Stage 4, GL 9 seeking advice

[Poollover]

After 10 months without pain, I'm starting to have pain in my back. Orgovyx and Zytiga have appeared to keep the cancer relatively quiet until now. Next month I turn 87. I'm quite healthy, apart from Prostate cancer. I have no illusions about a cure but would like to have as many QOL days as possible. My Oncologist just ordered a blood test (checking calcium) to see how to strengthen my bones. My blood work is good: PSA 0.95 down from 70 and every other marker is green. Where do I go from here? My Gleason 4 plus 5, which is a little better than 5 plus 4. The cancer is literally all over -- multiple sites.

[Nusch]

I‘m not a doctor, but I would go for a PSMA Pet/CT scan in addition to blood tests. With 87 back pain not necessarily has to come from metastasis. So the scan will give better evidence regarding recommenced treatment.

[Tall_Allen]

What is your T score on a DXA scan?

[Poollover in reply to Tall_Allen]

COMPARISON:

Previous: N/A.

Baseline: N/A.

FINDINGS:

Lumbar spine:

Region: L2, L3, L4

Total BMD: 0.979 g/cm2

T-score: -1.2

BMD change vs. Baseline: N/A

BMD change vs. Previous: N/A

WHO classification: Osteopenia

Left hip:

Neck: BMD: 0.754 g/cm2; T-score: -1.3

Total: BMD: 0.833 g/cm2; T-score: -1.3

BMD change vs. Baseline: N/A

BMD change vs. Previous: N/A

WHO classification: Osteopenia

Overall WHO classification based on lowest T-score: Normal

Lateral Spine: No definite acute compression fracture.

Additional comments: The WHO fracture risk assessment tool reports a ten-year fracture risk for major osteoporotic fracture at 9.4% and hip fracture at 3.9%. Fracture probability calculated for an untreated patient. Fracture probability may be lower if the patient has received treatment.

For additional information on FRAX:

International osteoporosis foundation: iofbonehealth.org

National Osteoporosis foundation: nof.org

WHO collaborating Center for Metabolic Bone Diseases: shef.ac.uk/FRAX

DEFINITION OF OSTEOPOROSIS:

The definition of osteopenia as defined by the World Health Organization is a T-score between -1 and -2.5 whereas osteoporosis is defined as a T-score less than -2.5.

FRACTURE RISK BASED ON BONE DENSITY:

In post menopausal females the relative risk of fracture approximately doubles (2X) for each standard deviation reduction in bone mineral density at any site (each -1.0 in T-score).

IMPRESSION:

1. Osteopenia of the lumbar spine and left hip.

2. Ten-year WHO fracture risk of 9.4% for major osteoporotic fracture and 3.9% for hip fracture.

3. No evidence of acute compression fracture on limited lateral view of thoracolumbar spine.

Report Electronically Signed by: Alexander Adduci, MD on 9/28/2023 9:41 AM

Want more information about DEXA BONE DENSITY AXIAL SKELETON W VFA?

[Poollover in reply to Poollover]

Also, my Oncologist is planning on me to start Denosumab in a day or so, just waiting on a new blood test regarding Calcium in my blood.

[RWRB]

HelloAs I say to all my fellow journeymen on this cancer journey. Remember hugs 🫂 and that positive vibes 1🩵 help alot.

I send both to you that pain will subside and you will be pain free.

Are you still on ADT?

Sending 🫂🩵

Wayne

[Grandpa4]

At 87 I would not assume back pain is coming from cancer. I would see a back specialist and get his help thinking about it. The doctors can use clues like does it hurt at night or wake you from sleep to figure out if it is likely to be cancer. If it is then maybe radiation to that specific area would help.

[SteveTheJ in reply to Grandpa4]

In my case, I had back pain not caused by cancer and this was confirmed by MRIs. All that to say that some imagining would help.

[j-o-h-n]

Next month you'll be my age........... welcome to the club.............I don't get pain anywhere I get it everywhere..........

Good Luck, Good Health and Good Humor.

j-o-h-n