Some Questions

[Dett]

Hello all. My husband (GL 9, PSA 77, 3-4 bone mets-diagnosed 8/19 - Casodex, Eligard, Zytiga/prednisone, plus radiation) had a CT and bone scan yesterday. Nothing of consequence on the CT. Bone scan showed “Focus of minimally increased uptake in T7 decreased conspicuity. No other significant interval change. Other osseous lesions without significant increased uptake. There are no new areas of abnormal tracer localization identified.” Overall quite positive, however I have some questions…

- What does “decreased conspicuity” mean?

- Does the fact that there is “minimally increased uptake” in one area imply that the Eligard and Zytiga are losing their effectiveness?

- Can “increased uptake” be expected to continue?

- Should any further steps be taken at this point?

PSA from three months ago was .008, testosterone was 3, and alk phos 87. Thanks for any insights that you can provide.

[George71]

Is it possible to radiate the 3 bone mets .. possibly knock them out entirely -- other than that I don't know what more you could do for now.

[Tall_Allen]

It means less clearly discernible/amorphous. No increased or minimally increased uptake is good. Everything is as expected, continue what you're doing

[Shooter1]

What Tall_Allen said.. decreased conspicuity means it is fading...that's a good thing. Minimal increased uptake==not as much uptake as before, but more than healthy areas of bone. Looks like treatments are working quite well. Life Is Good, and you have a long way to go before you have to worry much...

[JWPMP]

I see you were concerned about his ALP last year. it seems to have gone down. Did this happen on its own or did your MO cut his Zytiga? Very happy things are going so well for you all...

[Dett in reply to JWPMP]

Thanks! And thanks for the question. Strangely, my husband’s ALP dropped precipitously three months ago. MO thinks it’s probably because he started Prolia for osteopenia (which I also take for osteoporosis) three months before that. I thought about creating a post, but didn’t know if anyone would be interested. The picture is complicated by the fact that husband has a benign parathyroid tumor which is known to raise ALP. I’m just grateful that he is responding well to treatment and is holding his own. It looks like you and Jim have had some trials recently. I really hope you’re doing better.

[JWPMP in reply to Dett]

Thank you so much for the kind words. He actually is doing better. Having some groin pain down his leg since his BT, but hopefully will resolve. He keeps pushing through, stays very active.

My question regarding your husband was due to Jim's Alp was trending similar to your husband's, stayed within range, but steady increase over the last year (with undetectable psa since last October) since he started Abiraterone. He had his monthly bloodwork yesterday and it dropped 11 points from last month. All his numbers are in range.

Thank you again for answering and positive energy for continued good results!

[Dett in reply to JWPMP]

👍

[pakb]

We have had to deal with that recently as well. My husband has been on ADT, Zytiga, prednisone, zometa for 4 years since finishing 6 rounds of docetaxel Feb 2018 (diagnosed Aug 2017). He had mets to spine, hip, pelvic bone and local lymph nodes at diagnosis. After the last 4.5 years of decreasing PSA and met activity this past Dec his scans showed he had an increase in activity of previous T4 met and had that spot radiated. Results came back after bone scan 4 months later that the T4 intensity was less active, showing good response to spot radiation, but new "faint focus of increased activity located in the right of the left T9 corresponding to underlying metastatic structural lesion".

Both these spots (T4 on spinous process and T9) were there 4.5 years ago at diagnosis so not new. But last year's scans had shown no cancer activity in any mets.

I'm assuming his team is going to spot radiate the T9 spot like they did the T4. His PSA hasn't risen nor has his ALP. We meet with them next week. They haven't changed his meds since his PSA has still been declining and his Mets aren't new. But we will see at next meeting.

If your husband does end up getting spot radiation- it was fairly simple and my husband felt fine during and after. He had what he called "knowledge" of the spot the radiated- could feel it but wasn't painful.

Whatever your docs do I hope your husband remains doing well!

[Dett in reply to pakb]

Thanks for sharing. Actually, my husband had extensive radiation near the beginning of his treatment. The only met that still shows some residual activity is T7. I don’t know if it can or should be re-radiated or not. Please let us know if your medical team changes your husband’s treatment plan based on his current situation. Thanks and good luck!

[carbide]

I'm sorry but your inquiry is above my knowledge.God Bless.

[LearnAll]

Decreased conspicuity = less visible. "minimally increased uptake"= almost no increased uptake. Both are good.

[ishitasen]

Focus of minimally increased uptake in T7 decreased conspicuity means the increased osteoblastic activity seen earlier has reduced meaning there is healing at the site of the metastasis. Some increased uptake at the sites of disease may persist on a bone scan. Only if there are more than 2 new spots as compared to prior would it represent progressive disease