2Nd Biopsy in 3+ years of Bone Met

[Lavender22]

Greetings All,

A question about biopsies:

Upon PC-stage 4 diagnosis per discovery of pc lesions causing spinal compression in 2020, my husband had a biopsy taken during his back surgery-which showed his already metastatic pc not to be an inherited condition.

He went on to radiation of the spinal mets, then lupron injections, followed by 6 sessions of chemo (docetaxel), which failed. Sine the he’s had 3 successful years of Abiraterone and prednisone treatment. But now his psa numbers are starting to climb. (From .04- .15 in the last 3 mos.) His onc. has requested another biopsy from a newly discovered lumbar lesion (via psma scan 2 weeks ago). We are curious, in what ways will this 2nd biopsy provide info. for next phase of treatment?

Thanks in advance for your valued responses . This forum has proven to be invaluable to us for nearly 4 years. -E.

[God_Loves_Me]

may be SBRT radiations is good options.

Also dr may change medicine and prescribe him enzalutamide, or apalutamide or darolutamide with lupron injections

[103532 in reply to God_Loves_Me]

Hello, we are in the early stages of my husband's metastatic journey (currently undergoing salvage radiation to prostate bed, pelvis and abdominal lymph nodes). He is also taking Abi/Pred in addition to Lupron. My understanding is that in some cases, switching Prednisone to Dexamethasone can drag out the ADT effectiveness for a while longer. Maybe SBRT in tandem with the steroid change would keep things in check. I know there are many new therapies being evaluated for when the cancer becomes resistant to the ADT. If it were me, I would be asking the medical oncologist if it would cause harm to try ways to re-sensitize the cancer to the ADT a s a start. Hopefully, SBRT can wipe out the bone lesion, and maybe that is all that is causing the slight psa rise. I monitor this sight frequently to gain insight into my husband's situation and learn from others. Please keep us posted on how your husband is doing.

Sincerely,

Stephanie

[Lavender22 in reply to God_Loves_Me]

Thanks. Yes, I suspect his doctor will be changing therapies.

[Lavender22 in reply to God_Loves_Me]

Thanks. He meets with his doctor soon. We anticipate a change in therapy. I’ll be curious if the biopsy shows ups something new.

[God_Loves_Me]

yes PSA doubling time is < 3 months that’s rapid so dr will going to be aggressive

[Tall_Allen]

There are 3 types of analyses they can perform on biopsy tissue, if there is enough tissue extracted:

1. Histology - what kind of cells are they under a microscope?

2. IHC- they stain the tissue to see which proteins are expressed. Not all pathology labs have all kinds of stains. Here is my "wish list." Ask which you can get: AR (androgen receptor), PSA, PSMA, MSH2, MSH6, STEAP1, PD-L1, PTEN, chromogranin A (CGA), neuron-specific enolase (NSE), synaptophysin (SYP),  DLL-3, CD56, Somatostatin (SST)

3. Genomics - which genes are expressed in current metastases. This can change over time.

There are only a few tailored therapies available for certain peculiar findings. Many more are in clinical trials. Perhaps the biopsy will point you toward a certain clinical trial.

[Lavender22]

T_A,

Thanks for these specifics.

We wondered if the genes might have changed over time…

I believe Dr. Vintila is also looking for a match to clinical trials. We are in the NYC Metro area. My husband meets with her tomorrow, so the timing w/your response is really helpful. I will print your wish list to share with her.

As always, many thanks, E

[j-o-h-n]

Hello Elina, Since you're in the NYC area (Long Island is my guess) did you and Scott ever consider seeing a doctor(s) in Sloan Kettering c.c. ? They have two facilities in Long Island and of course the main one on 68th and first Avenue. Great facility and doctors....

Scott, one of the unsung heroes working at WTC during 9/11 recovery...

p.s. Helena (Elina) = Hellenic...

Good Luck, Good Health and Good Humor.

j-o-h-n

[Lavender22 in reply to j-o-h-n]

Thanks John,

Yes, we’re out on Long Island. My husband was a construction diver- welding, burning, concrete work on piers, etc.. He went into the WTC ground zero site in the immediate aftermath to help with recovery efforts and then later to do the cleanup/ transport of site debris.

He doesn’t dive anymore be cause his spine has been compromised by spinal lesions. He’d been going to a chiropractor in the previous months for back pain. It was that dr who sent him for a mri, which indicated it was advanced pc - mets to the spine. There was a really large one pressing on his spinal cord and he needed immediate surgery. His neuro surgeon was Dr. Kerr at Huntington Hospital. That’s when they obtained the first biopsy. We didn’t go into Mem. Sloan Kettering because all this occurred at the start of covid —so we opted for all local medical service— first at Huntington hospital and now the Monter Center (at the old League of Nations bldg. in Nassau co.) The do have big conference calls with other pc oncs. in the metro area. And I think that’s when the consensus occurred to do another biopsy. It’s slated for next Friday. And I’m sending my husband in with Tall_Alan’s wish list for today’s mtg..

He did have SBRT very early on— perhaps it’ll be on the list for the 2nd go-round. And we’re thinking maybe Xtandi? Or maybe a clinical trial? We’ll see.

My husband was in great physical condition and drs. think that’s partly why he’s done so well. He’s also cool as a cucumber in temperament.

Thanks for your concern. I’ll keep you posted.

Best, Elisa

[j-o-h-n]

Thank you for the update....and tell him "Just think, no more diving....no more wet wrinkles".............

Good Luck, Good Health and Good Humor.

j-o-h-n