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LUNG METS

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User

Posted 20 Sep 2021 at 19:59

Following a rapid PSA doubling time from 0.18 to 4.00 over the last 2 years, a bone scan showed no mets and a CT contrast scan showed none in the lymph nodes but 2 spots/nodules were found in my right lung, one 1.4cm, the other just under a 1.0cm. I was diagnosed with locally advanced prostate cancer in 2015. The oncologist is putting me back on hormone therapy to see if it shrinks the lung mets., so confirming it is from prostate cancer. I have never smoked and feel a primary lung cancer is highly unlikely. Today a PCuk nurse told me she had come across 1st mets being found in the lung, but it was not very common.

Has anyone else experienced this or heard of similar cases? My own theory is that there is probably micromets. in other areas of my body, but too small to be detected on my scans. I realise a PSMA Pet scan is more capable of detected micromets. I would be very grateful to hear people's comments.

Richard

User

Posted 21 Sep 2021 at 00:11

Hi Richard,

I have reposted this lecture more than once since you joined this forum but I think you must have missed it. However, as it is relevant to what you ask I will link to it again. I think what is said is still applicable other than the Choline pet scan referred to is/has been since bettered overall by some more advanced scans such as the 68 Gallium PSMA one for example. Very interesting lecture when you get by the introductory comments, https://www.youtube.com/watch?v=NkqizmvqJPo

Edited by member 21 Sep 2021 at 00:11 | Reason: to highlight link

Barry

User

Posted 21 Sep 2021 at 15:34

Thank you. Very interesting and points to a more advanced way of treating PC mets, beyond the scope of standard NHS treatment. Would still welcome anyone who is able to shed light on my post, regarding solitary lung mets.
Richard

User

Posted 21 Sep 2021 at 17:16

I can't remember offhand any case of mets in the lungs being reported on this forum but of all men with PCa, only a small proportion join us and we do know PCa mets can form in many places. Quite often mets are treated with radiation but this might be difficult in your case depending on their location and I believe the need to avoid radiating the heart. This might be a case where Proton Beam could be used so the dose would stop immediately before causing collateral damage. But this is just a thought and one you could mention to your oncologist. It may be that the spots of cancer are located where SBRT could be used. Re section of the affected lung may also be a possibility. You may feel that these possibilities are worth asking about before relying only on HT and various other systemic treatments.

NB. I was surprised that it was reported that Proton Beam would be used also to treat PCa at the new facility at UCLH, because I believed the limited time would be used to treat others cancers where the need was greater/more proven. I don't know whether UCLH have their Cyclotron operational yet but The Christie in Manchester has and could presumably treat in a similar way. There are also a few private facilities that can treat with Proton Beam. The worry is that however your cancer is treated it may still spread. You really need to discuss this with your Oncologist and perhaps get a second opinion based on your histology and scans. Maybe a biopsy might help establish aggressiveness and advantage of dealing with the mets radically as well as systemically.

Barry

User

Posted 21 Sep 2021 at 18:06

We have had a couple of members with mets in the lung but they also had other mets and were treated systemically rather than radically. Generally speaking, adenocarcinoma does not go to the lung (a recent research paper estimated about 1%) but there are many types of prostate cancer and a couple of these like soft organs such as the lung or brain more than others.

It may be worth asking whether your original biopsy / pathology samples were definitely pure adenocarcinoma or whether there were traces of small cell carcinoma, for example.

Fingers crossed for you that after a period of HT the suspect areas in the lung have not changed and it turns out to be something benign.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 21 Sep 2021 at 21:50

Thank you very much for this Barry. I will reflect on what you have shared.

User

Posted 21 Sep 2021 at 21:52

Thank you very much for this information Lyn. I will keep the forum informed how things go.

User

Posted 21 Sep 2021 at 22:13

Re my original posting and the fast PSA doubling times from Sept 2019 - 0.18 to 4.0 in Aug 2021 this would indicate active prostate cancer cells. My query is, is it possible micromets could be in bones for example but not picked up in the standard nuclear medicine bone scan, but might be visible on a PSMA Pet scan?

User

Posted 21 Sep 2021 at 22:46

I don't really understand your question Ricky.

Your doubling time is 5.5 months, which isn't great but not too bad. It definitely indicates active cancer.

Yes it is possible for micromets not to be picked up in a bone scan. A PSMA scan might pick them up but it might not. The point is that it doesn't really make any difference if you do have mets elsewhere that haven't been picked up in your bone scan or CT - you would still need the same systemic treatment.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 21 Sep 2021 at 23:18

Hi Richard
I have read your post with interest as my husband ‘s cancer has returned after a 5 year remission. His PSA trebled suddenly over the last 12 months and ended up at 5. He had the usual pelvic and bone scans which showed nothing and his oncologist was mystified and wanted to watch and see what happened. We were not happy with this so he relented and a CT body scan was done which revealed a lung nodule. He was referred to a lung oncologist who performed an EBUS and confirmed the nodule was malignant but not a primary lung cancer.

My husband then went on to have a PSMA scan at UCLH as the uro oncologist and lung oncologist could not agree at MDT. The PSMA scan clearly showed a lung nodule on the left and a couple of smaller nodules on the right lung which are prostate cancer. The rest of his body is clear. His uro oncologist had never seen this presentation in his career asit is rare. His uro oncologist was amazed that my husband has no cancer in the lower half of his body at all. He starts chemo on Friday along with the Prostap that he has already had. The oncologist has said he can only treat him with the information from case studies of normal metastatic progression. My husband does not have any symptoms other than the rising PSA which has now dropped to 0.47 due to the Prostap.

I don’t know if this information is of any help to you but just to let you know you’re not alone in this presentation and hopefully it has not spread anywhere else.

Loyell

User

Posted 22 Sep 2021 at 20:12

Hi Loyell
That is very interesting and sounds very similar to my own case. My CT scan with contrast was for the chest, abdomen and pelvis. I am starting on hormone therapy at the end of this week and my oncologist's view is that if this shrinks the nodules this would confirm that they are prostate cancer lung mets. In that case he will start me on chemotherapy or enzalutamide. We will discuss which one to choose if the need arises. My oncologist did not want to put me through the lung biopsy if it could be avoided.
I have a CT scan, not with contrast, arranged for November 17th, so the picture will then become clearer. Than you again for sharing about your husband.
Richard

User

Posted 22 Sep 2021 at 20:22

Thank you Lyn. Just to give you a bit more detail on my PSA doubling. My nadir was 0.18 in Sept.2019, rose to 0.37 in Sept.2020 (doubling time of 12 months).

It rose to 1.1 in March 2021 (doubling time of 4 months)

It rose to 3.0 in June 2021 (doubling time of 5 weeks)

It rose to 4.0 in August 2021 (so doubling slowed to 6 months)

Any thoughts on why this might be Lyn? Thank you. Richard

User

Posted 22 Sep 2021 at 20:41

Sounds like my husband his CT scan in July showed lung, liver, bone and some lymph mets. He started hormone therapy in August tablets now injections first monthly now 3 monthly as his psa has gone down. He had a turp a couple of weeks ago and is starting 6 cycles of chemo docetaxel on 30th. Have to say the East Kent hospitals especially the Canterbury hospital have been really quick starting treatment and face to face appointments. With all the bad press of delayed results, treatments etc we have not experienced any thank God. It's scary and side effects are numerous, but hopefully in 20 weeks we will be in a better place and the oncologist has said we do have a future and the tablets, the other option which he didn't advise as Sid is apart from the Cancer very fit for his age are always a backup if it becomes active again.

User

Posted 23 Sep 2021 at 15:00

Hi Loyell. It would be interesting to know were the lung mets on the CT scan and also on the PSMA Pet scan found before your husband started his latest round of Prostap hormone therapy? In theory and no doubt in practical terms hormone therapy would start to shrink the lung nodules, so they would then become less easily visible on scans. Richard

User

Posted 26 Sep 2021 at 16:46

In the winter of 2019, I had the worst cough and chest infection of my life. GP sent me for lung xray. Called me next day - something suspicious seen and prostate cancer metastases could not be ruled out. I told GP my PSA was <0.006 and that PCa usually spread to bones. He stated he was treating a few men with PCa mets in their lungs. To cut a long story short, 2 week cancer pathway and scans. Turned out the suspicious area was the shadow of my nipple. But they were worried it was PCa.

As an aside, 5 years ago in October 16 i was diagnosed. Doing well but waiting for penile implant surgery and currently being investigated for bowel incontinence. But all is looking good PCa wise.

User

Posted 26 Sep 2021 at 20:56

Thank you. My PSA has doubled rather quickly over the last 2 years and risen from 0.18 to 4.0 so I think my situation is rather different to yours. Richard

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