oligometatastic prostate cancer test

[lewicki]

Does oligometastic cancer show up on PSMA and other scans and does it register PSA?

[Moespy]

Any PCa giving off PSMA will be detected by the PSMA Scan. It is recommended a PSA level be 0.7 or higher. My 2nd BCR three years ago prompted me to join a PSMA Scan Trial at NIH which found a Pelvic Lymph Node expressing PSMA. Subsequent biopsy of the node confirmed PCa. I had the entire pelvic area radiated and have been undetectable for the past 2.5 years.

[lewicki in reply to Moespy]

Wonderful results.

[depotdoug]

Lewicki and Moespy, Justification for repeat PSMA PET:

I had my 1st baseline 68Ga-PSMA--11 PET scan 08/01/2019. Very successful, if you can use that word in cancer detection and scanning. PSMA avid hot areas on my prostate gland, it's still there. Pelvic lymph nodes, infrarenal retroperitoneal and some upper abdominal lymph nodes.Facts my PSA doubled from Dec 2021 0.156 to 0.300 Feb 2022. My newest MO stated in late Feb that since my PSA had doubled, only to 0.300ng/mL and if I developed Clinical Symptoms, physical pain issues, I could obtain a repeat PSMA PET Scan.

Saying that I am up for repeat PSA and T-levels again in three weeks. It will be interesting to see if I have doubled. Or not!

Secondly I've developed lower rib pains, left and right front and back. CT scans of my abdomen, Pelvis and Chest showed nothing.

I surely would like to get a second PSMA PET scheduled for a sanity check at least. My next Med Onc appointment is May 24th.

Comments?

[Moespy in reply to depotdoug]

Hey Doug! Your M.O. will likely check with your insurance carrier or Medicare to find out the frequency allowed for the scans. I would get one every 6 months if my medical team would recommend and if insurance allowed. The more knowledge the better. Since all PCa does not emit PSMA the CT, MRI, and Bone scans are invaluable. I owe all of my good results to scans and an awesome R.O. at Hopkins. Good luck to you!!

[lewicki in reply to Moespy]

Then the doctors should run other than PSMA scans to make sure the cancer is not Oligometastic . I question this since my PSA has been < 0.04 for 19 months without taking any ADT. I seem to be having some symptoms and as you know our minds play tricks on us. Woriesom.

[Moespy in reply to lewicki]

The scans allow for a different treatment path. If the scans find 5 or fewer spots most R.O.'s will treat with Radiation/ADT, avoiding chemo and other drugs. This keep more ammo in your belt if needed later. I have a personal trainer at my local gym which has turned out to be a great investment. I tell him what hurts and he gives me stretches and light weight training and the pain lessens or disappears. This definitely gives me the feeling we all need of empowerment.

[DarkEnergy in reply to Moespy]

Why avoid chemo?

Combinational treatments, including chemotherapy - may improve survival over ADT alone.

I've received Lupron and Taxotere early with my PCa (PSA 1000+) diagnosis. And then, PSMA PET scan characterized me as oligometastatic, specifically two sites, consequently, got treated with SBRT.

[Moespy in reply to DarkEnergy]

Certainly nothing wrong with chemo and it has it's place in a treatment plan. I wasn't going to throw chemo at one lymph node when radiation with ADT is an effective SOC treatment. Chemo will be used if I have mets in more than 5 spots and/or in a pre-radiated area that cannot be treated again with radiation.

[DarkEnergy in reply to Moespy]

Ok, check out the clinical trials regarding castrate resistance "timing" and Dr Snuffy Myers' talks, this retired doc has prostate cancer.

"Chemo will be used if I have mets in more than 5 spots..."

Well, this should be qualified as, when our current cancer diagnostics will detect this scenario. And, proactive action to prevent further metastasis could be effective.

All the best...

[Moespy in reply to DarkEnergy]

Agreed!Best wishes to you also

[lewicki in reply to DarkEnergy]

Thanks

[lewicki in reply to DarkEnergy]

Thanks

[Kittenlover50 in reply to DarkEnergy]

Bill was started with chemo when PSA didn’t go below 3 after surg ( had been found in pelvic lymph, not identified on MRI). Found in lymph in chest area). His treatment plan followed the PEACE1 phases closely. While 5 or more weren’t identified his PSA went from 3 to 5,5 in the 2 mo it took to get to Mayo. That is what it was pre surg.

[Hidden in reply to Moespy]

Moespy, do you buy in to the concept of micro-metastasis? It’s a good topic to discuss. In elementary terms, when unseen cancer cells escape into the vascular and lymphatic systems of your body, they float around, unseen, traveling until they find a place to place and start to colonize developing into metastatic lesions which you can now see. Early intervention of the systemic treatment of chemotherapy along with Lupron/Eligard injections has shown to either reduce or kill these unseen cells before they colonize and start the process of mitosis.

Gourd Dancer

[Moespy in reply to Hidden]

Hi G.D.,Absolutely believe this to be a fact. In my case after my second biochemical relapse, with a PSA of 0.7, I decided to go with full pelvic radiation and then Lupron for 2 years. With the hope that the radiation would kill the cancer in the Pelvic LN and the Lupron would clean up the micro metastasis.If I have a 3rd BCR I will do all the scans and if under 6 spots are found I will, if possible, go with spot radiation to those areas and again hit it with Lupron. If Lupron fails I will move to Chemo and Apalutamide.

If more than 5 spots are found I will go directly to Chemo and Lupron.

How does that plan sound to you?

[Hidden in reply to Moespy]

Your choice. The only thought that I have is about the unseen cancer cells in other locations..... for example traveling the lymphatic network under your arms or the vascular network in your lungs...... Neither ADT nor your targeted radiated sites will kill those little bastards. I never subscribed to a rule of five..... as soon as I had mets, I immediately had an injection and six weeks later underwent a chemotherapy clinical trial. This resolved my known mets and then hit the micro-metastatic cells. Can’t see them, but they are there. Good luck.

[Moespy in reply to Hidden]

Thank you brother! I respect your thoughts and will be going the Taxotere route if (when) it returns.

[DarkEnergy in reply to Hidden]

Can you imagine, this vasculature disease is still not understood by patients and IMHO physicians as well!

Sweeping the cancer metastasis is not 100%, just like you mentioned, these little basterds AKA crabs will crawl into tissue vasculature crevices; they will do their best to attack the host, we're still relying on yaw tree (chemo) discovery for treatment.

[Hidden in reply to DarkEnergy]

Exactly Dark. That why I was most fortunate to have the chemotherapy regime I had.

[depotdoug in reply to Moespy]

Thxs, yes it has been two years and nine months since that specific PSMA PET Scan. My recent, April 14th this year, CT Pelvis, abdomen, chest showed nothing. No adealympapathy(sp) anywhere. No masses, no abnormaities. Ok good news.

But I sm concerned about rib pain lower front back and other bone pains.

I could check my insurance for PSMA PET Scan payable intervals. That’s easy. I’m a not giving up now 70 year old guy! Yes with cardiac rhythm issues, on my 2nd ICD/pacemaker device.

Yes I like yourself watch our tests, medical procedures with accurate minds. Oh well got 3 weeks till next PSA & T-levels test.

[lewicki in reply to depotdoug]

I am always anxious prior to PSA and T.

[Nusch in reply to depotdoug]

I would go for PSMA Pet scan. My recent PSMA scan showed 3-4 mini spots in the pelvis at PSA 1.1. CT scan afterwards and before RT showed nothing!

[DarkEnergy in reply to Nusch]

PSMA PET scans are a game changer, which will result into a viable treatment that does not have a possibility to cause physical harm.

In the past, went through a spinal tap (hammered needle into bone) to vertebrae spot extracting tissue. Well, the tissue biopsy resulted into "No cancer"!

My point, this spinal tap procedure had a probability of causing spinal injury.

[lewicki in reply to DarkEnergy]

Cannot disregard its possibility.

[DarkEnergy in reply to lewicki]

Moreover, what would this procedure of micro fractioning the bone, would do in a lifetime?

[Tall_Allen]

Newly diagnosed oligometastatic (1-4 metastases) prostate cancer is an indication for prostate radiation that is only defined by a bone scan/CT and not by a PSMA PET scan. There are low PSA subtypes that don't put out much PSA, but most do. PSA is roughly correlated with the size and number of metastases.

[lewicki in reply to Tall_Allen]

Si I should ask for this test just to make sure. Thanks

[lewicki in reply to lewicki]

SO

[Tall_Allen in reply to lewicki]

I don't know why you are taking it, so I can't comment.

[lewicki in reply to Tall_Allen]

I am having some swelling in my left leg and swelling in the feet. I had lymph node cancer in the lower groin and alot of edema.. After LU-177 and AC-225 it went away.

[Tall_Allen in reply to lewicki]

The only reason to have imaging is if you are considering changing a treatment. You obviously were not oligometastatic.

[lewicki in reply to Tall_Allen]

I am only on Dutasteride and Finasteride for the last 17 months. just concerned because I expected to be on a treatment. ADT and perhaps Bat or just high T.OSA <0.04. T < 10.

[Moespy in reply to Tall_Allen]

Thanks T_A

[DarkEnergy in reply to Tall_Allen]

"PSA is roughly correlated with the size and number of metastases."

Interestedly, my diagnosis of PSA 1000+, was due to primary tumor extending the prostate size. Consequently, penetrating (shedding) through the prostate wall, into surrounding tissues (blood vessels). As oppose to passage via the lymphatic system.

This explained the massive necrosis findings in pelvic area scan - post initial ADT.

[Tall_Allen in reply to DarkEnergy]

Not surprising. PSA goes up with increased connections to blood vessels.

[Scout4answers in reply to Tall_Allen]

PSA is roughly correlated with the size and number of metastases.

Interesting but do you have any data?

[Tall_Allen in reply to Scout4answers]

I'm sure that if you dig in a library that has medical books from the early 1970s, you will find what is now universally accepted.

[john4803 in reply to Tall_Allen]

11-10-21 my PSA went from <0.1 to 0.4 & with subsequent PET CT FLUCICLOVINE Scan found fairly good sized lesion on the Lamina of T-11 & nothing else. So, MO designated me Oligometastatic & had 5 sessions with Cyberknife. Follow-up PSA, 3 months later, ZOOMED to 7.3. T increased 30%, also, possible cause? Not on ADT at time, been off 1.5 yrs.

A PET CT F18 PSMA Scan & MRI THORACIC Scan revealed another large lesion on T-4 & multiple small throughout skeleton, & pelvis. Seeing RO this week to decide what to do about T-4. Put on Lupron & Erleada, with, Xjeva injection in 3 wks.

My point is that one can go from Oligometastatic to widespread, quickly, at least in my case. And my MO concurs that GS 9 lesions don't necessarily express as much PSA.

[Tall_Allen in reply to john4803]

Many patients (and doctors) think that zapping all the metastases one can find accomplishes something. I'm skeptical, but willing to look at evidence when we get some. Meanwhile, if it's safe, why not? As you've learned, for every met you can see, there are many more you can't see , waiting for their opportunity to grow. IMO, it's dangerous to stop ADT just because PSA is low (needing a vacation is a good reason though, if the patient understands the risk).

[john4803 in reply to Tall_Allen]

In my case, following RALP, ADT & 37 Rounds of IMRT/IGRT & all subsequent PSA's <0.1, felt could go off everything. Was on ADT for 2.5 yrs. "Hindsight is 20/20?

[Tall_Allen in reply to john4803]

You are the poster child for the problem I see with zapping metastases. They call what you did "consolidative therapy" now. It destroys all the current sources of serum PSA but not the cancer. It is called "treating PSA."

prostatecancer.news/2020/07...

[john4803 in reply to Tall_Allen]

At the time, per NCCN Guidelines, ADT was recommended for just 2-3 yrs. I was becoming too much of a "Grumpy ole man", and decided to go off.

[Tall_Allen in reply to john4803]

Very understandable wanting a break, and I'm not criticizing. NCCN guidelines never have recommended 2-3 years of ADT when distant metastases (M1) are found, only when metastases are in the pelvic LNs only (N1) and the entire area has been irradiated.

[john4803 in reply to Tall_Allen]

My initial mets. were in 3 LN's in the Pelvic region. And the entire region plus higher up were radiated, initially.

[Tall_Allen in reply to john4803]

Thanks for explaining. That makes a lot of sense now. In many patients, that kind of therapy is curative and the adjuvant ADT IS TEMPORARY.

[Karmaji in reply to Tall_Allen]

Interesting....i had pelvic radiation for 2 tiny spots in nov 2019....On ADT since june 2019....PSA since 2 years <0.006....T3bn0M1After 3 years my RO and ONCO say go for vacation

and URO is not decided yes or no..

I will also ask prostate onco

in 2 weeks to see what she thinks...

Dear TA what is your choice

....stay on ADT....I was using 3 month dose every 5 month since 18 month and PSA did not change...

So far no problem living with ADT except sauna flashes

Thanks

[Karmaji in reply to Tall_Allen]

In my case nothing visible on bone scan...but Choline pet scan showed two tiny spots...Then I got them radiated....

You think should have awaited till visible on bone scan...

[Tall_Allen in reply to Karmaji]

No. Why?

[MateoBeach]

In answer to the first question: Yes. PSMA PET scan is probably the most sensitive scan for finding, diagnosing oligomets. You don’t need to wait until PSA is above 0.5 as some claim. I found mine in LNs in pelvis and abdomen at PSA of 0.18 when they were sub-centimeter size (8-10mm). Negative scan does not rule them out though, as depends on PSMA expression as well as size.

[lewicki in reply to MateoBeach]

Thanks. Also, to add to my concern is that I am having leg and knee pain and just the other day my feet are swelled, The left is worse. I had infection and bleeding of the lymph nodes after biopsy results several years ago prior going to Germany. Legs swelled to the point I had a hard time walking. I am thinking that todays swelling may be related .

[MateoBeach]

That is worrisome. I would get evaluated for possible deep vein thrombosis. D-dimer test and perhaps ultrasound of the deep leg veins.

[lewicki in reply to MateoBeach]

Thanks. I think the D-dimer test is important. Going to pursue it.

[CAMPSOUPS in reply to lewicki]

I dont mean to alarm you but a ultra sound of your leg is pretty important to rule out clotting. An ultra sound is almost a standard diagnostic procedure when edema of the limbs is present. The effects of clotting are of course dangerous.

[lewicki in reply to CAMPSOUPS]

Great advice will go to emergency tomorrow AM

[Kittenlover50]

Yes. Oliomet cancer is cancer that has spread from the original tumor to other parts of the body. The PSMA is the most sensitive with the c11 choline following. Yes, it is picked up along with there shoukd be rises in the PSA, ie velocity of the PSA increase, etc.

[lewicki in reply to Kittenlover50]

I do not think the choline scan was ever offered to me. I did the Axumin and it showed the same as a PSMA 15 months earlier.

[lewicki]

Thank you. Much appreciated.