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Metastasized Prostate Cancer

RocketsFan2018
Posts: 9
Joined: Aug 2018

My husband had prostatectomy surgery with 2 lymph nodes removed in October 2018.  The margins and frozen sections were clear and subsequent PSA tests are undetectable.  He recently went for routine eye exam and a lesion was noticed in eye, but he had no symptoms of any kind.  After MRI of brain, there were numerous areas of enhancement in brain.  Then an occular oncologist was called in and a team of doctors ordered many tests mainly to determine if this was from the original prostate cancer.  Bone scans were clear, and the thought was this was not from prostate.  His PSA was still undetectable.  After further tests (Ct scan, PET scan) areas of lesions were found in lymph nodes, liver and lung.  After biopsy of liver, there was evidence of prostate cells, and the diagnosis is large cell neuro-endocrine carcinoma.  Apparently the prostate cancer spread through the nerve system which is quite unusual.  Anyone out there with advice or know of cases like this?  We are in Houston so have a great team of oncologists.  I know the doctors will treat this aggressively, but this is a complicated case.   Appreciate any input, or support.

VascodaGama's picture
VascodaGama
Posts: 3033
Joined: Nov 2010

Rocket,

I am sorry for your husband's diagnosis. We know that there are about 25 types of prostate cancer but the large cell neuroendocrine PCa is probably the rarest among them. Large and small cell neuroendocrine carcinomas produce little or no PSA at all and they usually are found when in advanced status causing symptoms. Some of these systemic cancers respond to hormonal therapy but the recommended treatment is by using monoclonals. I would suggest you to discuss the matter with his physicians regarding such a possibility.

Monoclonal therapy uses the immune system to attack and kill cancer cells. The system works by using an antigen specific to certain cells. Their Cluster of Differentiation (CD) is identified and then targeted with an epitope. In prostate cancer the most common target is the PSMA which belongs to prostatic cells but some other targets are also used (such as; CD56, CD57 or Chromogranin A which is a protein released into the blood by neuroendocrine cells).

There are some clinical trials for patients like your husband. You can inquire with his doctors regarding the possibility in his participation in a trial. Please read this link;

https://clinicaltrials.gov/ct2/show/NCT00054574

Read the following links for more details on this type of treatment. You can also elaborate a List of Questions to the doctor for your next meeting. Take copies of these links to show them. You can also contact directly the people/institutions named in the articles for inquires;

https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/immunotherapy/types/monoclonal-antibodies

https://www.clinical-genitourinary-cancer.com/article/S1558-7673(14)00055-X/pdf

https://www.ncbi.nlm.nih.gov/pubmed/16723845

https://www.ncbi.nlm.nih.gov/pubmed/14571414

https://www.nature.com/articles/4500456.pdf?origin=ppub

http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-talking-with-doctor

This type of cancerous cells are aggressive and spread fast. You need to start something. I wonder if a monoclonal therapy prohibits any pre hormonal treatment. You should consult specialists before starting to administer some thing. Do not rush but be quick in getting a due plan of attack.

Best wishes and luck in your journey.

VGama

RocketsFan2018
Posts: 9
Joined: Aug 2018

Thank you for the resource links.  I will print them out and share at next visit.

Steve1961
Posts: 250
Joined: Dec 2017

I keep hearing that there are25 types but I can’t find that list anywhere at all do you have a link to the site showing different types and maybe explanations 

VascodaGama's picture
VascodaGama
Posts: 3033
Joined: Nov 2010

Hi Steve,

We have discussed on the various prostate cancer in this forum but the search engine doesn't get me anywhere to help you. I recall posting a link of the article on the subject describing in detail the variants. This was at the time when genomics were in full swing at researchers laboratories with a new PCa related gene coming out every day. I did read a lot on the matter including some of the laboratory study papers. You may try to find something here too. There ia a book on the matter titled VARIANTS OF PROSTATE CARCINOMA by Bahram Robert Oliai, M.D.

Below I post a link with some variants;

https://www.webpathology.com/case.asp?case=23

From Yananow you have this article too;

http://www.yananow.net/24Variants.pdf

This old article comments on aggressive variants;

https://www.medscape.com/viewarticle/748318

Best,

VGama

 

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