"Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined by rising levels of serum prostate-specific antigen (PSA) despite androgen-deprivation therapy in the absence of metastases on conventional imaging (1,2). Among nmCRPC patients, higher PSA levels and shorter PSA doubling time are associated with increased risks of metastases and mortality (3-5). Three androgen receptor inhibitors—apalutamide, enzalutamide, and darolutamide—have been developed as add-on therapy to androgen-deprivation therapy for nmCRPC since 2018. Phase III randomized controlled trials (RCTs) demonstrated their superiority to placebo in delaying PSA progression, metastasis, and death (6–8), "
NUBEQA did not work for him. Side effects were worse than Lupron, unfortunately! Also, it did very little, and only at commencent of treatment, in bringing down his PSA.
They are planning to do targeted Radiation on this lymph node that, as report states is “suspicious for metastasis.
I’m not sure it is a good idea to radiate on “suspicions”… 🤦♀️
Yes I figured it had something to do w nubeqa as the rise in psa occurred a year ago when starting nubeqa. Maybe do an fdg or super scan like mentioned above…
my dad has same thing his scans show stable every three months psa goes up to 10 now - the dr said sometimes he sees this - so they monitor him very closely
Would be interesting if you share blood biopsy results. Your bio suggests to me you have an excellent multi-disciplinary team. Dr Kwon of Mayo has informative YouTube discussion about different types imaging. Six years ago I went to Europe for Ferrotran nanoparticle MRI with PSMA for comparison. At usPSA 0.1 nanoMRI identified five suspicious pelvic nodes whereas the PSMA was clear. Cancer was confirmed by salvage pelvic lymph node surgery; so at least in my case the nanoMRI was better.
His blood biopsy result was he has CDK12 mutation. He recently had FRACTIONATED Blood biopsy from which I understand it will specify percentages of the load of mutation. Not sure it will change treatment plan whatever the result is.
I am in a similar boat though it seems you husband is CRPC and I am not yet. I am in that scan and see part of treatment as well. If he is not is pain that also makes it harder for a Dr to trace mets. However, if there is no pain as with me I am just going to enjoy this time as best I can. I went a year between recurrence and new scans. Now they want them again in 3 months. I feel good and PSA is low but for some reason they are concerned the cancer has morphed to a low psa version. Not sure why. I asked my Dr if I am just waiting to become CRPC and he said yes. After watching the posted video by Dr Scholz I am/was thinking about consulting with him ot somebody like him. Your Dr is top of the heep and has me rethinking it if any value in a another opinion.Thanks
Consider consulting Dr. Kwon at Mayo. He does a Choline PET there. He claims lesions show on that scan that PSMA PET scan won’t show. If PSA is rising, you have metastatic disease
Can anyone actually point to any scientific articles that actually document an imaging modality that detected lesions where 68Ga PSMA-11 or [18F]DCFPyL PSMA CT scans didn't as I've never seen one myself. Of those two, [18F]DCFPyL is supposedly slightly superior and outside a clinical trial I would assume is the most accurate you can currently get. (Sorry can't remember the study where they did a comparison between the two.)
Seems like there can always be an "exception to the rule" though but you would think it would be documented in scientific literature somewhere based on occurrences with multiple patients out of the millions of PCa patients since PSMA CT scans started to be used.
The other possibility that hasn't been mentioned here is incompetence (or more politely put as an error) in administering and/or analyzing his scan results. What might be described as "suspect" may be positive for cancer and responsible for the vast majority of his PSA level. This to me seems like the most plausible explanation. If it's not human error, tell them to fix their machine (joking, sort of.)
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