Bone scan is negative. What's next? What should I expect?

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mikee219
Regular Member


Date Joined Jan 2009
Total Posts : 53
   Posted 1/12/2009 6:26 PM (GMT -6)   
One bit of good news. I don't get to speak with the oncologist until Friday so I can't post a signature yet. My PSA was about 8.6 and I was told that my Gleason scores were 8, 9 and 10. What can I expect next, MRIs, CAT scan? Is the wait until next Friday going to make things worse for me?

Mike

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 1/12/2009 8:19 PM (GMT -6)   

Mikee:

With your PSA at or around 8.6 you'll probably be able to look at all of the different therapy options.  The bone scan being negative is obviously a good thing but if you have Gleason scores of 8, 9 and 10 I am a little surprised that you haven't had a CT of the pelvis/abdomen.  The CT does a better job(obviously not perfect) of picking up any organ problems and lymph node issues.

Are you seeing a oncologist or a urologist right now.  If its an oncologist you'll probably get a pretty fair suggestion on which road to follow because he shouldn't have a dog in the fight other than for your well being.  If its a urologist I'm sure he'll suggest surgery. 

 

David

 

 


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HBRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 


mikee219
Regular Member


Date Joined Jan 2009
Total Posts : 53
   Posted 1/12/2009 8:23 PM (GMT -6)   
Thanks, David. So should I be asking him for a recommendation for an oncologist consultation?

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 1/12/2009 8:31 PM (GMT -6)   
Oncologists are usually seen if there are some complications with your therapy but they are great to see if you can for a true unbiased opinion on which way to go as inital therapy is involved.
 
If you truly have some high Gleason scores like you think you do you should do your DD but don't wait around too long making a decision.  Us high Gleason guys need some therapy sooner rather than later.
 
Some other things to consider are how many sticks were positive and what percentage of each stick on your biopsy.  What is your staging T1c or such, it all matters in your decision making.
 
David
 
 
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HBRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 


mikee219
Regular Member


Date Joined Jan 2009
Total Posts : 53
   Posted 1/12/2009 8:48 PM (GMT -6)   
I guess I get all that information at the meeting on Friday. I hope waiting a week isn't too long. What do you mean by DD?

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 681
   Posted 1/12/2009 9:13 PM (GMT -6)   
mikee219 said...
I guess I get all that information at the meeting on Friday. I hope waiting a week isn't too long. What do you mean by DD?
   I know you feel like things are coming at you too fast right now.  Waiting a week or even months will make little difference on your final decision and outcome.  Slow down if you can.
 
Even if you have a very agressive situation, you have plenty of time to ask questions and make a good decision.
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion identified
Few continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02) (two years+.02)
One side nerve spared
success but some plaque with bimix 
born in 1941


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 1/12/2009 9:25 PM (GMT -6)   

Mike:

DD is due diligence meaning you look at all of your options.  Lifegyud is right in that you have time to make your decisions, I didn't mean to give the impression that it should be a few weeks but listen to what your Dr. has to say on Friday gather all of the info. you can, read all of the info. you can and make an informed decision.

To take more time to make a decision I decided to have a three month Lupron shot which allowed me time to think and decide on my course of action.  Its not something that has to happen but I felt much better because I was a high Gleason guy knowing that my tumor was shrinking while I was deciding which action to take.  There also is a lag time between when you make the decsision and when the procedure can be carried out.  These are all some things you have to take into consideration.

 

David


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HBRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/13/2009 12:31 PM (GMT -6)   
There are various scanning methods, some newer ones that may be somewhat more precise (conceptually speaking). Nothing so far is perfect or 100% definitive, in others words it is very possilbe to have a clear scan and not be guaranteed you don't have PCa somewhere. Prostatscint can even give false positives sometimes (written about in books), so maybe don't consider that method or realize it could happen.
Naturally if it shows up on a scan you have enough there to be "seen" and the minimun number of cells that that might be (heard from radiologist years ago-so don't quote me directly) 1-billion cells.

There is talk from the medical industry and maybe with good reasons, that scanning like every patient is wasting resources in insurance costs, probably because the majority of PCa presentations (cases) the persons have usually low psa, low stats, some have 'indolent' PCa or close to those parameters and will have clear scans in probably ultra high percentages. In effect maybe a scan is not needed in assessment of their condition. (Not my words, their talk on this).

Good old Bob here with my lousy stats, had clear ct and bone scans (I even got the real film in hand), it was reviewed by two other rad-onco-docs and agreed looks clear. Now what do the Partin tables and nomograms say comparatively about those odds???

Dx-2002 bpsa 46.7 (total urinary blockage) probably had prostatitis undiagnosed(had symptoms), 12/12 biopsies 75-95% in everyone, gleason scores found 7,8,9's about equally on both sides of the gland.
ADT3(neo adj.)+Radiations-Neutron & Photon-ADT1-3 for 2yrs., quit, started Des 1-mg 1.5 yrs., quit and no drug for 2yrs., just restarted Des as psa changes since Summer 2008, psa declined 2 wks. after taking Des again, dropped twice already, waiting for further psa's in future to compare.
 


sandstorm
Regular Member


Date Joined Dec 2008
Total Posts : 194
   Posted 1/13/2009 3:26 PM (GMT -6)   
Congrats on the bone scan mikee219,

Thats a good start. As others have stated, talk to and listen to your doctor/doctors, weigh your options, study, and take a little time to make that informed decision.
Age at DX 57
5-18-07 PSA 7.7
5-06-08 PSA 4.6  8% free psa
10-23-08 PSA 5.65 4% free psa
11-04-08 biopsy
11-11-08 2 of 12 cores positive
Gleason 3+3  6  stage t1c
CT and Bone scan negative
Da Vinci RRP 01-09-09
Time to heal now.


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 1/14/2009 9:52 AM (GMT -6)   
When exploring the options which may be available to you, include your primary care physician in the discussions - because he/she is the person most familiar with your health history and who should also be aware of specialists in the area with whom you might want to consult. Each of us is a bit different in the diagnosis and strength of the cancer, so what's right for me may not be right for you, etc. Stay strong!

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0

 

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