Dear Friends,
Sorry for being away from the forum for some time, primarily because of some family commitments. So , i will start with a summary of the illness.
Chief Complaints and History of Present Illness:
• LUTS Since Jan/Feb 2020. Past History Nil
Physical Examination
• PS 1
Clinical Notes/Old Reports
• TURP conducted on 22 June 2020
• PSA (post TURP): 258.47
• Biopsy: Adenocarcinoma Prostate
• Gleason Score (4+5=9) PNI present
• PSMA-PET: Prostatic Lesion with Peri prostatic Stranding. Presacral Soft Tissue with invasion of posterior and left lateral rectal wall. Multiple pelvis and RP lymph nodes. Multiple osseous sclerotic lesions
• Started on Degarelix and Denosumab (1 July 2020)
• MRI LS spine: Multiple metastatic focal lesions in LS vertebrae and bilateral iliac bones.
•Dexa Scan done on 20 October 2020: Normal T score-2.9.
• Genetic testing: BRCA1, BRCA2 Negative
•PSMA PET SCAN conducted on 16 Dec 2020
•Findings
oNear complete resolution of large, ill marginated PSMA, avid hypodense lesion in left lobe of the prostrate and complete resolution of the peri prostatic stranding.
oComplete Resolution of:
PSMA avid presacral soft tissue thickening.
A few sub centimetre size, F 18 PSMA avid bilateral retro- crural lymph nodes.
All but one of the multiple PSMA avid para ortic, aortocaval, bilateral common iliac , internal and external iliac, and para rectal lymph nodes.
PSMA avid predominantly, sclerotic lesions, in multiple osseous structures and reactionary sclerosis in the underlying bones.
Multiple, up to centimetre size, most of these partly calcified and some non-calcified , para trachial , pre carinal , sub carinal and AP window nodes.
PSMA avid , right hilar and a left para bronchial nodes.
Tumor Markers
• 27 June 2020 (Post TURP): 258.47 ng/ml
• 28 July 2020: (After 1st cycle): 7.87
• 23 Sept 2020: (After 3rd cycle): 0.88
• 18 Dec 2020:(After 6th cycle) 0.10
• 10 Mar 2020 (After 9th Cycle). 0.04
CURRENT STATUS
@. PSA has increased to 0.234 IN JULY 2021 from 0,04 IN APR 2021.( NEARLY SIX TIMES IN 2 MONTHS)
@. BACK ACHE IS TREMENDOUS .
@. MALAISE AND TIREDNESS IS KILLING.
QUERRIES.
#. IS THIS INCREASE IN PSA IS MERE FLUCTUATION OR MY HONEYMOON WITH ADT IS OVER?
# WHAT AFTER ADT ?
# HOW LONG WILL THE CHEMO BE EFFECTIVE AFTER ADMINISTRATION?
I shall be grateful if someone could please take out some time to answer these queries .
grateful