Mets after 2yrs and .01 PSA? New cancer?

[Hvacguy]

First off, I made this account for my dad but I am his daughter typing this. I am confused and looking to see if anyone had the same thing happen. Quick background...DX 2.5 years ago PSA 15 Stage 4 Gleason 8, all cores. He got radiation on his prostate and pelvic bone. Put on Lupron and Zytiga and Prednisone. Been doing very well. PSA has remained .01. Last bone scan 6 months ago, no spots. This past month, several spots on ribs and area on L3 lumbar spine. He has had fractures on the past on his ribs even prior to cancer. The oncologist called him in to tell him that he met with several other doctors because they are stumped. They are shocked his PSA is .01 but there are possible bone mets. They sent him for a cat scan on chest and mri on lumbar spine. There were some spots on the ribs and a spot on L3. The radiologist calls them unknown and suspicious for cancer. His next step is a biopsy on lumbar spine. His oncologist said that if it is cancer, it is some type of undifferentiated cancer. So, not prostate cancer, but some other type of cancer? I thought I understood what he meant but now I'm not sure. Has anyone with a low PSA like this, years into treatment got mets with a .01 PSA and if so was it prostate cancer, or some other type of cancer? Doctor told him he would have to start chemo immediately if so. Made it sound very rare and some type of "haywire" cancer. He told me that he is going to be realistic with his options

TLDR:Anyone end up with a different cancer years into treatment with a PSA of .01 or similar? Was it prostate cancer still, or some other type of cancer?

[Tall_Allen]

Bone scans pick up past fractures, spinal inflammation, and arthritis. You need confirmation.. An FDG PET scan will pick up undifferentiated cancer or other kinds of cancers.

[tango65]

There is treatment emergent neuroendocrine prostate cancer, a type of prostate cancer which does not express much PSA. This type of PC usually develops after the cancer is castration resistant and several systemic therapies have been used to control the cancer.

The FDG PET/CT will show if the bone lesions are caused by cancer but it will not determine if it is PC or other cancer. If the bone lesions are caused by cancer, a direct biopsy with histopathological and IHC studies could help to have a definitive diagnosis.

[Hvacguy in reply to tango65]

That’s what I was worried about. He’s going to end up getting a lumbar biopsy. We need ruined PET scan and his doctor said they use that more for soft tissue such as liver, etc. I guess when they do the biopsy we will find out

[tango65 in reply to Hvacguy]

Since he has possible bone metastases only, you could discuss doing a 18F Na F PET/CT which is used to detect bone metastases and it could be more sensitive than the FDG PET/CT for this type of mets. If the lesions are metastases they could proceed with the biopsy.

[Hidden]

One of the indications of progressing bone metastases is an increase in Alkaline Phosphatase. It's usually one of the blood tests we get peridocially. Do you know what his number is and if it has gone up?

[Hvacguy in reply to Hidden]

I do know that he just got all of his CBC and BMP back and that everything was basically normal except for slight anemia which we expect. So yes, his ALK Phosp was normal as well as other liver tests. Someone was saying that there is a specific ALK called bALK so idk if the regular ALL test is useful or not.

[Spyder54]

In my case, my bone scan lit up in all areas of previous injury. So his prev broken ribs would likely light up on bone scan. 6 moss later I did have one disappear vs first. Radiologist said that likely was a PCa met that resolved due to 6 mos of ADT therapy. If your Father is pain free and PSA is .01, it may all be good. I defer to professionals for any formal opinion. Very kind of you to look out for your Popps!

[Hvacguy in reply to Spyder54]

Thank you! I think I need to edit post because after the bine scan they sent him for a CT on chest and that’s where new rib areas showed up and he had a mri on his lumbar spine as well which they said suspicious for Osseous Mets. I really hope not but idk.

[Spyder54]

Yes. More information changes it a bit.

[Hvacguy]

Are you saying that you would expect the PSA to be above 1 if it was a prostate cancer that spread or would the PSA be elevated with the cancer types you mentioned as well? He is supposed to have a bone biopsy so I guess it will specify the type of cancer. He’s doing so well that I hate to see this. I’m assuming if it’s a different cancer does that mean it originated from something other than the prostate? I am an RN so I do understand to some degree some medical terms. Thank you for your response.

[Hidden]

Please have a honest discussion with your Medical Oncologist on micro-metastasis.

Gourd Dancer

[j-o-h-n]

Greetings Hvacguy RN,

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j-o-h-n Tuesday 05/04/2021 10:27 PM DST