 is not uncommon. Many medicines can cause this type of jump in ALT. There are cases where ALT goes to 500 or even 1000...and that can be really serious.

Liver has great capacity to repair itself and once the offending drug is stopped, liver heals itself and ALT and AST fall back to normal levels.

[Daisyelaine in reply to Seabird12]

Not much. In the lab we see enzymes rise to the high thousands.

[tango65]

Zytiga is associated with elevation of the liver enzymes. He has a mild elevation, When there are sudden jumps in the value of a test, it is prudent to repeat the study to be sure it is real.

He could have waited to see what happened after stopping Zytiga before ordering an imaging study

IMHO the doctor ordered the MRI to be sure that there is not any lesion in the liver which could cause the elevation of the liver enzymes. He is being careful.

[45yrsDenmark]

3 weeks after I got radiation, my ALAT rose to over twice of the maximum allowed level and also billirubins over the allowed (I am also on lupron and Zytiga +prednisone). I waited 2 weeks (while staying on my medications) and the liver numbers came back to normal. No one could explain this.. Maybe this is the same thing happening to your husband...

[Seabird12 in reply to 45yrsDenmark]

Hi, did the radiation cause low blood cells as well ?

[45yrsDenmark in reply to Seabird12]

Sorry to not answer before.. I got Leucocyts, metamyelocyts , neutrofilocyts and trombocyts measured before and after radiation (rapidarc). Leucocyts and neutrofilocyts increased slightly, but not dramatically. Don't know if those blood values are the correct names in english (I'm Danish)

[ctflatlander]

I had elevated liver enzymes on 1000mg of Zytiga and had to stop. Restarted with reduced dose of 750mg and settled on 500mg. Been on that dose 2 yrs.

[Gunnershome]

Look on his original biopsy to see if they listed Neuroendocrine features at all. I notice he is a Gleason 9 with low PSA. My husband is a Gleason 10 and has always had low PSA. He was on zitega and prednisone for 14-15 months. Everything was fine...then the cancer showed up in the liver and rib and hip area.

Get the MRI. Don’t panic. If it shows on the MRI....they will most likely need to do a liver biopsy to confirm. Be your own advocate. Research and look into treatment options. My husband is 57. We have two kids ages 15 and 12. Don’t give up hope. Prayers and positive vibes sent your way.

[RonnyBaby]

An MRI (Magnetic Resonance Imaging) is a diagnostic / scanning tool - it doesn't cause liver cancer.

It is NOT exclusive to Prostate cancer.

There are other types of scans that may be used to effectively serve the same function - some are more sensitive than others.

A bone scan might be another example of scans used to diagnose the state of the disease.

[wolf2gang120]

I never had any liver problems after my radiation treatments

[Seabird12 in reply to wolf2gang120]

Hi , did it cause low red / white blood cells?

[j-o-h-n]

Please take a short flight over the sea and cool down for awhile. Since English is your second language make sure the doctors give you results/opinons in writing so you can convert them to your native language when you have the time. Please take it easy, your husband needs you to be fit and healthy. Regards,

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 09/20/2020 5:52 PM DST

[monte1111 in reply to j-o-h-n]

It's Greek to me.

[j-o-h-n in reply to monte1111]

it's Italian to me....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 09/21/2020 5:44 PM DST

[Geter]

Age 72. Two years into diagnosis with mestastic activity to bone. Hormone treatments, bicaltamide (Casodex) lowered PSA. Then PSA rising again. Got Provenge treatment and went on Xtandi. That worked for 3 months. PSA continued to rise. Switched to Abiraterone (Zytiga) first 30days PSA went up to 68. Dr. suggested another 30 days. PSA goes to 98.7. Started external beam radiation, tageting tumors to help with pain. Last Appointment with Dr. says the hormone treatments are no longer working. Another visit in 30 days and he says to continue taking Zytiga until that time.Out of all the drugs, Zytiga is my least favorite. My weight is 116 last I checked. My wife doesn't want me to weigh myself anymore. I've keep eating, but no increase in weight. The last is Taxitere and the Dr. isn't highly recommending that. I will have a consultation with Chemo oncologist after next Dr. Appt. but I honestly don't know if I can survive the side affects. I know you guys and wives will tell me not to give up, and my wife is with you, but she is also scared of the side affects. Does it make sense to continue? I just dont know...

[Gec659 in reply to Geter]

How are you doing , My friend ?