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Rapidly increasing bone mets

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Posted 8/6/2014 12:45 PM (GMT -5)
Has anyone dealt with rapidly increasing bone mets even though the PSA is dropping? My husband just had his 2nd lupron shot and his PSA has dropped from 1200 to 8. He had a new round of scans this week and we are just getting the prelimary results in but it appears that the bone mets have spread significantly and into areas where they were not before.

"MUSCULOSKELETAL:
There is extensive osseous metastatic disease throughout the spine, ribs, clavicles, scapula, humeri, sternum, pelvis, and femurs. The degree of metastatic disease has significantly progressed since the prior with multiple new and enlarging lesions. Pathologic compression fracture of T12 has mildly progressed as compared to prior now with 50% vertebral body height loss centrally."

Is PSA no longer a reliable indicator of disease progression? Any thoughts on what is next? Our appointment is next Tuesday to go over all the results as he had an MRI, CT and Bone Scan all done this week, but obviously we are concerned.

Thank you for your input!
Barb
Husband dx 3/28/14
age 45
PSA 1200
mets to many areas including spine, lungs and lymph nodes.
Posted 8/6/2014 1:07 PM (GMT -5)
Terrible news - I'm sorry to hear it. His PSA has dropped considerably, but is not undetectable. That can mean that at least some of the mets have become castrate resistant. Some kinds of PC just put out less PSA than others. As the hormone-sensitive ones are controlled, the other ones may come to predominate.

I guess he won't be able to get Xofigo until his PSA actually rises, although spot radiation is a possibility. He may also be able to get Xgeva to help prevent spinal compression, fractures, etc.

Has he had chemo (docetaxel) yet? If not, his symptoms seem to warrant it. Perhaps you can discuss this with his oncologist. Also let your oncologist know if you are interested in clinical trials.

- Allen
Posted 8/6/2014 1:19 PM (GMT -5)
Thank you Allen, I appreciate your quick response. We have not done docetaxel yet. That was one of the reasons we were redoing the scans. We were told if the mets in his lungs got worse, we needed to do it. Funny thing is the lung mets actually look better, but everything else, not so much. At this point, we just have some prelim info that happened to be on the ct scan disc we received after the scan. Guess we will have to wait until next week for more detailed info.
Posted 8/6/2014 1:50 PM (GMT -5)
The latest learning about docetaxel is that it has the greatest survival benefit when there are multiple mets and before castrate resistance sets in. It is incredibly underutilized, perhaps owing to mistaken overestimation of its toxicity, and that it is a "last ditch" drug to try. Both are incorrect notions probably due to baggage from experiences with chemo from other cancers.

- Allen
Posted 8/6/2014 1:58 PM (GMT -5)
Our primary oncologist was steering us that direction and then we had 2 other oncologists tell us not to do it. We had an appt with the head MOPC at Emory 2 weeks ago and he was also not quick to jump on the chemo bandwagon. His thought process was if you add it in early, it may not be effective down the road when we really need it. He still views it as a last ditch drug. He was the one suggesting more testing before proceeding. I wish there were some straight forward answers. Everyone has a different opinion and it is never easy to know which is the right thing to do.:(
Posted 8/6/2014 2:32 PM (GMT -5)
Here's a write-up on the CHAARTED study, FYI:
NIH-funded study shows increased survival in men with metastatic prostate cancer who receive chemotherapy when starting hormone therapy

You can listen to a webinar by one of the study authors about it here:
advancedpcatalk.freeforums.net/thread/133/chaarted-webinar-available-viewing

It seems to me that there is no evidence that saving it for a last ditch strategy is better at extending survival or quality of life compared to using it earlier. When docetaxel is saved until after castrate-resistance sets in, it is effective in 45-50% of men, and the survival benefit is about 2-3 months. Resistance occurs within 3 years. In contrast, men with multiple mets when treated at the start of hormone therapy had a median survival increase of 17 months. There's also a benefit in quality of life towards treating while he is healthier.

If Taxotere should eventually fail, Jevtana was approved a couple of years ago and can be used. In fact, getting a good initial response to Taxotere is a good sign that Jevtana will work well after Taxotere fails.

- Allen
Posted 8/6/2014 4:10 PM (GMT -5)
It might be good to visit the AZ molecular Imaging center in Phoenix (Dr Fabio Almeida is great) or Sand Lake in Orlando to have an F-18 high powered bone scan which is less subjective than the standard bone scintigram. These are widely available and may even be available at Emory.

LupronJim
Posted 8/6/2014 7:30 PM (GMT -5)
Docs also should be using the urine testing for bone breakdown (they are sensitive testings) like the UnTx that indicate if you are out of normal range (and high), you can expect mets happening, also useful is the Alkaline Phostaphase test and other markers mentioned in Dr. Strum's book etc.

Aggressive PCa versions (morphed into later sometimes), don't give off much PSA to measure, so yes the PSA test in these situations is kind of worthless, thus the other marker tests and scannings are used to see what is actually happening. Hope is possible, other drugs might make a difference, get busy looking into options, maybe.
Posted 8/6/2014 7:30 PM (GMT -5)
I take it you are in the Atlanta area, as am I. If you want to get together, please let me know.
Posted 8/6/2014 7:41 PM (GMT -5)
Thanks! Kristi mentioned you to me when I talked to her just before the craziness with Paul happened. Hopefully we can all meet up soon.
Posted 8/6/2014 11:15 PM (GMT -5)
Barb,
Sorry to read of this news with your husband. I'm glad, though, that you have joined the HW community.
As always, you both are in my thoughts.

Lisa
Posted 8/7/2014 4:49 AM (GMT -5)
Thank you, Tall Allen, for your posting. Let me just cite what Pat Walsh has to say about early chemotherapy:

"Such is the transformation of chemotherapy for prostate cancer in recent years. It used to be that chemotherapy was the "Hail Mary pass" given to men of poor performance status - men who were in pain, often debilitated, who had lost weight and were too weak to tolerate strong doses of anything. Chemotherapy really wasn'nt given a fair shot - and we do not know for sure that in other, less down-beaten patients, it might not have worked better. But today, energized by scintists such as Mario Eisenberger - unsinkable, creative, stubborn, and above all confifdent that they can find the winning formulas -the field has undergone nothing less than a revolution"

"open at first sign of trouble. Strike early, strike hard, and set your sights on victory"

Patrick Walsh, Guide to Surviving Prostate Cancer", page 503.

Reinardo

 

Posted 8/12/2014 9:18 AM (GMT -5)
Hi all,

Thought I would post a quick update after John's doctor appt this morning. The think that the "spread" seen on the scan is actually scarring of the bone where the cancer cells have died off, not new growth. Psa has dropped from 8 to 5 and the visceral Mets have greatly diminished, so all in all great news.
Posted 8/12/2014 9:50 AM (GMT -5)
Great news!
Posted 8/12/2014 9:54 AM (GMT -5)
Yay! That's wonderful to hear Barb. You must be relieved.

Lisa
Posted 8/12/2014 3:45 PM (GMT -5)
Great news. I know you both are very happy. You both are in my thoughts and prayers.

Have a great day.

Dave in Bartlett, TN
Posted 8/12/2014 4:35 PM (GMT -5)
Awesome news!  We are in the camp of throwing everything at the cancer early to slay the SOB!
Of course we are on year 7 but still throwing everything we can get our hands on.
Stay positive!
Posted 8/12/2014 11:41 PM (GMT -5)
Great news. Great news.
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