Xofigo may be a silver bullet yet

After all these years, there is suddenly REAL HOPE for long-term optimism. (Please review the February 9, 2014, post below to set the background for this post.)

We did complete the six Xofigo infusions in mid-February and went back on Leukine injections a month later. The next step would be a PET/CT to look for skeletal lesions.

The PET/CT scan was finally performed last Friday, May 9th; we visited with the chief yesterday. Apparently, the radiologist’s report contained largely good news, and also an area of uncertainty. (Heidi and I haven’t seen it yet.) Because the radiologist observed a “lesion of uncertain cause infiltrating my bone marrow”, the chief has written a test order for another PET/CT scan – this time using the glucose analogue FDG. He is looking for cancers (often called small cell cancers) with an affinity for glucose. If these are found in this second scan, another bone marrow biopsy is tentalively planned to sample those tumors and send them off for genetic analysis. I sensed that this is a lesser concern. The followup procedures are necessary, however, to complete the assessment.

So, why am I writing this when it seems we’re up to our ears in yet another program of diagnostics? Yesterday, for the very first time, the chief used the word “remission” to characterize my cancer status. While Heidi admits she is “cautiously optimistic”, I have let myself become simply ecstatic!! He also speculated about a transition to a remission maintenance program. Wouldn’t that be a welcome change?

We earnestly hope he is on target. He isn’t known to “jump the gun”. We are moving quickly to complete all the procedures by, or soon after, the end of May. Please stay tuned.

Is Xofigo my silver bullet?

Biopsy to restage the cancer
This biopsy was performed at Martha Jefferson Hospital in Charlottesville last December 5th. It seemed to have been a success because we were later told that the representatives from both Caris DX and FoundationOne were confident about the value of the material they carried away for analysis.
Oops!…. or ……woo-hoo!! – Xofigo is a silver bullet?
So, you can imagine our surprise, just before Christmas, when the chief texted that Caris Dx had reported finding no viable cancer in the tumor cells their lab had analyzed! It seems unlikely that the Xofigo could so quickly have destroyed all the cancer in that particular part of my skeleton.

Bob and Heidi at the Fish Market Restaurant in Palo Alto, January 2014

Bob and Heidi at the Fish Market Restaurant in Palo Alto, January 2014

And, we still know nothing further at this point. In spite of this uncertainty, the blood test numbers are still looking encouraging. (See chart in the post under Recent Progress.)

In the near future
I will receive my sixth (and final) Xofigo infusion here in northern California next Thursday. After that I anticipate the chief will put me back on Leukine injections. This is the “immune system booster” that was a mainstay of my second-line hormonal therapy in 2009. As usual, we’ll wait and see what happens next.

Where is the Cancer Now?

This update relies heavily on the discussion in the previous Recent Progress post (November 23, 2013), especially in regard to the bone marrow samples being taken to restage the cancer.
Biopsy to restage the cancer
This biopsy was also performed at Martha Jefferson Hospital in Charlottesville. It was, in fact, the same “Interventional radiology” team that performed the November 2010 biopsy. This time, however, they used the CT scanner to pinpoint the sampling locations. I felt myself rolling in and out of the CT scanner during the one hour procedure; but, that’s all I felt. As noted in the November 23rd post, samples were taken for both Caris Dx and FoundationOne. I was later told that the reps from both those organizations were confident about the value of the material they carried away for analysis.
Oops!…. or ……woo-hoo!! – Xofigo is a silver bullet?
So, you can imagine our surprise, just before Christmas, when the chief texted that Caris Dx had reported finding no viable cancer in the tumor cells their lab had analyzed! We surmised two possibilities. First, something had gone wrong with the biopsy or the transport to the lab, and the samples were “dead on arrival” there, or, second, the Xofigo had been so quickly effective that, just two days after the fourth infusion, all the cancer in that particular part of my skeleton had been destroyed.
At this writing we still don’t know anything further. Nevertheless, it is evident from the chart below that bone-ALP continues to decline. The PSA, however, appears to be approaching an asymptote around 5.PSA&BALP Feb'14 (Click on thumbnail at right to see full sized, annotated image.)

In the near future
I will receive my sixth (and final) Xofigo infusion here in northern California next Thursday. Sometime after that I expect the chief will put me back on Leukine injections. There is some evidence that this immune system booster, a mainstay of second-line hormonal therapy, has been effective at further reducing the cancer after Xofigo. Unfortunately, we are pretty close to the frontier on this one and may have to experiment a bit.
Our current puzzlement
Suppose that Caris Dx’ failure to find viable cancer in the material from the chosen sampling site near the bottom of my pelvis means that Xofigo has managed to wipe out a large chunk (or all?) of the metastases in my skeleton. Then, what is keeping PSA up in the neighborhood of 5 ng/ml? Is there other cancer hiding out somewhere in my body producing this PSA?
We observed a similar phenomenon at the end of each of the first three rounds of chemotherapy. (See Recent Progress post for June 6, 2013.) In those cases, PSA settled around 1.5. In the absence of further treatment, my PSA rose again shortly after the end of each chemo round. If the anticipated regimen with Leukine, the immune system booster, succeeds in driving PSA below 1.0, it may also shed light on this conundrum.