Single Bone Met

[Beej59]

My partner was diagnosed three years ago, Gleason 9/10 and PSA 6.5 with Advanced Prostate Cancer. It had just gone into one of the seminal vessels but not lymph nodes. So removal was not an option. He was given radiotherapy and put on Zoladex for two years.. At the outset he was given a bone scan, and a single patch showed up on his rib but the hospital couldn’t decide whether or not it was a met or an anomaly. We took a second opinion from another local hospital who were sceptical about it being a met, but the Consultant then went off sick for 6 months and by the time he came back the Patch seemed to be virtually gone so in the end, no one was clear whether it was the treatment that dissipated it or whether it resolved spontaneously. Three years-later and 18 months off the hormone therapy his PSA went up from unreadable to 1.09 in 6 months and he was getting twinges in his rib occasionally. A bone scan has showed the isotope uptake on the rib so they have decided it is a met and we are having a ct scan and seeing the Consultant next week. He is also starting hormone therapy (Zoladex) immediately after the scan. My partner just wants the rib taken away, completely out of his body and I totally understand that, but I am not sure if that would allow the cancer to proliferate to other areas of the body. I believe targeted radiotherapy may be an option and I have also been looking into ablation, which looks less invasive but quite effective. Also chemo as a combination with either of these treatments. Perhaps then they maybe able to remove the rib when the cells become dormant again. Has anyone got any thoughts on this? I am never sure if the options offered are always based on cost and we would be offered the cheapest option when there maybe something else out there? (We are in the UK,). I feel we have been a bit piggy in the middle between two hospitals for three years and this situation now needs addressing . I should add he is very well and the occasional twinge in his rib is not at the moment an issue really. I am very concerned at this development and am now trying to pick my way through all the information so that I am as well informed as possible for when we see the Consultant on 26th. Any thoughts people? Many thanks in advance

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[Tall_Allen]

This is called "metastasis-directed therapy"- no one knows whether that accomplishes anything. Once there are metastases, the cancer is systemic, so removing just the ones big enough to see may not be a real benefit. Thousands of cells are released from the primary prostate tumor. They find their way to sites where they change the tissue they land in, making it amenable to future growth. This is called "seed and soil." A metaphor might be mushrooms growing at the base of an oak tree. The mycelium extends everywhere throughout the soil and into the roots of the tree. Occasionally, a mushroom crops up. You can pick all the mushrooms you want, but the fungus is never destroyed. There is no way to destroy the fungus short of destroying the roots of the oak tree and sterilizing the soil. This is what "systemic" means.

To hedge your bets, all that's needed is radiation in a single dose to the metastasis.

pcnrv.blogspot.com/2019/08/...

If he can get Zytiga with his Zoladex, that might extend survival longer than Zoladex alone.

[Beej59 in reply to Tall_Allen]

Everywhere I am looking, it all seems so hopeless from a survival point of view. If you see from my story he has apparently already had this for over three years and he is still completely well, with just an occasional twinge in his rib. As far as I am aware he is not drug resistant, as he PSA was unreadable for over 12 months off the Zoladex so when he goes back on it I think it will still be effective. But all I keep reading about is this 5 year survival scenario. I am utterly devastated. Surely there must be people out there who have lived longer than this?

[Adf2529]

Just read this today, re your question: medpagetoday.com/meetingcov...

[Beej59 in reply to Adf2529]

This looks promising ....

[j-o-h-n]

Listen to Tall_Allen he know this stuff as much as I know about ice cream...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/17/2019 7:07 PM DST