Brain lesion

[dnmrk]

anybody here who experienced brain lesions that might be from PCa? Current PSA is 0.025. It’s just confusing that after ADT works to remove all the symptoms including bone pain from bone mets, my dad was diagnosed with brain lesion after an MRI since he had mild stroke symptoms(slurred speech). Does it really happen to occur a brain metastasis given that therapy is working great to him. Does abiraterone also works on any part of the body including brain?

[Tall_Allen]

Strokes are often the result of brain lesions. It doesn't mean the lesion is a PCa metastasis, which would be very rare.

[Kapeman in reply to Tall_Allen]

My husband just died from a massive brain bleed from a tumor we didn’t know was there, as we were waiting for him to begin Pluvicto next week. Maybe it isn’t all that rare as we have all been led to believe?

[Tall_Allen in reply to Kapeman]

I'm so sorry. In men with metastatic prostate cancer, only 1.14% develop soft-tissue brain metastases (see link below). Most of them have already been diagnosed with visceral metastases elsewhere or have a rare PCa variant. It is more likely a second primary cancer, like glioblastoma or melanoma. But with men living longer due to better treatments, I think we will see more of it.

mdpi.com/2077-0383/11/14/4165

[Kapeman in reply to Tall_Allen]

Thank you very much for this link, and your kind words. In truth, the doctor told me he couldn’t definitively say it was PC because they didn’t have enough sample to biopsy, but his belief was that it was PC. I am grateful his death ended up being pain free, no small thing. My best wishes to all the warriors here.

[j-o-h-n in reply to Kapeman]

Dear Mrs. Kapeman,

You have my deepest sympathy and condolences regarding your dear husband's passing. May he be looking down at us and smiling about not having any more earthly cares or woes....(except his caring for you will be with him forever). God Bless him and God Bless you. May your Christmas be brighten by your thoughts of your wonderful past with your husband.

j-o-h-n Thursday 12/21/2023 6:54 PM EST

[Kapeman in reply to j-o-h-n]

thank you J-o-h-n. I wish those same things for you and yours.

[Radtech40]

My father is a rare one, his psa has been 1.1 which is the lowest ever for 7.5 years since diagnoses of stage 4 PCA. He is on Xtandi. He was having headaches and slurred speech, I asked to add a brain CT to his bone scan, it came back 5.2 cm dural mass, possibly mets from PCA or invasive meningioma. He has leptomeningeal enhancement. He is 90 so they dont want to biopsy, he had whole brain radiation, follow up scan Monday, the radiology report says, stable brain tumor, interval increase in leptomeningeal enhancement either due to inflammation from radiation/ post radiation or progressing disease, findings represent invasive meningioma or osseous metastatic disease with stable tumor size since prior exam July 2023.

Dad is actually doing well, no slurred speech, his appetite has increased since radiation, in July his last bone scan showed no new mets and a psa of 1.1 which is when they saw the lepto enhancement and found the tumor on his brain, so its confusing to me that if its been in remission for 7 years can it spread to the brain during that time? Is it just an invasive meningioma? They dont want to put my dad through a bunch of tests when the treatment was whole brain radiation for his age and they already did that. his MO says that it is rare and he doesnt feel it is from the PCA.

[dnmrk in reply to Radtech40]

Thanks for sharing. It is good to hear your story. Good result from your dad’s radiation. Hopefully ours is not from PCa metastasis with that 2.8 cm lesion. I am also not convinced from the MRI summary because my dad is doing very well with Pamorelin and Abiraterone. He’s been very stable and all the symptoms before were gone so it’s kinda contradicting for me that metastasis is happening when ADT kicks in very well with undetectable PSA.

[tango65]

Does he has a brain lesion consistent with a tumor or a stroke?

[dnmrk in reply to tango65]

as per MRI, it shows a 2.8cm lesion. Looks like this caused the slurred speech. Need to consult Neuro surgery and Radio onco for possible options. They still don’t know if this is metastasis or not. Might be a primary tumor as well.

[tayninhtom]

Like TA says, it's rare. I'm one of the rare ones. PC usually doesn't penetrate the blood/brain barrier. As a child, I had a serious head injury, in a coma and given last rites. Obviously didn't die. 2007 I got cancer, and it went metastatic. My PC was metastatic in lymphs, controlled by the usual suspects. Also my exercise regimen kept me in good health. 3 years ago an MRI showed brain tumor, which was PC. UF medicine kept the tumor for it's med school, ha ha. 6 months later, 3 lesions. Easily treated with SAS (radiation). My MO then put me or Apalutamide, because it's one of the few new drugs which penetrates the blood/brain barrier. Here I am, playing tennis, working out, and enjoying life. Every 3 months I get an MRI of the head, so far so good.

Suggestion: swith to Apalutamide (Erleada) just to be on the safe side.

TA?

[dnmrk in reply to tayninhtom]

hello. Thanks for sharing. How did you know that brain lesion is from PCa? Did you do biopsy?

How’s the radiation? Did it shrink? Any symptoms? Any side effects after radiation? Info will help us decide. Thanks

[tayninhtom in reply to dnmrk]

At UF Gainesville Fl, a teaching med school, the tumor was removed. A guy named Dr. Roper was one of the few in Florida who could do the surgery. The tumor was mostly water, the size of a thumb and mostly water. After draining, the mass was removed and biopsied. It was PC. Like TA said, it's rare, probably got there because of the childhood head injury.

6 months later, 3 lesions in the same area of the skull. These were radiated SAS, and then quarterly MRIs as f/u. So far, so good. My MO put me on Apalutamide (Erleada) because it's known to penetrate the blood/brain barrier.

Ironic that my PSA had not changed much even though I had a large PC tumor in the head. That's due to the blood/brain thing.

Regarding symptoms, prior to surgery the tumor caused me to lose the ability to read. I became somewhat dyslexic and my eyesite changed, because of pressure inside the skull. This tumor was inside the head, above the left ear. I also had headaches.

Years ago, this would have put me in the grave. Now, modern treatments keep us alive and healthy. I'm back to all my normal activity.

[vintage42 in reply to tayninhtom]

tayninhtom said, "MO then put me or Apalutamide, because it's one of the few new drugs which penetrates the blood/brain barrier... Suggestion: switch to Apalutamide (Erleada) just to be on the safe side."

Safe side meaning that Erleada will treat any prostate cancer cells that get into the brain? This site says "Enzalutamide (Xtandi) and apalutamide (Erleada) both cross the blood-brain barrier. " onclive.com/view/dr-higano-...

Evidently crossing the barrier is also the reason both drugs include warnings of seizure risk.

[NecessarilySo]

I have had skull metastasis and lymph node metastasis on my skull behind my left ear. I killed them with heat. I was worried that if they were left untreated for a long time they might grow into my brain. I'm not sure if it happens but I was worried. In my bio I explain what I did. I doubt that your father went through the lymph node pain without knowing it. I suspect that his brain lesion is not related to PCA if it does not cause headaches, which means it does not grow..

[dnmrk in reply to NecessarilySo]

He’s not complaining any headaches. I am also surprised with this saying it might be coming from his PCa. He does not have any lesion from CT on the whole body. Will get another opinion to other NeuroSurgeon.

[RosaryPower]

My hubby is a young 65, diagnosed in 2020 with stage 4, metastatic, Gleason 9. Being treated at MDAnderson in Houston.

In 2021 had Mets to the liver, treated with ablation.

Oct 2023, brain mets appeared (7-9, small); confirmed to be PC. Was not having any symptoms, medical oncologist wanted a new brain MRI since we had not done one in 9 months.

Treated with gamma knife procedure. Just had 6-week brain MRI as follow up. Possibly 1 new lesion (small), waiting to meet with radiation oncologist to confirm full results. RadOnc feels we can gamma knife again. No issues with that procedure.

Glad to hear about Apaludamide! Will be discussing with MO.

Noting that, at original PC diagnosis in 2020, all were shocked at the advanced state. PSA was never above 11, still has only been 18 at its highest. Advanced stage PC with low PSA is one of the known markers for the neuroendocrine variety of PC. Sharing this for awareness . Please do not rely on PSA alone as a marker.

[dnmrk in reply to RosaryPower]

Thanks for sharing. Yes, we also need to be careful with low PSA so a scan would help. My dad has 56 PSA initially year 2021. Now dropped to 0.09.

[dentaltwin]

Some of these "lesions" don't pan out. My late wife had a "lesion" on MRI and was told it could be a metastasis from her NSCLC (brain metastases from lung cancer are NOT rare). Nevertheless it never went anywhere and in fact shrank; never found out what it was.

[dnmrk in reply to dentaltwin]

Hello. How did you manage to shrink the tumor? Did she suffer from stroke?

[dentaltwin in reply to dnmrk]

It is doubtful what they saw was a brain metastasis. There were a lot of "lesions" that showed up on MRI and CT. Oncologist wasn't convinced it was anything. They were more concerned with some lesions in her skull, but they really didn't change over time either. At the end she had a seizure and never regained consciousness. They perhaps would have done a CT to determine if it was a stroke or a metastasis, but this was 3 years ago and medical care here in Brooklyn was pretty ragged in the height of the pandemic. She did survive over 4 years after being diagnosed stage 4, because she got on the right clinical trial, and most of those 4 years were pretty good.

[middlejoel]

Not sure when a routine scan found a lesion in my brain but it was prior to my Pca. and at least 20 years ago. The lesion was (and is) about 1 inch. Obviously not cancer.

[dnmrk in reply to middlejoel]

Hi. Did you experience stroke symptoms?

[middlejoel in reply to dnmrk]

INo don't remember exactly, l hað dizzy spells and it either the heartt or the braln

[j-o-h-n]

There are many past posts regarding Brain Tumors and etc. in the H.U. history file.

Note: I wish to offer my apologies if I offended anyone regarding my so-called humor about "race" or "misogyny". To me, humor is boundless and since we entered this word crying, I thought it would be a good idea to exit laughing.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/21/2023 7:10 PM EST

[MaxWife]

I am sorry to hear about your Dad. My prayers are with you and your family.

yes it can! Diagnosed with 4 cm brain tumor after having a seizure. Pathology confirmed metastatic prostate cancer, which was previously considered very rare. However, with all the current life prolonging medications available today, it is becoming more common. Treatment may include surgical removal, localized radiation or total brain radiation. Systemic treatment may or may not cross the blood brain barrier depending on the drug and/or treatment modality. For instance, docetaxel does not cross, but carbazitaxel might.

I’m curious if anyone knows if Pluvicto is known to treat metastatic prostate cancer in the brain.

[dnmrk in reply to MaxWife]

hello. Thanks for sharing. Doesn’t abiraterone cross blood-brain barrier? Did you do biopsy to confirm that 4cm tumor was because of PCa? How did you treat the tumor?

[MaxWife in reply to dnmrk]

yes it does, but there is no info as to whether it treats brain tumor. Took XTANDI for 2 years (12/17-1/20). Brain met occurred over 3 years later after 18 months of docetaxel, which does not cross the blood brain barrier. Bx confirmed PCa. Genetic testing slightly different than original tumor testing (now eligible for Lynparza).

Brain met treated locally with: surgical excision followed by radiation to excision site. Subsequent lesions also treated with local radiation. Holding off on total brain as long as possible.

Systemic treatment originally changed from docetaxel to carbazetaxel/carboplatin, and later to carbazetaxel/etopiside. Currently on Pluvicto (extensive bone Mets too). Lynparza next in line, followed by clinical trials, God willing.

Not sure if Pluvicto or Lynparza crosses blood brain barrier. Anyone else know?

[dnmrk in reply to MaxWife]

May i know your PSA when brain mets occurred?

[MaxWife]

Docetaxel had been keeping it in the 40s to 50s for about 17 months when it started to creep up into the 70s to 80s. Switched to carbazitaxel. Had the seizure the day after the first dose.

[Seasid in reply to MaxWife]

This is a detailed exchange about metastatic prostate cancer (PCa), particularly brain metastases, which are rare but increasingly recognized due to advancements in treatments prolonging life. Here are some key points from the conversation:

1. Metastatic Brain Tumor:

Diagnosed after a seizure, with a 4 cm brain tumor confirmed as PCa metastasis through biopsy.

Treatment included surgical removal, localized radiation, and systemic therapies.

2. Therapies Mentioned:

XTANDI (enzalutamide): Used for two years; its effectiveness in brain metastases is unclear despite crossing the blood-brain barrier.

Docetaxel: A chemotherapy agent that does not cross the blood-brain barrier but was initially effective in systemic control.

Cabazitaxel and Carboplatin: Switched after PSA levels rose; cabazitaxel might cross the blood-brain barrier.

Pluvicto (177Lu-PSMA-617): A radioligand therapy currently in use, with uncertain efficacy in brain metastases.

Lynparza (olaparib): A PARP inhibitor, considered due to genetic testing, with unclear brain penetration.

3. Management Approach:

Local treatments prioritized over total brain radiation to preserve quality of life.

Sequential systemic treatments with an adaptive strategy based on disease progression and response.

4. PSA Trends:

PSA levels in the 40s–50s during docetaxel, increasing to 70s–80s before switching to cabazitaxel.

Insights:

This conversation reflects the complexity of managing advanced PCa, especially when metastases occur in less typical locations like the brain. It underscores the importance of tailored treatments, genetic testing, and combining local and systemic approaches.

If you'd like, I can elaborate on any of the therapies or research advancements related to metastatic PCa and brain metastases.

ChatGPT said