Mass on pancreas (cancer) - mets from PC or pancreatic cancer…?

[LDC2024]

My Dad (77) was diagnosed in the spring with stage 4 prostate cancer, Gleason 10 with mets to spine. He has since started hormone therapy and had radiation to his prostate.

Recent scan showed a mass on the pancreas which came as a big surprise as the radiation had shrunk the mets on his spine and his PSA went down to 0.02. Today he had a scope for the pancreas and the surgeon said it is cancer in pancreas - they did a biopsy to see if it is a met from the prostate cancer - or if it is an entirely new cancer. Has anyone here had prostate cancer that metastasized to the pancreas?? Online, I am reading this is very rare. If it’s pancreatic cancer, we’re shocked this wouldn’t have been seen on the many scans he has had in recent months. Is there a link b/w prostate cancer and pancreatic cancer? We won’t know the stage until we meet with the oncologist September 6.

While he tells us he’s “feeling fine” - we can tell physically he has deteriorated quickly since starting ADT in March this year . Sad as he was feeling great prior to any hormone therapy and only symptom was more frequent urination (no pain).

We are truly sick over this news today …he’s my best friend and I can’t imagine my world without him in it. He’s been with my mom for over 52 years. Very tight-knit family. Ugh. Trying to cling onto any hope we can.

[Tall_Allen]

What were the results of the biopsy?

[LDC2024 in reply to Tall_Allen]

Thanks for the quick response. We find out the results at the next appt with MO on September 6.

[God_Loves_Me in reply to LDC2024]

May be call and get the biopsy result early ? Just call and leave message for triage line

[LDC2024 in reply to God_Loves_Me]

Right?? I feel like 2 weeks is long to wait for something so aggressive. We’re in Toronto. We’re not happy with the MO we have been assigned to (impossible to reach anyone at the clinic, doesn’t answer questions clearly, he’s very doom and gloom) and unfortunately it’s next to impossible to get a second opinion here or be transferred to a new oncologist. We’ll try to call next week to see if the results have come through yet. Could at least give us some time to prepare questions we want to ask MO on September 6. Thank you.

[JRLDH in reply to LDC2024]

I know there are many issues with the US health system but, anecdote, they really kicked into high gear when my husband's ultrasound (he thought he had kidney stones, back pain was his only symptom) showed lesions suspicious for metastases (the SHOCK of our lives). CT, blood tests, biopsy, diagnosis, Chemotherapy happened in I think less than two weeks.

[Tall_Allen in reply to LDC2024]

It's a slow and painstaking process- they have to use various IHC stains and look at each under a microscope, counting uptake in individual cells. Sometimes,results are equivocal and experienced pathologists must make close calls.But I hope you will let me know what they say.

[LDC2024 in reply to Tall_Allen]

Hi Tall Allen,

We got my Dad’s biopsy results back and it is confirmed cancer..and they suspect primary cancer, in the body of the pancreas. Honestly stage 4 prostate cancer was a much easier diagnosis to receive than this. He was doing so well with treatment for prostate cancer too and this came to us by fluke on a scan…absolutely devastated.

I can’t even look at pancreatic support groups or forums since they are all very doom and gloom, with everyone sharing painful stories of themselves dealing with it or loved ones passing away way too quickly. Nothing like this forum.

The biopsy report states:

FNB, pancreas, body. Adenocarcinoma. 27mm heterogenous mass in the body of the pancreas. No vascular invasion.

The tumour cells show normal expression of the MMR proteins MLH1, PMS2, MSH2 and MSH6. No immunohistochemical evidence of a mismatch repair deficiency and low probability of MSI-H.

We’re now waiting for a consult with a surgeon. If a possibility and if it has not spread to blood vessels, they may do surgery to remove the mass, but I’m not sure if he’ll go ahead with whipple surgery given how intense it is, high risk of complications and long rough recovery for many people. I don’t know if they offer laparoscopic option for this type of cancer.

[Tall_Allen in reply to LDC2024]

Ruth Bader Ginsberg lived a long time with it and had several treatments. Steve Jobs avoided conventional treatments and regretted it. Do you know if it is a neuroendocrine pancreatic cancer? If so, Lutathera may be beneficial.

[LDC2024 in reply to Tall_Allen]

I appreciate your voice of reason, Tall Allen. My Dad’s is adenocarcinoma unfortunately.

[Tall_Allen in reply to LDC2024]

Actually, adenocarcinoma has a better prognosis.

[LDC2024 in reply to Tall_Allen]

Unfortunately, adenocarcinoma has a far poorer prognosis and far more aggressive. Neuroendocrine would have been the better type to have, as it’s slow growing. We wish he had neuroendocrine

[JohnInTheMiddle in reply to LDC2024]

No you don't. I think you have been mis-informed about narrow endocrine cancer. Which suggests questioning the source.

[JRLDH]

Pancreatic Cancer has its own marker, CA19-9. It's got similar problems like PSA (can be elevated for other reasons, esp. biliary issues, hence it's not used for mass screening) but it's pretty good to use as one piece of the puzzle. Like if your dad's CA19-9 is normal, then the mass on the pancreas most likely isn't pancreatic cancer.

About imaging: Neoplasms sometimes aren't obvious, especially if they are small. And just like with prostate specific imaging, there are modalities that are more appropriate to check pancreatic cancer than others.

If he's got a typical pancreatic cancer, he'll need treatment ASAP. It's nothing like most prostate cancers. WAY more aggressive. My husband passed from pancreatic cancer 14 months after diagnosis (back pain -> immediate stage 4). And that already qualified as above average survival for this cancer. I've read many times of people passing a few weeks after diagnosis on discussion forums around pancreatic cancer.

And about link: Both can be caused by gene repair deficiencies, esp. BRCA or any of the other repair pathway germ line defective genes.

[LDC2024 in reply to JRLDH]

Thanks for the information - I didn’t know about its unique marker. He doesn’t have BRCA - not sure about other repair pathway germ line defective genes.

I’m so sorry to hear about your husband…did he have prostate cancer at the same time?

I know prognosis for pancreatic cancer is usually grim Hoping for the best case scenario in this situation and many more months / years with him.

[JRLDH in reply to LDC2024]

No. He didn't have prostate cancer at the same time. I would think that your dad's pancreatic tumors are prostate cancer metastases, which is probably much less severe than actual pancreatic ductal adenocarcinoma. Seems really unlikely to get both.

[LDC2024 in reply to JRLDH]

It’s a second primary cancer, not mets from the prostate cancer. It is very rare to have two primary cancers diagnosed within a year and he doesn’t have lynch syndrome. He’s the last person on earth this should be happening to and so full of life we’re terribly heartbroken.

[j-o-h-n]

I truly wish it's just a fluke in your father's scan....BTW You're a wonderful offspring.....

Good Luck, Good Health and Good Humor.

j-o-h-n