Well it appears that the radiologist who did my MRI was overly cautious. The report said I had a met on my left pelvis, one on my right pelvis, one on my sacrum, additional cancer in my prostate region and sclerotic foci in my pelvic region. Traumatic.
We followed that up with a PSMA scan 10 days later. A scary 10 days. The PSMA scan said that I had no cancer in my body. I have since also learned that the sclerotic foci is usually a benign bone lesion on the pelvis. Great news I think???
My PSA is undetectable. My testosterone is 8. I am currently on Lupron and Erleada for six more months. Ive been on both for 18 months now after radiation to the one cancerous lymph node, below the illiac artery, and my entire lower lymphatic area.
My questions to my good friends on this blog is this..
Can the PSMA scan have missed something? It seems to good to be true even though the hospital that did the MRI also did the PSMA and called me and said I was cancer free???
Also, are there any other scans that might be out there to double check to make sure the PSMA was correct. I was planning on doing four doses of chemo (docetaxel) on the back end of my treatment.....is this still an option if I am cancer free?
this blog has been great for me ......thoughts?
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icanwintwice
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Radiation kills some cancer cells immediately. For others, it inserts reactive oxygen species (ROS), mainly hydroxyl radicals, into the DNA, causing it to break. Those cells may stay alive until they try to replicate, and die then (called "mitotic catastrophe"). But the cells may become dormant for a while, avoiding mitosis. I call them "zombie cells"- they are dead, but don't know it yet. Sometimes it can take years to finally give up the ghost. Meanwhile, they may show up on non-metabolic imaging (e.g., MRI or PSMA PET).
Eventually, the cells will try mitosis. It's what cells do. But it doesn't really matter, since they are benign anyway. It took 3 ½ years for mine to finally disappear. PSA is a better guide, since zombie cells are incapable of forming the blood vessels that are necessary for PSA to enter serum.
Yes, of course. We have some really great medicines like ADT, second-generation hormone therapies, docetaxel, and cabazitaxel, that get many men to undetectable PSA after distant metastases have been detected. Some very virulent anaplastic types of PCa never express PSA. It is also possible to treat PSA without treating the underlying PCa:
I understand. For those of us who opted for surgery and continue to monitor PSA for recurrence, in that situation the PSA would move in the event that you had metastases, isn’t that right? Asking for a friend 😊.
If you have been on ADT for many months prior to both the MRI and PSMA, wouldn’t it be logical that the PSMA would be clear as the drugs usually drop PSA to undetectable levels?
They say the PSA needs to be at a .4 or .5 for increased reliability with a PSMABills PSA has inched to .22 and doc wants to wait until .4. His c11 choline showed activity last year but was around an old break in back and had been lifting a lot of heavy furniture. Two MRIs were neg. The next c11 was neg too.
I have been told more then once that SCANS should be done once a year and no more ! This way the body can recover somewhat . I was also told that too much radiation weakens the immune sistem .
I am not a radiologist but have looked at a lot of advanced imaging during the course of my training and career. First thing you learn is that what looks like nothing with one form of imaging can look absolutely catastrophic on another. I distinctly remember training during the hay day of AIDS as it was called then and seeing a patient with distinct neurologic findings with minimal changes on a brain CT that seemed not to explain my clinical findings. Then an astute neurosurgeon (I was on his service at the time) told me to order an MRI which I did. The brain on MRI looked like Swiss cheese. Different modalities of imaging have differing strengths and weaknesses and may or may not show differenent things.
With regard to PSA it clearly is not the end all in determining the course of all prostate cancer. I have looked for and failed to find a good paper on how prostate cancer markers drop out or emerge over time. This would be very valuable data.
For example, in later stages of prostate Ca there may be a role for Chromogranin A (CgA) and Neuroson Specific Enolase (NSE) as neuroendocrine transformation raises its ugly head. In fact after a point it may be better to monitor for these markers than for PSA.
My understanding is PSMA is not expressed in ~10-15% of cases, and in those cases an Axumin scan might find tumors. What is your oncologist saying about the MRI result?
I'm not aware of any method(s) to rule out existence of metastatic cancer while on ADT.
My oncologist said he thought it was wrong which is why he ordered the PSMA test to follow. Its frustrating that your PSA can be undetectable, your testosterone can be 0, and you can have a PSMA test that shows 0 prostate cancer and you can still have metastatic prostate cancer. No wonder its so hard to beat this disease….
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