Bone, kidney, lung mets but PSA >.03

[hjup]

Hi there,

My dad (84) was diagnosed with stage 3 PC 3.5 years ago, received 6 weeks of radiation and has had 3 mthly standard hormone treatments. His PSA was .7 prior to treatment and has been .00 and up to .01 ever since, although now it has apparently increased to .02. Gleason score is 9.

He has just had MRI done - It shows mets in bones (esp lower spine - He has also just had spine surgery for stenosis....pain level never improved following Op and he still has sciatica type symptoms with pain down one leg and slight temporary numbness in one side of bottom and foot) and specialist who treated him for stenosis says space in bottom of spine L4 to S1 has closed up again - due to mets ?). Few mets in lymph nodes.

We just found out from latest scans that he also now has a renal carcinoma (or possibly just a cyst ? They are not 100% sure yet...) in one kidney only and a number of cancer cells in both lungs. (I am assuming they are both linked to the PC - unsure at this stage).

He is seeing his urologist in Germany tomorrow. I live in Australia.

What do you think is the best ongoing treatment please ? His brother died from PC a few years ago. Would you expect much benefit from any Parp Inhibitor or an Immune therapy or would it be best to use stronger and clinically 'more proven' drugs ? - eg Arbi/Enza/Apa/Xofigo/Lutitium

Dad also uses blood thinners. He is in reasonably good health otherwise and does very light exercises daily to keep mobile. He is not keen on chemo at all.

I would be very greatful for any constructive input on effective meds

Steph

[Tall_Allen]

He requires biopsy to see if he has RCC, or there is an RCC-PET scan now. A PSMA PET scan should tell him which metastases, if any, are due to PCa.

PARP inhibitors are only useful if he is BRCA+.

[kainasar in reply to Tall_Allen]

Whats RCC? Sounds like he hasnt had ARSI or docataxel.

[Tall_Allen in reply to kainasar]

Renal Cell Carcinoma

[hjup in reply to Tall_Allen]

Thank you very much Allen. He has possibly had this done but I have not been told. Unfortunately I live a long way away. I will get onto it. No, he has not had docitaxel, or any 2nd gen hormone as yet, only 1st gen so far....very low PSA score seems deceptive.

[EdBar]

if he hasn’t been on continuous hormone therapy (Lupron) I suggest he starts immediately and add a second line therapy like Xtandi. Gleason 9 PCa is a very aggressive cancer and should be treated accordingly.

Ed

[hjup in reply to EdBar]

Hi Ed, Yes he has been on continuous hormone therapy.

The trouble is that his spinal surgery (stenosis) in September failed and he wants it redone if possible in the spinal clinic (worried he may lose feeling in leg altogher due to assumed compressed nerve etc and wants to reduce pain medication he has been on for a year), hoping the ongoing sciatic/numbness in leg and foot may cease second time around. His oncologist and urologist are now saying that the renal carcinoma may indeed only be a benign cyst - The cells are too small to tell and they do not recommend biopsy for either lung or kidney at this stage due to concern for further tissue damage (through biopsy incision) . Dad is also on blood thinners.

My sister was told they suggest waiting 4 months til all cells are larger and clearly measurable on an MRI scan, then rescanning affected organs and then giving specific 2nd line treatment (s). During the 4 months Dad may get the stenosis OP done again...

ie. They are not sure if the cancer cells in lungs/spine/kidney are related to the prostate or not.

As I said, his PSA is virtually still nil....but yeah, I am aware of the high Gleason score. When they scanned spine, they noticed bone mets there too. (I am sure they are PC related). Let us hope the kidney only contains good cells......

[j-o-h-n]

Greetings hjup,

All I can add is that my lung metastases due to a melanoma was treated with Keytruda and it worked. Ask his doc.

Please update your dear Dad's bio. All info is voluntary but it helps him/you and helps us too. To save time maybe glean some of the info from you post above and post that into the bio. This is a great site for information and Camaraderie, so keep posting. Bless your Dad and bless you for being a lovely daughter.

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Hi John,

I have very limited current Bio for Dad. Where/how do you access Bio info on this website exactly ? ie. Is it contained in the summary I wrote above ?

Thanks for the recommendation to Keytruda. I do like the idea of immunotherapy and Keytruda may help fight all 3 potential cancer cells from what I just googled. I will email his uruologist tomorrow to suggest, though may have to commence following spinal OP if he decides to get this done.

[tn12 in reply to hjup]

The bio is found when you click on a person's name and it displays their profile