Scan Results and Treatment Begins

[ChicagoJ]

My last post was about 4 months ago. I had planned on posting the results much sooner, but the trip had a few more twists and turns than I planned. Here’s the promised update of my adventure. My history is in my profile and my MO is Dr Maha Hussain.

So after 3 clear Axumin scans since 2019, the September 1st PSMA PET/CT scan found something. The scan showed a “subtle“ uptake of tracer on 4 ribs which the radiologist said was a mild to moderate indication of cancer. There was also uptake in the subcarinal lymph nodes in the chest and very subtle uptake in a nodule in one of my lungs. No other uptakes were seen. The radiologist suggested that either we schedule another scan in the near term or possibly biopsy the lymph nodes in the lung area.

My doctor recommended and I agreed to another PSMA scan along with blood work approximately 5-7 weeks after the first one. So on October 18th I had my second PSMA PET/CT. This scan showed uptake again in the subcarinal lymph nodes, 1 small area on one rib (the uptake on the other ribs disappeared), and uptake in a small (less than 1 cm) lung nodule. Dr Hussain was concerned about the lung uptake and the slight possibility that a second (lung) cancer could be involved. She referred me to a pulmonologist who recommended an EBUS bronchoscopy. I had this procedure done on November 15th. It found metastatic prostate cancer in the subcarinal lymph node and no evidence of a second cancer. The nodule biopsy showed no evidence of cancer but it was so tiny that any cancer might simply have not been seen.

I also should say that Medicare and my supplement paid for both scans and the bronchoscopy. I haven’t had to pay anything. My part D drug plan covers abiraterone as well so all that is good.

So, 11 years after my prostatectomy and six years since my salvage radiation I’m back in treatment again. I got my first Lupron shot and have started on abiraterone. There may be treatment modifications after the holidays early next year. Let the games begin!

John

[Tall_Allen]

Kudos to you for pursuing it. Small rib metastases are known to be false positives on PSMA sometimes. Lung metastases usually respond very well to systemic therapy.

[ChicagoJ in reply to Tall_Allen]

Thanks! That’s good to know about the rib metastases. Interestingly the pulmonologist who did the bronchoscopy was on the team the did the first double lung transplant on a Covid patient in 2020 so I was in good hands with her.

[Hidden]

So certainly PSA was your guide. It was just a matter of where. Was there the possibility of spot radiation depending on where it was?

[ChicagoJ in reply to Hidden]

We have discussed radiation as a concept, but these lymph nodes are in the center of my chest, right between the lungs and near the heart. Not a good target area.

[tango65]

Do you know if they have enough tissue to do genetic , histological and IHC studies? Metastases may be different from the original tumor. These studies could indicate the presence of mutations which could make the cancer respond to medications like olaparib, rucaparib , keytruda etc.

I wish you the best of luck in your treatment.

[ChicagoJ in reply to tango65]

There probably isn’t enough tissue, but they are trying. We should hear soon if it was successful.

[MateoBeach]

Rats. Unwanted guest shows up at the door. Hate it when that happens. But good that you are on it early.

[Scout4answers]

Hi ChicagoJ

Sorry to here that it is coming back

MO is Dr Maha Hussain. Her name has come up a number of times in my research, How long have you been in her care and what has your experience been?

[ChicagoJ in reply to Scout4answers]

We moved from Seattle to Chicago in late 2015 (kids and grandkids are here) and for a while I continued to see a doctor at Seattle Cancer Care Alliance remotely. In late 2016 my PSA became detectable again so I started looking for a local MO. I discovered that Dr Hussain, who’s name I had seen in articles, had recently moved to Northwestern Medicine from Michigan. I consider myself very fortunate to have found her. She is an excellent doctor, one of the leading prostate cancer specialists, who also listens and gives her patients time to ask questions. She comes across as compassionate and truly concerned. I feel like my treatment decisions are made collaboratively- that our input and concerns are taken seriously. I would highly recommend her.

[j-o-h-n]

Keytruda for your Lungs.....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 12/12/2021 7:38 PM EST