What does recent biopsy mean positive for NKX3.1?

[julyturqsee]

since we assumed NE/CRPC (low psa/aggressive cancer growth: diagnosed 8/20 gleason 9), my partner requested biopsies (lung and pelvic node). Results reveal tumor cells in iliac node positive for NKX 3.1 while INSM1 & synaptophysin "show very rare positive cells." and adenocarcinoma in one lung. A chromogranin A test shows an upward trend, from 52 (9/20) to 86 (11/21). We're meeting with his oncologist tomorrow. Any suggestions for future tests & treatments/trials (currently infusions of Docetaxel + Carboplantin every 3 weeks for possibly 3-6 more infusions)?

[Tall_Allen]

It just means the cancer came from the prostate, and not somewhere else. Did IHC show low PSA expression? What about PSMA expression? EGFR? MSH2? DLL3? PD-L1? AR? Any genomics testing done?

[julyturqsee in reply to Tall_Allen]

there was supposed to be genome testing but i don't see results. 12/12 PSA: 2.50. He hasn't had a PSMA PET SCAN. no mention of PSMA expression. What is DLL3? and the others??? We went to see Dr Beltran of Dana Farber last week. Before she can discuss a prognosis/trials, she wants to see biopsy slides & suggests a CTC test (which our MSK oncologist is reluctant to order (cost??). btw, we liked her a lot (empathetic, knowledgeable, curious -- all excellent traits in a MD). Your replies are always appreciated!

[Tall_Allen in reply to julyturqsee]

Those are all IHC stains. Request analysis from the Wang Lab at Duke. Here's a list I like:AR (androgen receptor), PSA, PSMA, MSH2, MSH6, PD-L1, chromogranin A (CGA), neuron-specific enolase (NSE), synaptophysin (SYP), DLL-3, CD56, Somatostatin (SST). You already had CGA and SYP, and don't bother with NSE, but the rest may be useful, if there is enough tissue.

[julyturqsee in reply to Tall_Allen]

Wondering any difference between MSK lab & Duke?

[Tall_Allen in reply to julyturqsee]

More complete set of stains.

[julyturqsee]

thanks Tall Allen.

[efsculpt]

Dear Julyturqsee- Tall Allen is "on target". He is pointing out you need more information from your medical partners.

I had 4 lymph nodes positive around the illium area, no other spots. I was in a G-68 PSMA PET scan test at UCSF. That detected cancer in lymph nodes earlier than a "normal" PET scan would have.

The treatment I followed is: Started Lupron plus Zytiga/Prednizone (PSA dropped to 3), had one treatment of docitaxel at 1 month into ADT ( was going to do 4 treatments but wimped out- side effects too nasty), at 3 months had full pelvic radiation- 6weeks), at 2 years stopped ADT (I would recommend stopping at 18 months because I had real problems with edema in legs at about 20 months- triggered by going off the prednizone too fast- 6 weeks- and damage to pelvic lymph nodes). PSA less than .1 for 3 years 4 months, so far. I still have a bit of edema (but not much) .

[j-o-h-n]

who is your m.o. at mskcc?

Good Luck, Good Health and Good Humor

j-o-h-n Tuesday 12/21/2021 7:32 PM EST

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

thank you John. Dr Autio.

[Hidden in reply to julyturqsee]

j-o-h-n says MSK is the best .and my man knows what he’s talking about .Your partner should get the best care there . IMO .. my wife and I wed two weeks after my dx ..

[j-o-h-n]

Thank you..... My M.O. at MSK is Michael J. Morris, MD

Prostate Cancer Section Head, GU Oncology...

Good Luck, Good Health and Good Humor

j-o-h-n Tuesday 12/21/2021 10:06 PM EST

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

You’ve got the head guy because you’ve got the best humor and attitude ! God bless you j-o-h-n.. Happy New year to NY! 🥳🥂❤️

[Hidden]

Welcome julyturqsee! Good job finding this cite early on . Please don’t let The fear of not knowing persist . He’s in treatment . Pray that it pushes the pc away . He will be stripped of much . Only your love and compassion will help in the hard times. He has you . Love is our reason to endure what comes . Please keep him from gloom and any negative .. He must get oxygen pc hates oxygen and exercise helps everything . Get him through it day by day . Then seeking recovery and healing in any form . If not for my wife there would be no me .. Her love and care got me so six years past a #4 dx . No two of of us react the same to treatments . Some breeze through relatively unscathed . Other simple don’t make it long . Keep his spirits up and any thing y9 make him more comfortable . This disease for me started off in hell with tubes into kidnies and a fole6 for 18 months . I escaped and can pee again . That was my only prayer for two years ..I did 8 weeks imrt and Lupron plus Tak -700 ( now a defunct adt test drug ) that I’m still on today . The is no sugar coating the dx and first year of treatments . It’s whittles us down .. Unfortunately it takes som poison to stop an aggressive pc .. Lot of prayers your way . Stay strong yourself . Often our caretakers suffer along with us . He will need you more than even . In this I’m confident that he’s ok . No matter what . You’ll take it on together . I’m sorry tha you’re here . You can really make him feel better by asking questions and getting answers from thos in the trenches with you two . You’re not alone in this . We can talk about anything pc here .. 🙏🙏🙏🙏💔. Scott