Is it Prostate Metastases or Lung cancer

[wpeebles]

Brief background- Current age 75. Prostate cancer 8 years ago. Gleason 4+3 Radiation and Eligard shots for six months. All good until 6/2023 when PSA went to .6. On 1/2024 went to 1.0 then 1.6 on 6/2024. During the last year I have had many scans.

8/23 - Pet/PSMA - Multiple right lung nodules but no abnormal uptake but another metastatic malignancy can not be excluded.

1/2024 - MRI Prostate w/o contrast - right apex peripheral zone- Pi-Rads 5 lesion

4/2024 - Prostate Biopsy - Gleason score 4+3

5/2025 - Lung Pet Scan -Multiple hypermetabolic right lung nodules and growing. Suspicious for metastatic disease or primary malignancy.

5/2024- Pet Scan/PSMA - Nodules are FDG avid (hypermetabolic) but none demonstrate PSMA avidity with no uptake. Scattered areas of low level PSMA. No bones or lymph nodes metastatic.

5/2024 Lung Biopsy - Inconclusive so sent to Johns Hopkins for second opinion. Patchy positive for INSM-1, Focally positive for CDX-2 and PSMA (weak). Negative for for CK7, CK20, TTF-1, SATB2. Non specific but compatible with metastatic adenocarcinoma of the prostate due to history of previous PC.

So, everyone assumes but not sure that PC has spread to lungs. Stopped smoking over 30 years ago. On July1, 2024 I started on Abie, Pred. and Eligard shots. After one month PSA is .26 from 1.6. The plan is to have another Lung Scan done in two months. If the nodules reduce in size, then treatment is working, and most likely PC spread. If nodules have grown, then probably separate lung cancer.

Does this all sound like the right approach to my situation. Thanks for any comments.

[NanoMRI]

Sympathizing, questioning as well, as I am working through a recently Pylarify identified liver lesion. Imaging report states "metastatic disease of uncertain origin".

Concurrent with Pylarify, liquid blood biopsy identifies TP53 R248Q; can come from almost any type of cancer. You have not mentioned you had similar testing.

I am maximizing all investigative methods, questioning is lesion benign cyst, PCa, melanoma (I have had two), liver cancer, or?

[wpeebles in reply to NanoMRI]

Thanks. Did have similar testing.

[Tall_Allen]

Your low PSA suggests a mixed type, possibly some prostate adenocarcinoma and the FDG avidity and INSM1 some beginning of neuroendocrine differentiation. I doubt you will get much response to abi. You may get a better response from docetaxel+carboplatin.

[wpeebles in reply to Tall_Allen]

Thanks, I will inquire about that.

[Justfor_]

Second cancer caused by irradiation isn't something unheard of. Yet, 7-8 years is a bit early for that. 10-15 years post RT is more likely.

[wpeebles in reply to Justfor_]

Thanks.

[Cp014]

that is exact same as me. My MO does not think my lung nodes, cancer?, is from my prostrate. She thinks this because there is no evidence in my pet scan of met other than the prostrate.

She refused to do anything until a lung biopsy confirms or disproves.

I am looking for another, multiple experienced MO who can better help me. I am afraid I may have been too hasty but this is the same MO who made me wait 4 months cause she never got back w bcbs. She also said she don’t think it can be prostrate cancer met cause no sign anywhere else specifically lower body.

Anyone thoughts? Was I too hasty? Will my psma pet scan reveal if the lung nodes are prostrate c or not?

If so, why the biopsy? I am ok w biopsy but I rather they just take it out when they biopsy?

I’m tired and frustrated folks seem to just be tip toing along here.

[wpeebles in reply to Cp014]

Depends on if your nodes are growing or not. Mine were increasing in size every couple of months. If they didn't increase, we probably would have left them alone until they did. . I am no medical expert, but like me your PSMA pet scan may or may not reveal if nodes are PC or not. A lung biopsy should but not necessarily. In my case my lung nodules were increasing in size and due to my recurrent PC I had the PSMA pet scan done and that was inconclusive so the lung biopsy was performed. They could only get to a smaller node so that came out 60/40 PC spread due to my history but still not conclusive. If the hormone therapies I'm on reduce the nodes then it is probably PC spread. If not I will have to get another lung biopsy done. People tell me its better to have PC spread to lungs than separate lung cancer since you can treat both the same.

[Cp014 in reply to wpeebles]

Thank you so much.

Sounds so much like what I am facing now. I will know more after psma scan.

I hope you don’t mind me sharing with you I appreciate all you have to say pass along to me.

If so, please just let me know.

Thankyou

[wpeebles in reply to Cp014]

Don't mind at all. We are all in this together.

[timotur]

The CA-19 blood test is one screen used for lung cancer.

[j-o-h-n]

My lung cancer metastasized from a treated neck melanoma (not from my Pca). The miracle immunotherapy drug Keytruda worked. Good Idea to ask your doc if it can work for you. if need be. (Working for President Jimmy Carter).

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Jets Jets Jets......glad it worked for you buddy.

[Hidden]

I had a lung biopsy. My PSA went from 93 to 166. Last scan said my lungs were clear, two nodules and four lymp nodes. Two cycles of chemo, ADT and Nubeqa. Another CT scan coming soon.

[RoseDoc]

Seems like the lung lesions are metastatic prostate CA. You are a candidate for triple therapy; ADT + docetael. Nubeqa may be a better choice than Abbie.

[chips1942]

My PCa has become MCRPC . Over the past 2 1/2 years I’ve had several biopsies of my lungs. The samples indicate the probability it is PCa however early indications suggested NSC Lung cancer. So the doctors performed a lobectomy of my upper left lung and tested the samples where they determined it probably not lung cancer. Both PSMA scans & FDG scans have shown only some of the nodules are PSMA avid . Now after 7 docetaxel treatments & 4 Lu177 treatments the PSMA avid nodules seem to be stable. However the nodules which were seen on the FDG scans continued to grow so we treated the larger 2 with HDRBT recently. Sounds like my lungs have been through the wars. Yep. By the way my PSA has remained under 0.1 for the entire period. Currently, I’m not on any PCa drugs. I will be happy to discuss lung related issues with anyone who has Mets to their lungs. Wish you well!