Encounter #: Location: DHK IR IMAGING Age/Sex: 62 / M
CLINICAL INFORMATION:
Prostate cancer (C61) DIAGNOSIS:
A. Liver, lesion, biopsy: Small focus of metastatic prostatic adenocarcinoma; see note.
Note: The biopsy shows hepatic parenchyma with a small focus of adenocarcinoma that stains positive with a NKX3.1 immunostain, supporting the above diagnosis.
5/6/2024 GROSS DESCRIPTION: A. Received fresh, the specimen is labeled "liver biopsy mass X6" and consists of seven cores of tan-white tissue measuring from 1.0 x 0.1 x 0.1 to 1.3 x 0.1 x 0.1 cm. Four is/are submitted for ancillary studies. The remaining tissue is entirely submitted for routine histology. Summary of sections: A1 t
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Shorehousejam
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I messaged through portal Orginal MO at NYP as I have two MO’s at two separate hospitals, one is just a cancer only hospital, MSK, where I’m getting chemotherapy starting tomorrow, it sure looks like the prostate bed seeded back to liver and possibly lungs by not radiating. I’m so confused.
I revisited your history, and - man - I was reminded that you have been through the medical wringer with extra run-around! You and your wife have been rock stars (pun/reference intended?). I agree with TA in that you shouldn't beat yourself up - You are obviously hella smart and you've routinely made tough decisions about your health since this s#!+-show started.
Chemo-time, brother. We'll be pulling for you! - Joe M.
Thank you Brutha, My wife is really pretty smart, it’s her who helps with bio and keeps a medical journal. We make a great team. I am fighting to stay alive and be with her.
The liver biopsy results you described ("hepatic parenchyma with a small focus of adenocarcinoma that stains positive with a NKX3.1 immunostain") do not necessarily indicate neuroendocrine prostate cancer (NEPC). Here's a breakdown:
Adenocarcinoma: This is a type of cancer that originates in glandular tissues. While prostate cancer is often adenocarcinoma, other organs, including the liver, can also develop adenocarcinoma.
NKX3.1: This is a protein commonly found in prostate tissue. A positive NKX3.1 stain on the biopsy can suggest that the cancer originated in the prostate. However, it is not exclusive to prostate cancer and can be seen in some other cancers as well.
NEPC is a distinct type of prostate cancer characterized by the presence of neuroendocrine features, which are not necessarily indicated in the biopsy results you provided.
If you are concerned about NEPC, it is important to discuss these results with your doctor. They can consider additional factors and tests to determine the type and origin of the cancer. This may include:
Medical history: Your doctor will ask about your symptoms, risk factors for prostate cancer, and any previous biopsies or treatments.
Other prostate cancer tests: This may include a PSA blood test or additional prostate biopsies.
Imaging tests: A CT scan, MRI scan, or PET scan can help to determine the extent of the cancer and identify any metastases.
I asked if there is more histology and staining to be done. I messaged through portal Orginal MO at NYP as I have two MO’s at two separate hospitals, one is just a cancer only hospital, MSK, where I’m getting chemotherapy starting tomorrow, it sure looks like the prostate bed seeded back to liver and possibly lungs by not radiating. I’m so confused.
I have been praying hard for you because I can tell how worried you have been (understandably)! From what I can tell, I believe this is the common adenocarcinoma that contains cells similar to the primary tumor. I would be cautiously optimistic. I hope this gives you peace, and that you can have a really enjoyable weekend!
I asked if there is more histology and staining to be done. I messaged through portal Orginal MO at NYP as I have two MO’s at two separate hospitals, one is just a cancer only hospital, MSK, where I’m getting chemotherapy starting tomorrow, it sure looks like the prostate bed seeded back to liver and possibly lungs by not radiating. I’m so confused.
"it sure looks like the prostate bed seeded back to liver and possibly lungs by not radiating." That is an unwarranted assumption. It is well known that met-to-met spread predominates over prostate-to-met spread. You seem to have a false impression of what radiation of metastases accomplishes.
I understand your point, true it’s very possible circulating tumor cells, could have well started seeding the liver….possibly even before or after my Davinci Radical Prostatectomy. I’ll never know, either will you.
As that’s the conundrum with this cancer. Multi modal approach seems to be the only thing that extends the life of guys with pca.
Please share with me, this research or fact, as I never realized this fact.
Your quoted statement:
“It is well known that met-to-met spread predominates over prostate-to-met spread.”
We actually do know that prostate-to-met spread is only consequential very early. Afterwards, met-to-met spread predominates. Most mets are invisible to any kind of imaging. I hate to see you beating yourself up over what was always outside of your control.
They could have been in circulation or in tissue reservoirs. In fact, they may have been in the lungs and liver for a long time. It takes quite a while to become big enough to be detectable on imaging, but once they become established they grow quickly. This is called exponential growth: very slow at first but picking up speed as they grow. We also know that cancer must first prepare the "soil" in which it can grow, and this takes some time. This is called the "natural history" of prostate cancer, and it is well characterized. We can slow it down, but we can't stop it after the first cells have metastasized.
It will kill some but not all of the cancer. IDK if the cancer on the prostate bed will be killed - why do you care which? It kills rapidly growing cancer.
Regarding histology, what our (and I mean this!) very dear Mr. Spock...er...TA is saying is that the positive NKX3.1 immunostain is definitive for prostate cancer (See, e.g.: pubmed.ncbi.nlm.nih.gov/311..., so no other histology is needed in order to proceed with treatment.
As an aside, here on HU TA rarely touts his work on his "blog" - a term that brings to my mind homespun thoughts on the household uses of vinegar. But prostatecancer.news is WAY more than a blog - it is true scientific reporting with a focus on prostate cancer. It doesn't pull punches and expects readers to be able to keep up with very technical topics, and there is a treasure trove of information and references on PCa topics on the site compiled by our esteemed science officer!
The prostate cancer news site supplements and explains many of TAs responses to members here on HU. I suppose it would appear very self-serving of TA to simply respond to so many posts with "See my blog, bro." But he could.
For the record, I don't use prostatecancer.news because there are exactly ZERO posts on the uses of vinegar! 😉
Just in case you need one...... Mix 50% water 50% white vinegar to rid your house (indoors) of ants. Works faster than having sex with your wife........(Just wipe counters in kitchen where most of them hang out - they can't handle the smell of vinegar and will pack up and leave).
My ex-wife is the opposite of the vinegar tonic...... THE TONIC WORKS!!! Two days and they're gone, gotta tell the cops to use it on those demonstrating college students.
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biopsy - fragmented cores and progression risk 
26 months post Laparoscopic Robotic Prostatectomy on T gel for LOH.
