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Posted 11/17/2016 9:47 AM (GMT -5)
Hi All,


We are do to see Onc in a week, but I am doing my research, and hoping for clarification before we go.
We just received the results of my husbands latest Bone scan. He is on HT and has a Psa currently of 0.5. The latest bone scan states Focal site of increased tracer localization in the lower sternum, increased focal sclerotic density compatible w/ metastatic disease. It is little changed in intensity since prior scan 6 months ago before restarting HT. ( In that report it was not referred to as compatible to Metastatic disease).
This spot has been there for 2 years on all the bone scans.
At what point is it determined to be metastatic, and is this now classified as castrate resistant.

I know the Bone scan is not the most reliable for detection of mets , buts that's what is available for us at the time. I did try and get into a trial for the f-18 scan, but since he was on HT , they did not want him

He was about to go off the HT intermit, but I am afraid that is unlikely now.
What options are we going to be looking at. Zytiga, Xtandi, xofigo ? Spot Radiation.

The CT scan report , originally stated no evidence of metastatic disease, but then adds an addendum taking into account the finding on the bone scan.
So I am confused.

I know that the Dr. will guide us, but any help would be greatly appreciated,
Thanks
Posted 11/18/2016 2:50 PM (GMT -5)
As you say, the bone scan can only suggest mets. But because the sclerotic density has increased it is suspicious. I'm guessing that because it is "focal" it may not have showed up on the CT. Because his PSA has risen to 0.5 while on HT, there is some castration resistance setting in. His MO may want to start him on second-line hormonals (Xtandi or Zytiga). He probably will not do anything about the focal met on his sternum because it is not load bearing. In one respect he may be better off not confirming the met with a biopsy because he gets access to second-line drugs that he could not otherwise qualify for unless he has a diagnosis as metastatic.
Posted 11/19/2016 6:02 AM (GMT -5)
Thank you Tallallen for your reply.
His PSA has not risen it has continued to go down since he started his 2nd round of HT in May . We were hoping for <0.1 at the next test. What concerns me is the increased activity while his PSA continues to go down. How does alkaline phosphate levers factor in. They are within normal limits. You think it's better to be classified as metastatic then not. I do understand the adding of 2nd line drugs thought. But I think my husband was looking forwards to the HT break.
As always thanks for all your help.
Posted 11/19/2016 2:04 PM (GMT -5)
Well then if his PSA is going down since re-starting HT, he is not castration-resistant. Sorry, I was confused by your statement that his PSA is 0.5 and the last PSA you mentioned in the signature was <0.1.

So the bone scan was taken when his PSA was higher during a vacation? Of course any mets will be more active when HT is off than when it is on. That's what HT is supposed to do. I guess I'm not understanding. It makes no difference, then, to any therapy decision in further investigating the spot on the sternum. You already know it is systemic.

I also don't understand why you're saying he can't continue on intermittent HT - who told you that?
Posted 11/19/2016 11:31 PM (GMT -5)
I'm sorry I wasn't clear. He is on his 2nd round of intermittent HT. He has been on zolodez for 8 months. His PSA continues to go down . Latest reading 0.5. The Mo has him have a CT And Bone scan before he stops the HT for a break. So this bone scan is the one that has the inc in focal intensity, ( he is still on HT and no rise in PSA )we spoke w the MO today, and are scheduling an MRI.
I thought that if mets develope, you had to stay on HT. I am happy to be wrong.
It's all the waiting , uncertainty,and fear that can take its toll.

My heart goes out to all you guys fighting this.
Have a Happy Thankgiving
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