Stage IV, rib pains

[reconjj]

Hello All , just DXd , Dec. 7, metastatic to 1 pelvic lymph node . Received a 6 month jab of Eligard at VA . had a marker ( fiducial ) placed into the lymph node Dec. 17 . Next stop , planning on Dec.30th . Then 3 sessions of SBRT to the node , then 25 sessions of IMRT . Since then I have moderate pain along my rib cage left and right side . I feel it at night and day . No meds yet . Could this be from the Eligard ? Since the Pylarify scan did not show anything but the 1 hot node it dont mean there is no other cancer there . I visit Dr. Szumivits , ( MO ) Jan.7 at the Univ. of Chicago . With these pain is that a game changer as far as treatment , or can it be the Eligard ? Thanks

[Skipper238]

Hello Reconjj, I am also recently diagnosed, and I received my first Eligard shot about the same time you did. I have not experienced any new pains after the shot. You might want to read through this link carefully. It does mention that if you experience any bone pain you should notify your doctor. Good luck, my friend.

webmd.com/drugs/2/drug-1723...

[Tall_Allen]

It is only natural to attribute any pain to the cancer.

[leebeth]

My husband tries to keep track of any new aches/pains to tell the doctors, but so far his have all been related to overdoing physical activity and the pain goes away. He has no pain at all in the areas that his recent PSMA show to be full of metastases, so I think your pain is likely not related, since nothing showed on your scan. You should tell your doctor, though, because if persistent it might be cardiac in origin, or anxiety. It’s something to check on. Take note as to when it is most bothersome: upon movement, when sleeping or awakening, etc. All this will be valuable info. My husband sees Dr Szmulewitz on January 7 also, but virtually, so we won’t meet in the waiting room. You will like him. It is our second consult with him.

[larry_dammit]

Not to tell the doctor what to do but it sounds to me. ( stage 4 ) since 16. That it’s time for a CT and MRI. With contrast. The earlier they spot the cancers the better. Just saying 🙏🙏

[NecessarilySo]

I have had many lymph node pains in my back and neck and skull, over many years, of which almst all have disappeared; one migrated to nearby rib and has been there for many years, still there Once it gets to bone, it gets harder to apoptise. In addition to hormone therapy, I use heat and regular intake of lycopenes, (self-therapy). Rib pain is mild but constant, ever-present, fades with heat and lycopenes. I assume a lymph node that was near the rib years ago spread to the rib. My worry is that it may evgentually spread to kidney. That's the way the cancer grows. I would say that if it is a muscle pain it heals and goes away in weeks, but metastasis lasts months and years

As for scans, they show tumors over 3/8" or so but not smaller, so pain is the best indicator until that size.

[HopingForTheBest1]

I have also been experiencing pain below my left rib. I can't attribute it to Eligard as I had the shot almost 3 months ago, and this pain started about 3 weeks ago. When I googled it I got several possibilities, none due to cancer side effects. Many of us attribute any kind of new pain due to our cancer, but it could be from something else. I will follow up with my PCP.

[slpdvmmd]

As a practicing physician with advanced prostate cancer it is no different for me; the first thought I have with every new pain is that it is cancer. But I think this is not altogether unjustified. As a practicing hand surgeon I twice diagnosed prostatic mets when I got simple radiographs followed by more complex imaging for atypical shoulder pain that was being attributed to age (am sure I blew more people off for pain over my career so not claiming sainthood). Also I personally began having atypical left periclavicular pain a year into my disease. Got plain radiographs which showed nothing. At two years when I my PSA began to rise and my pain was still there got an Axumin PET that was read as negative. PSA dropped with switch from pred to decadron with zytiga. At year 3 when PSA again began to rise and atypical pain remained I got CT and bone scan, both again read as negative. Then paid out of pocket for Pylarify scan when it first became available in Florida (had been on list at UCSF for months). Low and behold three mets in left supraclavicular area just anterior to my brachial plexus. Retrospective review of Axumin scan, and standard CT then showed lesions which were subtle but there after the academic radiologist saw the glowingly obvious lesions on PSMA PET. Point is we are justified to worry and we should be taken serious with subtle changes and multiple forms of advanced imaging is probably indicated more frequently than it is used. Always a fine line between abuse and appropriate use of test but spend some time working in an ER of you want to see overuse of tests/imaging without any clinical basis!!! Wish you well.

[reconjj in reply to slpdvmmd]

Thank You for that imput . So did you have those new lesions radiated , ( SBRT ) ? And did those pains diminish ? John

[slpdvmmd in reply to reconjj]

After being told rather abruptly by a Medical Oncologist at Fred Hutch/SCCA that I "wasn't bad enough to meet treatment criteria in his opinion" I uploaded my scans to the University of Heidelberg who felt early intervention is probably the real role for radioligand therapy a fact that was not be demonstrated by the Vision trial (despite its many weaknesses) and I then went to Heidelberg and got treated with a combination of 177 Lutetium PSMA and 225 Actinium PSMA. Followed this up based on recommendation of some prostate cancer researchers I know with 39gy of image guided fractionated radiation. SBRT is not without its side effects/complications and the radiation oncologists I spoke to felt the brachial plexus was too close for high dose. Alternative might have been proton beam. Now just have some typical down stream neck fibrosis that I have changed my yoga routine to try to address. PSA at this moment in time is below ultrasensitive test but I have no delusions and am continuously working on how to be functionally PET scanned at this point rather than another targeted PET scan like PSMA/PET.

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

Thank you doctor for your insight. As a hand surgeon you may be aware that Roosevelt Hospital in NYC was well known for it's hand clinic. My left hand pinkie can attest to that.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/29/2021 10:30 PM EST

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

Yes I am aware of the long history of Hand Surgery at Roosevelt Hospital. I served on the History Committee for the ASSH and had the great pleasure of meeting William J Littler when he was alive. Also one of my former partners (now deceased) was a Littler-Eaton Hand Fellow. Littler, Eaton, Glickel all giants in the field.

[Chugach]

My prostate cancer mets on my left rib finally broke my rib. When it hurts, I can tell the dragon is stirring. Get a bone scan