What type of scan? Can we get an X-ray of just the back of neck to see if a new met has appeared? Or does it have to be a MRI or Cat Scan?

[Shorehousejam]

My husband is Gleason 8 DX July 2022

Original PSA 942.40 9/13 0.34

4 cores out of 15 

3 Lytic Bone Mets 

Multiple Pelvic Lymph Nodes 

Ductal subtype Prostate Cancer 

Husbands suffers from severe plaque psoriasis 

Treatment:

Firmagon @ 28 days

Zytiga and Prednisone @ Daily 

Chemotherapy @ 21 daysfor 6 sessions 

My Husband has had a rough start

 First Chemotherapy session was put off due to bad psoriasis flare because he is no longer taking the Tremfya injections (They are immune suppressants)

Started Chemotherapy 8/11

Bad psoriasis flare from chemotherapy or because of no Tremfya as MO was not sure.

My husband also had and has constant back right side neck pain, that started 10 days after the first chemotherapy infusion…

Which MO and fellow said it was muscular and didn’t want to do a scan.

So again, when he went for follow up for lab on 9/1 they still convinced us for the second time, it was muscular, by just looking at it and talk us both out of a scan or X-ray. 

We weren’t happy. 

So, Second chemotherapy was put off to 9/13 

Since then and through out, my husband cannot move neck all the way right or left

His range of motion is off 

What type of scan or is it an X-ray, that we should asked his Medical Oncologist to do? 

We feel we have to constantly begged for a scan, then we are talked out of it anyway…

We spoke to my Husband’s Primary Doctor, but he wants the MO to do it at their location because of the bone Mets etc 

What type of scan

Bone or Cat Scan or an X-ray of neck?

 The MO certainly won’t do a PSMA Pet Scan at this point. As my Husband had one this past July 2023

We want to make sure the pain in neck and limited range of motion is not a new bone met or God Forbid something else

We are at a top teaching hospital

[NPfisherman]

Hi SHJ,

How are they treating his Psoriasis since stopping Tremfya??

I would guess that they examined his neck-ROM, check for lymphadenopathy (swollen lymph nodes), muscle tone, point specific pain... Is that correct?? If they thought it was muscular in origin, then did they try muscle relaxers, NSAIDS, etc..??

A PSMA scan is not indicated since it is unlikely that it is bone mets, since he is having a fabulous response to treatment for PCa, and the scan has decreased accuracy at low PSA numbers.

I would get an MRI since that is a great test for detecting arthritic changes and inflammation. I am guessing that with his flares that this is possibly psoriatic arthritis.

Don Pescado

[Shorehousejam in reply to NPfisherman]

Thank you for your precise reply, NPF Don, I messaged the PA through the portal since we are heading in tomorrow for my husband’s monthly Firmagon injection and Chemotherapy…We have to discuss tomorrow some sort of medication for his psoriasis as it is completely out of control now…

[NPfisherman in reply to Shorehousejam]

Part of the solution could be increasing his prednisone to 5 mg twice daily instead of once. While that regimen is usually used for MCRPC, but there is NO reason that could not be used in his MHSPC given his other diagnosis. Let us know how his meeting goes with the PA.

BTW, another test possibility for the neck pain is ultrasound.

ncbi.nlm.nih.gov/pmc/articl...

Now, you can call me NPF Don, or you can call me DonP, or you can call me Fish, or... the list goes on... but for the record... I have only one profile on HU ... Can you believe all that silliness in one profile ???...

Good luck,

A Variety of Names..

[Shorehousejam in reply to NPfisherman]

got it lol