Bone met biopsy = [b]PSMA-POSITIVE, PSA-NEGATIVE TUMOR[/b]

[Gl448]

What are the implications for treatment and more importantly monitoring progress of PSA-NEGATIVE metastases?

My PSA was never over 1.1 before cystoscopy found PCa (Stage 4B throughout almost everything connected to prostate and mets in pelvis, sacrum, spine, and pelvic lymph nodes).

The PSA-NEGATIVE finding explains the low PSA despite extensive spread, right?

With that in mind, won’t it be pointless to use PSA as the key metric for judging the effectiveness of treatment?

FINAL DIAGNOSIS

ISCHIUM, RIGHT, CT-GUIDED CORE BIOPSY:

- METASTATIC PROSTATIC ADENOCARCINOMA.

IMMUNOHISTOCHEMICAL ANALYSIS:

- PSMA-POSITIVE, PSA-NEGATIVE TUMOR.*

[GP24]

If you have PSA negative tumor you have to rely on imaging e.g. CT/bone scan or PSMA PET/CT. Yes, it is probably the reason for your widespread tumor and low PSA value.

Because you have PSMA positive tumor, I would try to get into the PSMAddition trial. Here is a drop-down list of 117 study locations: clinicaltrials.gov/ct2/show...

[Gl448 in reply to GP24]

I’ll check those out. The only treatment I’ve had so far is Eligard in August, will be interesting to see if any of those studies take newly diagnosed patients.

Thanks.

[Tall_Allen]

Your IHC (and the "Mixed sclerotic lesion") is showing both PSMA positive and PSA negative cancer, so PSA is not very useful. Have you had a bone-specific ALP blood test? My guess is that metastatic spread is more likely to show up on FDG PET/CT scans, which should be done periodically to show the effectiveness of therapies.

A lot more important information can be gleaned from more detailed IHC of the bone lesion biopsy. But IHC is limited by the amount of material they extracted and the IHC stains available there. They can send the tissue to the Wang Lab at Duke for more detailed analysis. The stains I think you should discuss are:

AR (androgen receptor), PSA (you already have), PSMA (you already have), MSH2, MSH6, STEAP1, PD-L1, chromogranin A (CGA), neuron-specific enolase (NSE), synaptophysin (SYP),  DLL-3, CD56, Somatostatin (SST)

This will guide your therapy and clinical trial selection more than anything else. Meanwhile, a modified triplet therapy (docetaxel+carboplatin + darolutamide or abiraterone + Eligard) is probably your best bet.

[Gl448 in reply to Tall_Allen]

Allen really is the best. He quoted something from my rather lengthy bio/history which shows he considers your actual individual conditions before answering.

I’m sure many others do also.

Thanks.

[Gl448 in reply to Tall_Allen]

Never had a BAP, but ALP was always around 40 for the last few years, then started climbing early 2022 and peaked out at 145 last month (35-130 normal range). It seems to have started right around the time the urinary retention leading to my first TURP and eventual PCa diagnosis.

I’ll ask doc about BAP, or order one myself if MyQuest offers it

[Gl448 in reply to Tall_Allen]

Finally discussed the bone biopsy results with the MO who ordered it. She completely blew off the "PSA-negative" labeling when I questioned her about that, explaining that since it was a bone biopsy they sometimes don't stain as well as tissue and I shouldn't "put too much weight on that."

How much weight should I give that opinion? LOL

[MateoBeach]

Good advice certainly from T_A. FDG PET scan will be valuable for monitoring. But also F18-NaF PET scan specifically for bone metastasis. See:

practiceupdate.com/C/144539...

You won’t want to consider Lu-PSMA treatments unless there is high concordance of these two scans with a PSMA PET scan (all lesions match).

[Gl448 in reply to MateoBeach]

okay. I wish I’d had a PSMA PET instead of Axumin. The Uro didn’t know any better, and the RO I saw said the same but said it was too soon to get another PET or something doing those lines.

[slpdvmmd]

Not a lot more to add other than that when I was at Mayo Clinic in September, Dr. Eugene Kwon told me they have a growing series of patients who have low or undetectable PSA with Positive PSMA PET/CT scans. He said there may be a role for a periodic survey PSMA PET/CT despite a low or non detectable PSA i.e. below the PSA levels that insurance has determined as a trigger to pay for said scan.

[Gl448 in reply to slpdvmmd]

That’s interesting. I wonder if it’s because more of these cancers occurring or just much better detection/testing.

[slpdvmmd in reply to Gl448]

I think an element of both. I think as we who should be dead live longer we develop more mutations. Also there is no doubt imaging has and is evolving.

[Battle_on]

Our MO uses scans and CEA blood marker to guesstimate how things are going.

[slpdvmmd]

2021 review that may help in comparing GA PSMA PET and FDG PET. frontiersin.org/articles/10...

[Gl448]

August 18, 2022. Almost four months now.

[Gl448]

It's all in my profile...

Entire prostate, seminal vesicles, nueroblood bundle, bladder neck, pelvic lymph node for localized cancer. Bone mets in the pelvis, sacrum, and three lumbar spine bones.

Yes, was considering chemo via triplet therapy as suggested by several here.

[Gl448]

I think we're cross-posting and should move most of this to this thread: healthunlocked.com/advanced... I posted earlier.

This one was just to bring the bone biopsy results to light on the original thread I posted about it.