Soft tissue lesion on liver

[Mikes21]

Has anyone heard or experienced a soft tissue lesion on the liver as a result of prostate cancer spread? I’m waiting on psa and cea blood work. The lesion appeared on my Ct scan along with fatty liver. Thanks family for your response.

[Tall_Allen]

Yes, I've seen it. It showed up on FDG scans.

[Mikes21 in reply to Tall_Allen]

Hi Tall Allen. So cancerous and does it just get cut out and move on? Thanks

[Tall_Allen in reply to Mikes21]

How do you know it's cancerous?

[Mikes21 in reply to Tall_Allen]

I was asking if you know if it’s high probability of cancer. My oncologist said we will do surveillance and Ct in April.

If it grows then I guess biopsy it? I was hoping it’s part of the fatty liver. Thanks

[Mikes21 in reply to Tall_Allen]

Forgot to mention it is 9mm

[SeosamhM in reply to Tall_Allen]

Question, TA: A PSMA scan would have more directly answered Mikes21 question of the lesion's relationship to PCa, yes? Thx.

[Tall_Allen in reply to SeosamhM]

Liver lesions are often not PSMA-avid, but might be. FDG may be better.

[SeosamhM in reply to Tall_Allen]

Thanks for the response - unsurprising, I guess; no detection method is perfect. After your response, I did some more directed searching. FYI for the group:

cancerimagingjournal.biomed...

[Mikes21 in reply to SeosamhM]

Not able to open link

[SeosamhM in reply to Mikes21]

Hmm... Here's a alternative link to the article on NCBI:

ncbi.nlm.nih.gov/pmc/articl...

[Mikes21 in reply to SeosamhM]

Thanks so much

[timotur in reply to SeosamhM]

Good find, thanks! I’m trying to figure out if a hypodensity in the dome of the liver is anything to worry about. I may need to get a PET to determine.

[tango65]

I would request a biopsy. There may be soft tissue lesions in the liver which do not have anything to do with PC or other cancers such as hepatic adenomas etc. You need to have a definitive diagnosis to plan the adequate therapy.

[Mikes21 in reply to tango65]

Thanks. Yeah I’m good with doing a biopsy.

[tango65 in reply to Mikes21]

I wish you the best of luck. If it were PC request Immunohistochemically studies and genetic studies which may help with further therapy.

[Mikes21 in reply to tango65]

Forgot to mention it’s 9 millimeters

[tango65 in reply to Mikes21]

It is small, but they should consult with interventional radiology and see what they have to say.

[j-o-h-n]

I hope it's just because it's fatty liver.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 02/22/2022 7:19 PM EST

[Mikes21]

Sounds bad. I’ll do surveillance on it and get a biopsy too

[Mikes21]

I have a psa result coming. If it was spread from pca wouldn’t psa be high? We will see. I also have a cea result coming

[MarkBC]

My first scan showed a lesion on my liver too. The oncologist said lesions on the liver are common and most are non cancerous. We needed to wait to make that determination. Subsequent scans showed that my bone and lymph node lesions changed as a result of treatment but the one on the liver has never changed. As a result, it has been declared benign.

[Mikes21 in reply to MarkBC]

Thanks Mark. Yes my oncologist wants a repeat scan in April. I’ll let you know how it goes.

[lokibear0803 in reply to MarkBC]

I had a very similar experience. Suspicious spot found with PSMA PET, but no CT correlate. My history and disease trajectory, combined with the research I did (many false positives in liver from imaging with PSMA PET), made me very suspicious of the initial consensus (“likely a PC met”).

Got on ADT, with intention of rescan to see what the spot did. If it shrinks? More evidence that it’s PC met. If it grows? Let it keep growing until it’s big enough for biopsy. If it stays the same? In my case, all other lesions shrank except the liver. It was therefore (tentatively) declared benign…by a radiologist with a lot of experience around the PSMA false positive dynamic in liver region.

Mikes21, doing the repeat scan seems right to me. If it grows and biopsy is feasible, that sounds right also.

[HerbieP]

I too had a lesion noticed on my liver, initially it was 6mm. We compare it's size each CT scan and each time it's smaller - showing the treatments I'm taking are working on that.

[Mikes21 in reply to HerbieP]

Thanks. My concern is that I have been on treatment and this just appeared. Also fatty liver appeared so maybe it’s part of it. Hoping so.

[HerbieP in reply to Mikes21]

My sister had fatty liver too, had to change her diet to mostly plant based (which I do for PCa as well).

[Ylwhorse]

Yes my husband's prostate cancer spread to his liver

[Mikes21 in reply to Ylwhorse]

Sorry to hear that. How’s he doing?

[Ylwhorse in reply to Mikes21]

We take it day to day. His spirits are good. He's having radiation for tumors in the spine and has been on platinum chemo. Unfortunately his prostate cancer is small cell. A beast

[Skipper238]

I am dealing with this situation, now. Briefly, in Nov. 2021, I had a CT with contrast, which showed my liver clear. Three weeks ago, by happenstance, I had another CT with contrast done. This was an exploratory CT scan, to see what might be causing pain in my mid-right abdomen. So, when the results came back, approximately 1/3 of the liver showed what I would call "waviness" on the scan. My liver enzymes were also at least twice as high as the top of the normal range. So, I had a RO look at both scans, and he said it looked suspicious or concerning or something along those lines. I am now scheduled for a PET scan tomorrow morning. If it better informs the doctors in the direction of the possibility of PC Met to the liver, I will have it biopsied. I'll probably have it biopsied anyway, but it is of significant concern to me right now.

[Mikes21 in reply to Skipper238]

Yes definitely concerned too for you. Please stay positive and I’ll also send prayers your way. 🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻

[Skipper238 in reply to Mikes21]

Hello Mikes21, I wanted to circle-back on this and provide you with the results of my PET scan. It turns out that I have quite extensive metastatic spread to the liver. It is not 100% proven to be metastatic from my PC, but I think we're in the 99.9% category at this point. There was also spread to the spinal column and several other places.

My case is maybe a bit unusual. I started out this journey in November 2021 with a relatively low PSA (4.68) coupled with very high Gleason Scores (9's and 10s). There was significant spread to the lymph nodes, leading the pathologist, MO and RO to all suspect Lymphoma in addition to the PC. I had a supra clavicular lymph node biopsy done, and the results came back as metastatic from PC. Now, fast forward 3 months and the PET scan pathology report has this to say: "There are innumerable hypermetabolic lesions throughout the liver. Discrete lesions are difficult to

visualize on this noncontrast CT. The maximum SUV is 34.7 in the anterior right hemiliver"

So, to summarize, it seems the answer is definitely "yes" that PC can metastasize to the liver. From the reading I have done over the past 48 hours, it doesn't really seem to be that uncommon (see below):

"Metastasis of prostate cancer to the liver is not uncommon, being the third most common site after bone and lung, with the incidence of clinically evident liver metastases as high as 25%, with a greater number of patients with clinically silent metastases found at autopsy (1, 9, 38). " ncbi.nlm.nih.gov/pmc/articl....

It seems to be a situation of severity, once the PC metastasis hits the liver. Mine seems advanced, but yours hopefully not so much, based on what you're hearing from your doctors.

All the best to you.

[Mikes21 in reply to Skipper238]

Sending prayers your way my friend. 🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻Yeah since my psa is undetectable I’m chalking it up that there’s no spread from pc. Also since my cea is 1.6 I’m feeling good it’s not spreading to my liver from the removal of my stage 1 colon cancer where local lymph nodes were negative for cancer. We all have to keep on fighting the good fight:

[Mikes21 in reply to Skipper238]

I read this again and wanted to ask what your psa has been reading out as? I’m on hormone treatment and my psa is undetectable. I would think if the pc spread to liver I would have a high psa. Thanks

[noirhole]

My PC also spread to my liver have been treating it for a year to slow it down and shrink it to no effect. The chemo to target the liver mets was brutal. Gem-Ox combo which had a 60 percent success rate unfortunately I am in the 40 percent minority. Last week went to the ER feeling poorly, very weak and jaundice. Did a CT mets continued to grow. Liver was 27 cm a normal liver is 10.5 cm so quite enlarged. Saw my MO last Monday and I have exhausted all treatments and I do not have any genetic abnormalities. Feeling very weak with little appetite as the liver is encroaching on my stomach. Hospice is visiting tonight for an initial consult. Good luck and I hope you have some options still available!

[Mikes21 in reply to noirhole]

Sorry to hear that you are going through this. My gastro who is also a liver specialist said no need to panic as my liver tests are good and the tissue is 9mm so I will repeat the Ct in April and hope no growth. I’ll send or your way 🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻

[noirhole in reply to Mikes21]

I wish you the best!

[Ylwhorse in reply to noirhole]

The best to you.

[timotur]

Mike, do you have any further updates on your liver lesion? I'm wondering if it's just a sub-cm, benign cyst? I had a CT scan last week to test cardio calcification, and it picked up "sub-cm hypodensities-- cysts". Since my PSA is u/d, I don't think it's a PCa met. I did some research and it looks like hormonal treatment can make benign cysts grow. I'm looking into it further this week with a hepatologist and have an ultrasound done. Thx- Tim

[Mikes21 in reply to timotur]

Hi Tim I pray that’s my situation that benign cysts can grow from hormone treatment. I’m waiting for the call for the ct follow up. Should be this month. Best of luck this week and appreciate any feedback you get. Thanks so much