Skull Metastasis

[spencoid2]

I just received an order for a brain M RI from Dr. Aggarwal. I was wondering why. My recent PSMA PET scan an d probably confirmed by SPECT scans after Pluvicto show bone metastasis in my skull as well as in other bones (one of which has an SUV of 38) and which was quite painful before Pluvicto but has lessened quite a lot in pain level.

I just read (paraphrase) that "distant bone metastasis of the skull is rare and is associated with poor prognosis" Such encouraging words. Should I be concerned?

[GP24]

If you have widespread bone mets you have a poor prognosis. I do not think things get worse if they also affect the scull.

[CAMPSOUPS in reply to GP24]

correcto! lol.

[Izzygirl1]

My husband had bone and skull mets when diagnosed almost two years ago. Have you met with a radiologist yet to see if the skull mets can be radiated? I should have asked that question two years ago but I think my husbands was too widespread to do that (he did triple therapy) and now it is in his meninges (rare). He starts radiation to that dural area on Monday and his 2nd Pluvicto treatment 2/6. I’m encouraged to hear Pluvicto has lessened your pain!! Hopefully it will also attack your skull mets! 🙏

[Avanat]

My husband was diagnosed with multiple bone mets, as well as lymph node involvement, at initial diagnosis. That was in March 2020, almost 4 years ago. He also has skull mets but because of the number of mets he was not a candidate for radiation. Besides ADT, his treatment has been chemo (Docetaxel) and immunotherapy (Nivomulab a/k/a Opdivo) which was done in 2020 as part of a Phase 2 clinical trial. He had a PSMA scan this past September and the only PSMA avid areas that showed up were his prostate and just traces of it in 2 lymph nodes. His MO said my husband either had an extraordinary response to the chemo or the immunotherapy or both. Either way, we’ll take the good news! I wish you luck on your scans and your treatment. I hope the Pluvicto continues to help with your pain. Hang in there as there are always new things to try. 🙏

[CAMPSOUPS]

Maybe its a little too anecdotal but here on the forum many including myself with "widespread bone mets" include skull mets. Very rare for these mets to interfere with even the first outer layer of the brain. I can't dig up the statistical info. for now but I've seen the statistics before. Very rare for brain involvement.

Mine continue to be seen for the last 4+ years since diagnosis. 4 large ones (2 on each side of top of skull from front to back, one on each side of skull front to back, and 2 on each side of the back of the skull from top to bottom. Then all the smaller ones. Right eye orbit, Left mandible, etc.

It used to bother me. At any sign of dizziness etc. I worried about the skull mets. But again statistically very rare for brain involvement.

You have a well regarded MO. Anyway it is odd that he jumped to do a brain MRI. But since odds of brain involvement are so low you will have some peace of mind knowing all is well after the MRI. Hopefully there wasnt more to the radiology results that didnt get communicated to you. Lets think not lol.