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Was hoping not to be back for a long while
Well, was hoping not to be here but here we are. Long story, which I’ve laid out in prior posts asking questions, was that I was diagnosed with advanced PC in April-May 2025.
Scanned showed large tumor in prostate area, Tumors and lymph nodes in the area and also remote, and bone involvement in the area and in ribs and shoulder. In short, a lot of cancer.
5/8/2025 - PNB - up to grade group 4
Initial stage: stage IVB on PET imaging
5/8/25 PNB - GG4, 3, and 2; most cores involved
5/30/25 - PSMA-PET - pelvic nodes, spine, pelvic bones, L scapula, possible LNs in chest
Gleasons were 7 and 8
Started ADT (Nubeqa and Orgovyx) in June, 2025. Very good results. PSA went from 83 (3/25), 91 (4/25) and 138 (6/25) immediately down to 1.13, and lower ever since. Later chemo took it down to .04 range consistently . Started and successfully completed a six round regimen of doxytaxel from August 2025 through December 2026.
Tolerated all well.
Bone scan/CT scan/PET all clear in late January 2026. No detectable cancer. Like it had vanished. PET PSMA late March 2026 was likewise. Care team ( I am at a good cancer hospital in Chicago) was quite pleased as was I.
Blood work on July 9 was otherwise fine, but except PSA rise from .04 to .22. Testosterone was still technically suppressed but rising. 7/2025 at 18, 10/2025 at 17, 7/2026 at 22
Had follow up PET PSMA last week. Seeing oncologist tomorrow. All of the original cancer sites remain clean, which is great . However five new worrisome bone lesions showed up. They are:
"There are at least 5 new high intensity PSMA-positive bone lesions, which are follows:
- The largest lesion is in the left hemisacrum and correlates to a 1.6 cm sclerotic lesion (image 246)
- lesion in the T11 vertebral body (image 171).
- lesion in the left hemisacrum , which had only minimal PSMA uptake on prior PET (image 246).
- lesion in the anterior right fifth rib (image 164).
- lesion in the anterior left sixth rib (image 164).
Obviously this is not what I nor the the doctors were hoping for. New PSA and testosterone will be taken tomorrow which will also inform the future.
So it’s quite concerning to me, and I’m curious as to what tools will remain in the toolbox here, if any. Would appreciate anybody’s thoughts in advance of my appt tomorrow
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That’s a lot to digest. Let’s try it one bite at a time…..
Recent PSMA PET scan —> Regarding the 5 new worrisome bone lesions:
> is the lesion in the left hemisacrum a sclerotic lesion or is it active prostate cancer?
> what is the SUVmax of the lesion in the T11 vertebral body?
> what is the SUVmax of the lesion in the left hemisacrum?
> what is the SUVmax of the lesion in the anterior right fifth rib?
> what is the SUVmax of the lesion in the anterior left sixth rib?
> What is the SUVmax of your blood, liver, and parotid (or lacrimal) glands?
All of those SUVmax scores should be in the PSMA PET scan report.
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Hug
2 ReactionsWell... this just sucks. Sounds like were trudging down the same path except I just started chemo. Cycle 2 last week. Mets L5 down through the sacrum and right hip.
I don't see any mention of somatic or germline testing to possibly put you in place for some of the advanced stuff. Pluvicto perhaps? Or maybe they can zap some of the remote sites like the ribs and T11. (SBRT) Don't know if you've had RT to the prostate. If so, they may or may not be able to target the sacral area. I know in my case it's may not. I also was told that if Taxotere didn't work, Carbo/Jevtana was another option.
Wishing you the best possible outcome and keep us in the loop.
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2 Reactionswell dont jump yet !!! If the lesions are not too big, I am guessing radiation followed by short course of chemo. Your original sites are still clean (?) so that is a good thing. May not be too bad after dust settles..see what the docs say and go forward...I am betting it wont be too much of a set back !
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2 Reactions@xahnegrey40
Thanks for the reply. Original sites still clean gives some hope. I'll stay on the ledge, thanks to your support and that of others who have helped every time I posted here.
@mjp0512 Thanks for the reply. Never had RT to prostate, cancer was pretty well diffuse and large so we never got that. Am hopeful SBRT would be an option here. Will indeed keep you posted