Metastatic Prostate Cancer (?)

[avenasse]

Hi eveyone,

My husband’s PSA was being followed by our family doctor. He is 62 years old with a family history (2 older brothers that live in Jamaica don’t share much details about their conditions or treatment).

PSA Hitstory

24/01/2020: 2.90

12/04/2024: 5.48

24/05/2024: 4.02

We ended up in the emergency room on July 27 due to fever. We saw the oncology team through the emergency visit. It was determined he had an enlarged prostate and they treated him for a UTI. The CT showed something on his tailbone they said they were not worried about- perhaps something he was born with-but would send for bone scan to be safe.

CT results: BONES / BODY WALL: A note is made of very subtle sclerosis involving the sacral alae. This is accompanied by heterogeneity of the bone marrow. [Axial series 601, image #114 and 106]. The largest sclerotic lesion within the sacral alla measures 8 mm. No body wall abnormality.LOWER THORAX (lung bases, heart): No important abnormality.

The prostate gland is heterogenous in appearance. It is enlarged. Changes of BPH are suspected. No measurable nodule. There is projection of the transitional zone into the base of the bladder. The seminal vesicles are slightly ill-defined and appears edematous. This is a nonspecific finding. Mild periprostatic stranding is noted. Stranding is also identified surrounding the seminal vesicles

A referral was sent to cancer clinic to “get in system” as the wait can be long and better to get ahead of it all. We felt very reassured we were ahead of anything that could develop. He did the bone scan not thinking anything of it. The doctors also said do another PSA as we were leaving. We were not advised to wait a specific time period for UTI and medication run its course.

He did another PSA on August 24 – which was 16.

We got the bone scan results which shocked us:

FINDINGS: There are multiple foci of intense radiotracer activity noted involving the sacrum, sacral alla and iliac bone at the sacroiliac joints correlated to the finding seen on the CT images likely metastatic in nature.

Also noted focus of mild radiotracer activity noted at the anterior aspect of the right 10th rib correlated to a tiny lytic lesion seen on the CT images, likely metastatic. (my husband said he was shot with a fish gun years ago and we never indicated this on the form so he is confident this is from past injury)

Small foci of increased tracer activity noted at the level of T5 vertebral spinous process, that could represent metastatic disease versus enthesopathic changes.

Small focus of intense radiotracer activity noted at the level of upper cervical spine likely within the C3-4 facet joint, likely representing facet joint arthrosis. Degenerative changes seen involving the mid thoracic spine, AC joints, sternoclavicular joints, bilateral knees which might limited assessment for early metastasis in those regions.

We met with a urology doctor last week at the cancer clinic

PSA test – Sept 21 results 10.23

Free PSA .11.

Upon doing a rectal exam he said he felt something right away that must have been missed by the other doctors. He is confident with prostate cancer diagnosis, but next step is biopsy.

He was however surprised that the bone scan results came back as is as it does not correlate with everything else he is seeing (or something to that effect) especially with PSA trending downward. He said he would almost think it is a separate bone cancer but my husband presents as a healthy person so he doesn’t think that is it either. I guess the biopsy will tell more. He said he wants to take it step by step. Also ordered a chest scan as he said that was never done.

While we are waiting for the biopsy appointment I thought I would pose the question to the forum. Do you think there is a chance that the uptake on the bone scan is something else entirely not cancer related. Any thoughts really on this case is greatly appreciated. I will end by adding that other than the UTI he is asympomatic.

[Tall_Allen]

Can he get a PET scan? A PSMA PET/CT or a NaF PET/CT will tell you if those bone lesions are cancer or not.

[avenasse in reply to Tall_Allen]

I mentioned the option of PMSA at the consult, the doctor nobbed his head but didn't want to put the horse before the carriage. I am guessing the biopsy is natually the next step and will add peices to the puzzle and he will go from there. He calls it a peculilar history. I have done so much research on prosate cancer the month of Septmeber while waiting for consult that my head is going to explode . I am very nervious for biopsy and to see the Gleason Score.

[Tall_Allen in reply to avenasse]

A prostate biopsy will only tell you what is in the prostate - it tells you nothing about metastases, which is a bigger concern. In fact, if he has a reliable diagnosis of metastases, he can avoid a prostate biopsy altogether.

[avenasse in reply to Tall_Allen]

If the biopsy and bipassed and metastases was confirmed would they just assume its its advanced and treat from there. Is this possible ? Every forum I read seems to ask for a gleason score as being important for exact staging and informing treatment.

[Tall_Allen in reply to avenasse]

Gleason score is an indicator of the risk that the cancer will metastasize. IF it is localized, Gleason score is important. If it has already metastasized, Gleason score is not important.

[avenasse in reply to Tall_Allen]

Thank you Tall_Allen !

[garyjp9 in reply to Tall_Allen]

TA, if the cancer has already metastasized to just a couple of places, does a high Gleason score tell you if there will be more/recurring metastases over time?

[Tall_Allen in reply to garyjp9]

No. Gleason score (and stage and PSA) only tells you the risk of metastasizing. Once cancer has achieved the state in which it can spread and travel outside the prostate, it doesn't matter what the architecture of the cells used to be.

[garyjp9 in reply to Tall_Allen]

Thank you, T_A

[robert570]

At 52 I had no symptoms or pain at all. Woke up one morning with pain. Went to the doctor, he sent me to a urologist and they did a biopsy. It came back with a PSA of 10.65 and I had the worst type of aggresive prostate cancer. They immediately took it out. To make a long story short, I'm 62 years old now and have had everything but the kitchen sink thrown at me and I'm still here. I can tell you that everyone's journey is different, so go with your gut feeling and don't panic from some statements that are posted online. Remember, everyone has different DNA and one treatment might not work for someone else but could do great things for you, good luck.