low psa with bone mets?

connsteele · New User Joined: 27 Jun 2008 Posts: 3 Location: Dayton, OH

This is my first post. Not sure I'm doing this right, but here it goes.

My husband had a psa of 2.8 when he was diagnosed five years ago with a Gleason 8. Had a RPP. Two years later, when psa went to 0.3, he had radiation to surgical bed. Since then his psa has creeped up so now it is 0.7. His urologist said once it doubles in a 6-month period, he would need hormone treatments, but he thought that could be years down the road. Well, five weeks ago, he started with severe back pain. Due to a history of back problems (arthritis, herniated and bulging disks, and last Dec. a fractured L-1 due to vehicle accident) we/family doc naturally assumed it was a spine problem. After spinal MRI showed no herniation, another pelvic MRI showed "increased uptake/activity" on right hip. Dx: pc mets.

In the meantime, after 2 1/2 weeks of severe pain that drugs only dulled, he started improving. And, get this: his psa went down to 0.6. Not dramatic of course, but encouraging. However, both radiation oncologist (ro) and family doc (fp) says for sure, this is pc mets. And the only option left is "quality of life" care. So, Jim had an IV injection of Quadramet, a "radio-pharmeceutical" drug that is palliative only, and targets area of the bone "with increased activity" like pc, and according to the ro can alleviate pain up to 4 months. The next day we had a bone scan which is suppose to show areas where the drug has targeted.
The radiation tech was great. He showed us the image and where hot spots were showing up. However, what he said caused us to pause: Apparently "hot spots" on a MRI/ bone scan look the same whether it's from arthritis, bone trauma, or cancer.
Sorry for going on so long about this, but the bottom line here is: How do they know for sure that what's showing up on the scans is pc mets? The docs refuse to consider that just maybe, what's showing up is something else. Could the hip hot spot be residual trauma from the accident? Maybe we're in denial here, but considering his low psa and dramatic improvement, it sure makes us wonder.

Anyone have a similar experience? Has anyone had a Quadramet treatment and how did you do?

thanks much,
from Ohio

Replicant · Moderator Joined: 01 Nov 2006 Posts: 219

I don't know the answer to your question about distinguishing bone mets from non-cancerous spots. If you don't get an answer here, I suggest posting it on Prostate Cancer Infolink: http://prostatecancerinfolink.net .

Good luck!
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

brainman · Posted: Sat Jul 05, 2008 5:15 pm Post subject: Re: low psa with bone mets?

connsteele, I am so sorry about your husband's cancer. I am not sure about your MRI question but I assume that if it was related to the accident, they would have seen it before. So, my hunch (and it is only a hunch) is that the doctors are correct.

I have heard about Quadramet before but this is the first time I have seen a post about it on this forum. It is very cutting edge stuff. But, yes, as you said, it is only used to improve the quality of live by helping to manage the pain. Did your husband's RO say if they can use it multiple times?

You and your husband are in my thoughts and prayers.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

johnw100 · Posted: Sat Jul 05, 2008 7:53 pm Post subject: Re: low psa with bone mets?

"How do they know for sure what's showing up on the scans is PC mets?"

I don't have a definitive answer to that, but would be asking myself the same questions that you are.
Since his Dec. accident had there been any other MRI for comparison ?

Your urologist previously mentioned hormone therapy: has this been discussed in more detail now that they see PC bone involvement ?

There's always the question on when hormone treatment should be started, but given the circumstances, I'd personally be investigating this option sooner rather than later.
For anyone who might need to consider this, I always suggest they read the publication by Dr Charles Myers, " Beating Prostate Cancer: Hormonal Therapy& Diet.

connsteele · New User Joined: 27 Jun 2008 Posts: 3 Location: Dayton, OH

An update on trying to get a definitive diagnosis of my husband’s back pain: The radiation oncologist says it’s definitely bone mets and because his low psa is so low (0.7), it’s highly aggressive and he has more or less has written him off. However, the urologist who did the surgery isn’t so quick to jump to that conclusion as the bone scan/pelvic MRI report says the areas of activity showing up are “suspicious” and “suggests” bone mets “in light” of the patients history of prostate cancer.

So, we decided to pursue more definitive answers and in doing an exhaustive internet search we came across something rather startling—and less dire—: sacral insufficiency fracture (SIF). Although this occurs primarily in elderly women with osteoporosis, someone who has had pelvic radiation (which my husband had) is also at risk. The symptoms fit him to a tee: sudden onset of intractable back pain that had a burning quality and radiated to groin and down the leg. And the pain intensified (if that was possible) and had a burning quality. The pain also intensified with movement and standing.
Plus, get this, this condition is often misdiagnosed as bone mets, especially in people who have had a history of cancer. Even our family doc said that a radiologist’s diagnosis can be “colored” by a patient’s medical history.

Our family doc is great and says if we want to pursue this by seeing an orthoped/neuro doc, that’s fine, but he warned us that in his 30 years of practice, he’s only seen one case. But the literature says that considering our aging population, more and more SIF cases are being diagnosed.

Well, this certainly has given us new hope, especially in light that the radiation doc has pretty much hung Jim out to dry (“nothing can be done”, “2 years at most”). We discovered the SIF literature after Jim received the Quadramet from him, which now might have been unnecessary. Personally, I think the rad doc had a financial incentive for pushing this treatment ($5,000 an injection). He seemed pretty proud that he’s the only one in this region that has the expertise to administer it.

Oh well, that’s water under the bridge. For now, we’re getting a referral to a bone/neuro doc, ‘cuz there’s no way I/we can accept “Dr. Doom’s” prognosis without first ruling this out.

This goes to show that ALWAYS request a copy of the radiologist’s report (not the generic letter from the lab/doc’s office) after a test. Without that, I wouldn’t have known where to start with an internet search on this.

Will keep you posted.
Thanks!

	Cancer Forums Forum Index -> Prostate Cancer Forum	All times are GMT - 5 Hours
Page 1 of 1

A website for discussions about any type of cancer, including lung cancer, breast cancer, mesothelioma, prostate cancer, laryngeal cancer, leukemia, lymphoma, multiple myeloma and others