Seeking Advice: I'm working with the... - Prostate Cancer N...

Prostate Cancer Network

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Seeking Advice

I'm working with the premise I'm experiencing a BCR. After 2 years of undetectable psa, my recent psa test were the following:

My last 3 mo eligard shot was July 2021. I stopped the AA at this time also

Oct 2021 psa <.1 T < 3 ng/dl ALP 97

Jan 2022 psa < .04 T 230 ALP 103

April 20, 2022 psa .31 T 255 ALP 88

May 4, 2022 psa .51 T NA ALP NA

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Pylarify PET/CT scan May 17, 2022

Study Result

Impression

IMPRESSION:

There are tracer avid left hilar and AP window nodes. Although this raises the possibility of prostate cancer metastases, the lack of coexisting abdominopelvic metastatic adenopathy would be somewhat atypical, and raises the possibility of these nodes representing a separate metastatic process besides prostate cancer.

No evidence of prostatectomy bed recurrence nor solid organ metastases.

Narrative

EXAM TYPE: NM PET TUMOR SCAN W/ CT SKULL BASE TO MID THIGH

EXAM DATE AND TIME: 5/17/2022 3:12 PM EDT

INDICATION: Elevated prostate specific antigen (PSA); Subsequent treatment strategy

COMPARISON: None

TECHNIQUE:

Approximately 60minutes following the intravenous administration of 7.88i of F-18 DCFPyl (Pylarify), PET/CT fusion imaging from the skull vertex to the mid thighs was obtained.

The CT portion of this study is a low dose, non-contrast CT, used for attenuation correction and localization only, and is not a diagnostic CT.

FINDINGS:

Prostate:

There is no abnormal activity in the prostatectomy bed to suggest prostate bed recurrence

Lymphatics system:

There are no abdominopelvic nodal metastases

However, there is a tracer avid left hilar node, SUV max of 12.76, difficult to measure but about 1.4 cm in axial dimension.

In addition, there is a tracer avid AP window node, SUV max of 10.09, about 1.0 cm in axial dimension.

Distant metastases: There are no lung, liver, or skeletal metastases.

Nondiagnostic CT findings: Multiple liver cysts. Azygous lobe

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I'm now exploring what options are available to me. I'm not in a rush to do something as the psa is still low. I'm in the process of seeking out prostate oncologist for second and third opinions.

My MO wants me to make appt with my urologist. While there is little to nothing he can do for me, he seems like he would be open to working with me if I chose to implement a BAT protocol. The MO not so much.

I'm in the gray area of prostate cancer treatment. No known metastases but rising psa.

So I'm seeking opinions from other men who may have encountered this same situation to understand what my choices would or could be.

17 Replies

I don’t know. Your present may be in my future (just finished 3 years of ADT with 39 sessions of EBRT). My gut says there are 2 choices,

1/. Immediately restart ADT with a 2nd gen anti androgen

2/. Monitor PSA monthly and rescan in a few months (in the hope that the recurrence can be identified and treated with curative intent).

There are probably other options but I can’t see them. As I read your post I had that “rabbit caught in the headlights” moment, which you may have had yourself.

Fortunately for us both there are better informed members on this site who can give you a better steer. I would really love for your premise to be wrong but I’m aware of the gray area.

I wish that I could be more supportive.

Hugh

Justfor_ profile image
Justfor_ in reply to Aodh

Your third option,somewhere in between, is what I am currently doing. It is early to draw any conclusions, just a proof of concept. I am reporting what I am doing in my Bicalutamide Maneuvers thread.

in reply to Justfor_

Thanks for the response...wow..seems complicated system..are you retired or still working...im still working so, while I could afford the monthly testing cost, I don't know if I have the time to allocated to the frequency of tests.Interesting concept....this seem like it would be a nice application for a machine learning algorithm. Something along the lines of a cost function.

What's your opinion on that?

I'm exploring hitting it with 2 lu177 treatments. I added my pet scan results to my post...what are thoughts?

Justfor_ profile image
Justfor_ in reply to

Thanks for your interest. I am retired so I have plenty of time. I am not familiar with the cost function. Could you please elaborate?

PS: No need, I Googled it

Now that I learned what a cost function is I can tell you that I have been using it for my PSA monitoring without knowing it had that name.

In particular, before starting the Bicalutamide experiment, I was trying to model my PSA's post RP untreated trajectory. In theory it should be an exponential rise but in practice it proved very far from such. I used a weighted sum of a linear and an exponential component that approximated the measured values better. The weighting coefficients of the two components were factored in in a try and error fashion using the sum of the errors^2 to guide convergence.

I also tried a Kalman filter approach, but instead converging it was diverging, hence, abandoned.

To answer your question now, machine learning can be a good idea as the medical stuff can not do such things on individualized basis.

in reply to Justfor_

What are your thoughts on LU177?

Justfor_ profile image
Justfor_ in reply to

I would liked to see it taking the place of sRT or even primary irradiation, i.e. many-many stages earlier than now, in lower isotope concentrations and total number of fractions.

But, there is such a huge number of invested RT equipment and professionals making a living out of external irradiation treatments that I am sure I will not see it happening in the next decade, when I hope I will be still around.

in reply to Justfor_

Jettison the excel spreadshhet...look at a software called Octave....im using it in my machine learning project...it is free and will allow you to do matrix calculations along with other types of mathematical methods.

I doubt you need Matlab and this will allow you to do serious analysis...more than you can do with excel....

gnu.org/software/octave/

Can't hurt to take a peek.

Justfor_ profile image
Justfor_ in reply to

Thanks, I will do

Justfor_ profile image
Justfor_ in reply to

It seems that the problem is in your (2 at least) LN. If you could afford time and cost for a nanoMRI at The Nederlands, it could confirm or deny this hypothesis. Regardless, I would waited to see how the pioneering MateoBeach fares.

in reply to Justfor_

I'm going to pursue a biopsy of the two problem nodes...my MO is of the opinion that they are indeed not pca but something else entirely....the psma scans are not absolute..there are plenty of sources tissues that will uptake the psma radiotracer.

Justfor_ profile image
Justfor_ in reply to

Ah. Since you are planning a biopsy that will probably be laparoscopic with the odds of missing the suspected LN, you can take it a step further. There is a γ-camera (probably two) that attach to the DaVinci system. If you take a PSMA injection before biopsy, it will direct the surgeon right to the suspected LN.

in reply to Justfor_

I'll bring this up tomorrow. I have an appt with the Urologist. He performed the DaVinci radical prostatectomy. If he can't do it, I'll ask for a referral.

Thank you..you've been very helpful.

Maybe in the near future, when I complete this Deep Learning course I currently take we can collaborate on a we application for calculating precise prediction for Casodex dosages.

Regardless. Thanks again.

Justfor_ profile image
Justfor_ in reply to

Thank You, I am looking forward to the Casodex de-mystification. For a Bicalutamide-naive person it responds as predicted. But, after longer use it acquires, sort of, "memory", like viscoelastic materials do.

Justfor_ profile image
Justfor_ in reply to

Check this video: youtube.com/watch?v=JdnY1VI...

entitled: "First in-human translation of a DROP-IN gamma probe"

I cannot speak to your situation, but wonder if seeking another opinion from an oncologist who specializes in prostate cancer might help.

Mark Scholz runs Prostate Oncology Specialists in Marina del Rey, California is someone I have consulted with on my issues. I know he deals with all forms of Prostate Cancer, from low grade to advanced.

Wishing you the best

in reply to Yearofthecow

Thanks for the response and I am in the process of getting 2nd and 3rd opinions from prostate oncologist.

Cheers

It does seem prudent to take action (as others already suggested). Best wishes with figuring out what is best for your situation.

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