PCa spread to Liver

[A-rat-22]

Hi all,

My father got diagnosed with metastatic PC in November 2022 with Gleason's score (4+3=7) - Grade Group 3, PSA 235. He was put on triplet therapy right away. And after 6 rounds of Docetaxel his PSA scan came back with significant improvement to lymp and bone mets. And PSA has been v low since then. .4 in the last 2 tests. He experienced 2 incidents of excruciating pain in abdomen so we got his tests and biopsy came positive for liver mets. The cancer seems to have spread there too. Anyone with similar experience? What was the next line of treatment we should opt for? He is currently on Enzalutamide + hormone injections(monthly) and has had 6 rounds of chemo (Docetaxel) finished in first week of March 2023.

[Tall_Allen]

Can the liver metastases be biopsied?

[A-rat-22 in reply to Tall_Allen]

sorry not biopsy but FNAC for liver lesions shows ‘Carcinoma cells seen, compatible with known prostate primary’.

[Tall_Allen in reply to A-rat-22]

I was looking for more info - histology, IHC,genomics. Probably not enough tissue from FNAC.

[A-rat-22 in reply to Tall_Allen]

CELL BLOCK PREPARATION

Biopsy Number : HS-4556-23

FNAC from liver SOL, cell block preparation

Clinical details - Carcinoma prostate with liver metastasis.

Microscopy -

Sections reveal clusters and acini of cells with scant cytoplasm and hyperchromatic, round nuclei.

Impression-

Carcinoma cells seen, compatible with known prostate primary.

:

CYTOPATHOLOGY

Specimen details-Received 5 mL of brownish coloured fluid. 2 smears were prepared and stained with H&E stain.

Microscopy -

Smears reveal clusters of cells showing scant cytoplasm, high NC ratio and mild nuclear membrane irregularity.

Impression-

Atypical cells, favour carcinoma.

FNAC INTERPRETATION

Cytology Number : CY-1013-23

B - FNAC from liver SOL

Clinical details - Carcinoma prostate.

Specimen details-Received 8 smears for interpretation, stained with H&E stain.

Smears reveal clusters and acini of cells showing scant cytoplasm, high NC ratio, coarse chromatin and mild nuclear membrane irregularity.

Impression-

Carcinoma cells seen, Compatible with a known prostatic primary.

[A-rat-22 in reply to Tall_Allen]

this is the entire report. The MO has suggested to shift to Arbitarone from Enzalutamide. And do genetic tests to determine if immunotherapy is an option. His PSA is low and not increasing. I am wondering what this means. Everything i have read about metastasis to liver is v scary and hopeless.

[Tall_Allen in reply to A-rat-22]

Ask if biopsy (histology, IHC, and genomics) is possible.

[A-rat-22 in reply to Tall_Allen]

we are getting those tests soon. Will share the results with you. Thank you for always responding!

[antisocialsocialwrkr]

Hi, my dad’s metastasized to the liver. Next step was a biopsy based on a CT scan. Biopsy gave us more info - learned it was neuroendocrine and aggressive and that unfortunately, there were no genetic markers qualifying him for clinical trials. He is on chemo (cistplatin and etoposide). It’s all they can do for him now. It is shrinking the nodules but it will grow back. They may add an inhibitor but not sure yet. Not telling you this to scare you but to let you know my dad’s journey and possible next steps. If it’s not Neuroendocrine, prognosis is better, so I hear. I’m sorry you’re going through this.

[A-rat-22 in reply to antisocialsocialwrkr]

thanks you for sharing your dad’s experience. What medication and therapies is he on now? Triplet therapy? Did he get Docetaxel in the past? My dad just finished 6 rounds of chemo (Docetaxel) in march first week. He has been on monthly degarelix injections + Enzalutamide since.

[antisocialsocialwrkr in reply to A-rat-22]

My dad began with hormone therapy (Lupron) about almost 2 years ago and his PSA remained undetectable which really fooled us. Never did chemo until now. He was given several opinions about chemo in the beginning…some said go for it while he was strong and it was early and others said it should be used last. I saw both sides of that debate. Anyway, my dad appeared absolutely fine until earlier this year. Spread to his clivis and occipital bone in March and they wanted to do docetaxel until they discovered it in his liver. I believe he gets xgeva and something else for the bone mets but they said the bone mets are the last thing they’re worried about.

[A-rat-22 in reply to antisocialsocialwrkr]

yes that’s what they suggested for my dad too. That go for chemo (Docetaxel) first. The results seem pretty good too. There was significant improvement in the spread to his bone and lymph nodes. V low PSA until he had 2-3 episodes of stomach ache. He has switched to abiratrone now. Lets see how that goes. Feeling more hopeful now as we have had some time to process the news and there are more treatment options available.

Wishing your dad (and mine) many more years of good health. Let’s continue to not lose hope.

[Muffin2019]

I have had the liver Mets for a year, did jtanna till March of this year, took a month break to get over the side effects. The PSA went to 504, started Docetaxel and after 3 infusions it dropped to 133 but last check it went up to 184, not happy about that. They did a biopsy and found that it was normal prostate cancer. Since being on the liver I have had no alcohol, ate some of a Mediterranean diet so will see what the readings are in two weeks. I have scheduled my yearly whole body scan next week and a CT scan after the next infusion on the 19th. This is a roller coaster, do have an open appointment with MSK till September had been approved by the insurance. I would like a PET scan to see if the Mets are radiating PSMA. If not plevicto trials if I qualify, the next treatment could be Y-90 to target the liver Mets that could buy ne months or maybe years. I do have my down days but my cats and garden keeps me going and better off than some on here.

[Believeit]

My husbands prostate has spread to his liver also and has shown to be neurodocine which is aggressive. He just started chemo. Carbalatin and etoposide. He has no symptoms and the first round of chemo went well. We are waiting for rest of biopsy results to see if a park inhibitor may be of help. He is also scheduled to have a PSMA scan to see if Pluvicto might work. It is very worrying not knowing what the next steps might be but so far his QOL is good and we are getting out walking etc as much as possible. Hope your dad is doing ok too and best wishes for the future.

[A-rat-22 in reply to Believeit]

thank you, good luck and good health to your husband as well

[j-o-h-n]

I can't say this enough "FUCK CANCER".........

j-o-h-n Saturday 07/08/2023 3:04 PM DST

[strummer]

my husband’s spread to liver, multiple spots both lobes

He just finished 4 rounds of Jevtana which helped bone Mets but no effect on liver. Started carboplatin and Jev this week . Tuesday he has angiogram to see if Y90 would help. Friday has PSMA scan to see if Pluvicto is a possibility. He’s tried practically everything else so hope the results will be beneficial. Good luck to all of us!

[Rrrspc]

What are his AST and ALT in blood?

[A-rat-22 in reply to Rrrspc]

what are those? Im not sure. All his liver tests have come out fine according to hus oncologist.