Prostate Cancer,Psa Low,-Why Is This Cea High

hi folks, i'm 75.severe backpain led to hospitilisation,discovery of enlarged prostate,with mri/niclear scans indicating malignant lesions on spine vertibrae,followed by prostate and hip bone (ileum) biopsies which confirmed prostate cancer metastised to bone. psa below 3.o. cea 10.. gleason 3 plus 4.all this in feb 2008.my oncologist assumed it to be a prostate primary. performed an orchidectomy. psa fell to below .3 in a week. backpain reduced by 60 %. doctor put me on a tab, once a day-bicalutamide 50 mg. he sent me home. said review after a month.

my backache increased. the oncologist had my prostate and hip bone biopsy material compared by pathology lab. they said the two malignant species were different!!! threw us all into some shock. pathology said, look for primary in the lungs. cea was seen to be 100 and psa below 0.2.

lungs were ct screened twice and cleared of adverse pathology.to be on the safe side,we had a colonoscopy done, also twice, and the colon and rectum were cleared. the oncologist said," well, its one of those cancer dilemnas, we are not going on a fishing expedition any more" he had me go through 6 cycles of chemotherapy, once in 21 days with carboplatin, docetaxcel, and zolodronic acid , a mixture, by i.v.

cea came down to 8 for 2 readings two weeks apart, then 7 and then 9. my oncologist then put me on bone strengthening i.v. zolodronic acid. once a mont for 6 months . i am now on this course.

HERE'S MY CONCERN after the first bone treat cyclein august this year, the cea showed 17, up from the 8-9 which was present at the end of the chemo. the doc had me go thro an mri which said no change in status as compared to previous report, no additional cancer growth, some healing has commenced. thereafter i  had the second bone treatment cycle in september, last month, and had my cea and psa checked a week ago. cea has GONE UP TO 31, and psa is below 0.2. again, doc says "we'll look for physical symptoms, that is an increase in your backache. if that happens we'll do an mri/ct as needed to see if cancer is progressing again. inthat event alon, i will put you thru a secon chemo cycle. but i think you will come out of this without another chemo."

anyone out there with anything similar that happened, or at least the psa staying low and the cea going up? i believe the cea is specific to rectal and colon cancers mostly.

am i having to deal with  two cancers-one at the prostate that's taken care of, and another which is there side by side, causing the cea to go up? i will be grateful for views that may help me to understand where i am ?thanks

Your doctor concentrated so much on the Prostate he ignored the chance of a second primary. (synchronous primary)  An Adenocarcinoma of some sort which could originate from different cancer sites.  Sometimes the starting point is so small you cannnot find it.  Did you Have a PET scan done?? You should as this will give more information than CT or MRI alone.

Finding a primary is important in that it can guide future chemo therapy in some instances.

You should have radiation treatments to "problem" areas of bone that are involved.  Not wait for sxs in this case.   Zometa is appropriat for lytic bone lesions and DOES NOT TREAT THE CANCER.  Just slows resorption of bone.  It is being overused by Med Oncs and the government is about to come down on it like the overuse of epogen , neupogen etc. (I have seen it used for single mets (without the addition of radiation and blastic metastasis , once again without irradiation.  It is given high dose and is not an innocuous medication)

Overall the initial response to therapy was good, however, the bad part is that many cancers that respond quickly, also recur quickly.

Get the Pet, Have special studies or stains done on the path to try to lock down the source.

Second line chemo will not be as effective.  I would go back to the original drugs and see if they give a second response, which is possible and as above I would address the local areas as well ie. avoid pain and Path fractures.

On 10/14/2007 Witchdoctor wrote:

Your doctor concentrated so much on the Prostate he ignored the chance of a second primary. (synchronous primary)  An Adenocarcinoma of some sort which could originate from different cancer sites.  Sometimes the starting point is so small you cannnot find it.  Did you Have a PET scan done?? You should as this will give more information than CT or MRI alone.

Finding a primary is important in that it can guide future chemo therapy in some instances.

You should have radiation treatments to "problem" areas of bone that are involved.  Not wait for sxs in this case.   Zometa is appropriat for lytic bone lesions and DOES NOT TREAT THE CANCER.  Just slows resorption of bone.  It is being overused by Med Oncs and the government is about to come down on it like the overuse of epogen , neupogen etc. (I have seen it used for single mets (without the addition of radiation and blastic metastasis , once again without irradiation.  It is given high dose and is not an innocuous medication)

Overall the initial response to therapy was good, however, the bad part is that many cancers that respond quickly, also recur quickly.

Get the Pet, Have special studies or stains done on the path to try to lock down the source.

Second line chemo will not be as effective.  I would go back to the original drugs and see if they give a second response, which is possible and as above I would address the local areas as well ie. avoid pain and Path fractures.

 

dear witchdoctor, thanks for your apparently well studied responseto my questions.

okay, in the family, and a second opinion ,there was a strong feeling that the doc missed out on some small lurking primary source. so to satisfy this question, my doc had me go through ct scrrening/scan, an additional mri, and a colonoscopy, all TWICE, because there wre reservations expressed over the first tests. my family felt they were done too quickly. these tests covered the lungs, colon/rectal areas ( because of the cea rise) as the most probable sites that could be affected.the onclogist ,gastroenterologist and the  radiologist worked closely together in this instance and came out with their opinion and decision that there was no primary in these locations.they also took note of the pathologist's remarks to "look for primary in the lungs."  the chemotherapy mix of medication was made to take care of cancer in the lungs/breast,urito tract/testicular area and the metastised cancer,YES, ASSUMING IT WAS FROM THE PROSTRATE.

perhaps, there is a very small lurking zone of infection that missed out in detection, but the docs discussed the very same points you have raised, to say that this kind of cea increase is not unusual in quite a few instances  and has created confusion and uncertainty in the process of arriving at a conclusion.

i am going to raise questions on the lines of your response, for which i am very grateful, with my oncologist. on zoldonat, he has told me it does not attack the cancer cells but carries out a process that enables the bone to fill up with neccessary calcium compounds needed to build corroded areas.

the other important scan to be done is th PET, which you have suggested, wehave discussed this. doc says we'll wait for a couple of weeks, get another cea and  assess my level of pain (increase/decrease) and go on to the PET. i have to be prepared for another set of chemotherapy cycles. ofcourse, i would like to avoid this terrible experience if it is possible!! but i will have it done if that's the only way!!

please accept my grateful thanks once again for your thoughtful , valuable comments

On 10/14/2007 Witchdoctor wrote:

Your doctor concentrated so much on the Prostate he ignored the chance of a second primary. (synchronous primary)  An Adenocarcinoma of some sort which could originate from different cancer sites.  Sometimes the starting point is so small you cannnot find it.  Did you Have a PET scan done?? You should as this will give more information than CT or MRI alone.

Finding a primary is important in that it can guide future chemo therapy in some instances.

You should have radiation treatments to "problem" areas of bone that are involved.  Not wait for sxs in this case.   Zometa is appropriat for lytic bone lesions and DOES NOT TREAT THE CANCER.  Just slows resorption of bone.  It is being overused by Med Oncs and the government is about to come down on it like the overuse of epogen , neupogen etc. (I have seen it used for single mets (without the addition of radiation and blastic metastasis , once again without irradiation.  It is given high dose and is not an innocuous medication)

Overall the initial response to therapy was good, however, the bad part is that many cancers that respond quickly, also recur quickly.

Get the Pet, Have special studies or stains done on the path to try to lock down the source.

Second line chemo will not be as effective.  I would go back to the original drugs and see if they give a second response, which is possible and as above I would address the local areas as well ie. avoid pain and Path fractures.

 

dear witch doctor, today i sent you a message on my post PET STATUS  using the message of another patient or message sender/linda.

i am sorry, i should have used this channell to communicate to you.

your comments were so important, i told my doc, a fine oncologist, and a better human being. he takes care to listen to his patients suggestions.

he got me thru a PET scan. you can read the comments i made in the other message i sent you.

i did not answer the question you raised ., namely, that the possibility of another primary may be the reason behind the cea rising after the chemo when it had fallen from 100 to 7 and went to 55 now.

the PET people were specifically told of your questio/doubt. so they did take care to view the screening/film and give their report.they discussed this orally with my oncologist. and he with his team. their conclusion: the primary is  still the prostate.the cea could be a biochemical reaction reflection on which they will keep a bi weekly analysis watch.the metasis is steady in intensity and spread areas for the last 4 months.PET says no malignant spots seen below the diaphragm in the abdomenal region.not in the neck and head. if there is anothe primary, they have not detected it.

any other options/possibilities. grateful for your views.