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Reoccurence after HDR Brachytherapy and MDS

cchqnetman's picture
cchqnetman
Posts: 119
Joined: Sep 2012

 

I was treated for PC in Feb and March of 2013 with High Dose Rate Brachytherapy (HDR).  In October of 2014 I was diagnosed with Myelodysplastic Syndromes (MDS).  I was treated for that with a stem cell transplant.  Since then my platelets have taken a nose dive (I receive platelets every week) and my PSA has steadily increased.  It is up to 20 now.  My nadir was 0.9.  Any ideas????

 

 

 

David

 

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

David,

You got replies to your query in a previous thread. Most probably you will require a salvage treatment that includes additional radiation. To such extent you need to get the advice from a radiologist at the facilities where you did HDR. They have the information regarding the radiation field administered in 2013. Your previous thread is here;
https://csn.cancer.org/node/307425

I recall your discussion in regards to the value of the quality of living, when in desperation. Surely you are confronting again a difficult moment  with both diseases involved, but you should try to overcome the situation. Get second opinions on the issue from a medical oncologist too.

https://csn.cancer.org/node/248299

Best wishes and luck in your journey.

VGama

cchqnetman's picture
cchqnetman
Posts: 119
Joined: Sep 2012

VGama,

Sorry for the double post.  One thing the radiation and chemo have done is affect my memory.  I had forgotten about the prvious post.  My applogies.  I have been to my urologist at the VA and he confirmed my Prostate Cancer is back.  He is going to schedule a PET scan to see the extenet to which it has spread.  The only treatmeent he mentioned was Androgen  Deprivation Therapy (ADT).

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Sorry to hear about your apparent recurrence of PCa and the complications of MDS.  Recurrence following any form of radiation is rarely reported on this forum but that is of no help to you.

I note that you are getting a PET scan.  You don't say but I hope it is a C-11 PET scan that will target the presence of choline which is a marker for cancer.

If the cancer has not escaped the prostate capsule, I would recommend inquiring about Cyberknife radiation as the followup treatment.  Standard IMRT should be fine but CK is much more precise and should be better able to target the remaining cancer.

Good luck!!!

 

cchqnetman's picture
cchqnetman
Posts: 119
Joined: Sep 2012

 

The PET Scan didn't yesterday as planned. The person who scheduled the test wasn't supposed to be scheduling this type of PET Scan. She scheduled the wrong test (this is a very specific test for prostate cancer) on the wrong day (they only do this test on Tuesday and Thursday) for the wrong person (she had pulled up the records for another person with the same last name as me).

 

The PET Scan will use: 

Axumin™ (fluciclovineF 18) injection is indicated for positron emission tomography (PET) imaging in men with suspected prostate cancer recurrence based on elevated blood prostate specific antigen (PSA) levels following prior treatment.

cchqnetman's picture
cchqnetman
Posts: 119
Joined: Sep 2012

I don't see my urologist until later this month but I got the scan on a CD and the report.  The report says:

 

 

Findings:

There is activity in the right lateral aspect of the prostate gland. There are small inguinal nodes with mild uptake.  There is uptake in the left iliac bone without corresponding loosening or sclerotic lesion.   

There is uptake in a right cervical lymph node and in the right piriform sinus. 

Nondiagnostic CT images show: There are changes of prior right craniotomy. There is no evidence of acute intracranial abnormality. Punctate air is a small punctate sclerotic lesion in the left iliac bone (image 267 of series 2) which has the appearance of a bone island. There are similar lesions in the right iliac bone along the SI joint (image 257 of series 2).

There are degenerative changes in the lumbosacral spine.

Impression:

Activity in the right lateral aspect of the prostate gland, likely corresponding to primary site of disease. Small inguinal nodes with the uptake and uptake in the left iliac bone without corresponding lucent or sclerotic lesions are nonspecific.

Uptake in the right piriform sinus and in the right cervical lymph node. ENT evaluation is recommended as Axumin uptake can be seen in cancers other than prostate.

 

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

David,

According to the PET report, they found evidence of lesions/uptakes in the prostate (lateral) and close lymph nodes including the bone at the iliac. This is the area typically involved in RT salvage approaches. However, the PET results also indicate unusual uptakes at the neck (cervical lymph node) which place should get additional check to confirm if such is metastasized PCa (probably a biopsy of local lesion is the best to do).
I read guys reporting about metastases in the upper body, at the pit lymph nodes, which seems to be the typical route taken by the bandit before it invades the lungs. The radiologist comments that other type of cancers are a possibility as Axumin is not specific to prostate cancer, but it also does not confirm that those lesions are cancerous. You need to investigate because if PCa is detected that far then you have a systemic case that should be treated accordingly. Salvage therapy would not be enough. You may need chemotherapy or a combination of chemo plus hormonal.

I recommend you to get a second opinion from an oncologist before advancing with a protocol. ADT alone is palliative and may provide some control but when the cancer invades other organs the patient status deteriorates rapidly.

Best wishes,

VG 

cchqnetman's picture
cchqnetman
Posts: 119
Joined: Sep 2012

Thanks for the input, VG.

I see my urologist the last week of July.  I have other problems with my MDS (declining blood counts) and I was also hospitalized for a week and a half for a bleeding ulcer.  They took a third of my stomach.

 

Thanks again for the input!

 

David

 

cchqnetman's picture
cchqnetman
Posts: 119
Joined: Sep 2012

My PSA dropped to  7.4 (from a high of 20) last Friday).

I saw a ENT Doctor and a Urologist.  The ENT doc said there was no cancer in the piriform sinus or the cervical nodes.  The Urologiost revised the diagnosis to prostate cancer that is "contained in the prostsate".  I am going back in 3 mo9nths to have my PSA retested.

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

No cancer at the cervical nodes and the diagnosis of the urologist (contained in the prostate) are great news. I wonder what could have caused the Myelodysplastic Syndrome, in first place.

I do not know much about MDS and never heard that PCa survivors have get it as a treatment side effect but some possibilities exist. In any case, HDR is a localized treatment so that it may not be related. However, the chemotherapy (you refer above) could affect stem cell's DNA, impairing these and making them to multiply with damaged/abnormal DNA, therefore turning the newer ones into immature blood cells.

Have your doctor say anything regarding the spike of the PSA from 8.07 in January to 20.0 in June? Was it a cause of the stem cell transplant?

The last PSA of 7.4 (July) is similar to the level found last January but still higher than the PSA of 2.44 of February 2016. My first thought was that you were experiencing a case of bounce PSA, which is typical in RT guys with the gland in place. The experience can take years with a PSA increasing and decreasing in a bounce mood till it goes down to a real nadir. However, this is your fourth year since RT so that recurrence seems to be apparent.

I wonder what salvage treatment has been suggested by the urologist. Your case with MDS may be influential in the choice, in particular for any additional chemotherapy. I recommend you to get the opinion of a hematologist before advancing with a salvage therapy.

Best wishes,

VG

cchqnetman's picture
cchqnetman
Posts: 119
Joined: Sep 2012

VG,

I think the major reason the diagnosis was changed was the drop in PSA, the clean bill of health in the piriform sinus and cervical nodes, and the change in doctors.  The doc and I talked about "bounce" but ruled that out since I already had one bounce and the amount of time since I was treated (Feb/Mar 2013).  I don't think I am going to do anything as far as salvage therapy at the point.

 

Thanks again for the comments

 

Data

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