2nd Combidex MRI update

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John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 2/14/2009 7:36 AM (GMT -6)   
I had the MRI today. Laying in a tube for over an hour wasn't pleasent but doable. A valium helped. Before I left I was given a disk that had over 1500 images on it. They looked really clear, but I sure don't know what I'm looking at, so I'll leave the interpertation to the experts. They also took images of the prostate, so I'm curious if the tumor shows up on them.
I was really impressed with the Dutch medical system. There was no wait and the staff was professional and courteous. So far well worth the trip and added cost.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/14/2009 11:12 AM (GMT -6)   
Thanks John I know I appreciate the information on this, you are kind of our local pioneer on this. It is one thing to read about such in a book or online and it is another to hear first hand accounts of all the details surrounding such. What do they think about our PCa proceedures and methologies, it might be interesting medical perspective to know??
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/14/2009 12:24 PM (GMT -6)   
John,
Just out of curiosity, have they taken a PCA3 since you have been there? What are their feelings about it? If you have had the test what were the results?

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 2/15/2009 2:46 AM (GMT -6)   
Tony, Zufus,
I had a PSA3 in Nov after my 1st diagnosis. It was 41 (high normal is 35). My Onco was surprised that it was so low .Since I'm only here for diagonistic scans I didn't get into any treatment methods. Dr Batantsz is a radiologist oncologist and concentrates on diagonistics rather than treatment. He says he works closley with Dr Strum, Myers and Sholtz and is also working with UCLA to get their new diagnostic equipment dialed in. I know they do a lot of open RPs over here.

JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


reinhartdm
Regular Member


Date Joined Feb 2005
Total Posts : 20
   Posted 7/31/2009 6:27 PM (GMT -6)   
I am currently in the queue for a Combidex MRI with Dr. Barentsz, but I have not yet been scheduled for treatment and not given even a general idea how long the wait might be, other than the report that some patients have been waiting several months. This is disturbing.

My low PSA/Large tumor variety of PC often progresses very quickly after radical surgery, so I am anxious to get started on the triple hormone blockade and then broad IMRT recommended by Dr. Myers.

My big question: Is it worth waiting another two or three months to get the Combidex scan or should I start hormone treatment right away, and then progress onto the IMRT?

John T, how long did you have to wait for your Combidex scan? I've heard that it is now available at UCLA. Does anyone know about this?

I appreciate any information anyone can provide.

Dan

PSA = 2.3 ng, Robotic surgery at NIH 5/28/09, tumor involved 30% of prostate, pT3a, ECE, Gleason 3 + 4, SV neg, LN 0/10 (but Dr. Myers says "inadequate sampling"!)

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/1/2009 11:25 PM (GMT -6)   
Dan,
It took about 5 weeks from the time I first requested to when I got scanned. I was initially told it would take 60 days. I think it helps if you continue to e mail them for a schedule date. I'm glad I waited because it affected my treatment decision and my PC wasn't as agressive as yours. I don't know what I would do in your case. I would ask Meyrs. I would also ask Dr Myers to e mail Dr Barantsz.
I doubt UCLA has it because it's not FDA approved, but they could be doing trials. I know Dr Barantsz was working with them to set up some new scanning technology. I would give them a call, it couldn't hurt.
I do know you can't have any type of HT before the test as it nulifies it.
The only thing that would concern me about UCLA is the skill of the radiologist reading the scan. Barantsz is the best in the world.
Good luck, I know it's tough waiting.
Johnt

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 5/27/2010 3:19 PM (GMT -6)   
We were researching the Combidex MRI and Prostascint since BF had lymph mets. Some lymphs were removed but we want to make sure undetectable PC is not in other lymphs. Looks like we started the research a bit too late. Did not know that you cannot be on HT. Once we get the ok to stop HT (could be another year and half!), can we wait a certain amount of time to test? Or once you start HT, you can never test? If we cannot, do you feel Prostascint would be effective then? Can we do this test in conjunction with PET and bone scans to see if PC comes back in other lymphs? Thanks for your help as I continue to read more on this!
Boyfriend dx at age 44 with Stage 4 PC on 11/09. Gleason 4+5, 11 of 12 cores +; PSA 51.34
DaVinci surgery on 12/09

Gleason 4+5 confirmed. Lymph and vesicle invasion, right nerves spared.

HT: Casedox and Lupron started 1/10

PSA 1/13/10 23.15 2/8/10 .37 3/18/10 <.05 5/14/10 <.02

Bone metastasis

Radiation: 42 sessions ending 6/10


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 5/27/2010 7:49 PM (GMT -6)   

As a diagnostic any scan will be affected by HT as it immediately shrinks small tumors and makes them very difficult if not impossible to detect. It may still pick up very large masses that have not yet shrunk.

It is already confirmed that your BF has lympnode involvement. And with a Gleason 9 and a psa of 51 it is almost certain that surgical sampling of the lymphnodes and surgical removal of the prostate would not have cured him. A prostascint scan is inaccurate and now would be even more so that he is on HT. With those stats it was 99% certain that the PC was not contained and surgery would have been used as a debulking procedure only. I hope your BF was informed of this before his surgery. What did his CT scan and bone scan show before his surgery

If your BF does not already have a good prostate oncologist then I would suggest getting one of the top ones as it is well past the stage that any surgeon or urolgist can provide any meaningful help. I would also suggest "Beating Prostate Cancer, Hormone Therapy and Diet" by dr Charles Snuffy Myers as he also had PC than had spread to the lymphnodes.

Scans can be used to monitor progress, but only the Combidex will pick up small mets, PET scans should only be used if they are free and part of a clinical trial, because they have shown to be almost useless in detecting prostate cancer. You should also be aware that Combidex is no longer available as the imaging agent used is no longer in production. It is hopeful that in a year or two a new imaging agent can be found.

Good luck ,and at this point in time PSA and other blood tests may be a more accurrate way to monitor progress than any scans.

JohnT

 

 


64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 5/28/2010 12:08 AM (GMT -6)   
John T-
Thank you so much for your wealth of information. I do not have the pre-op but have post-op. Left bladder neck, left pelvic lymph positive for PC. L and R pelvic nodes--2 nodes almost completely replaced by carcinoma; largest at 2.0 cm. Extranodal tumor extension and extensive lympovascular invasion noted. Extensive lymphovascular invasion and extensive extra and intraprostatic perineural invasion noted. AJCC stage is pT3v N1 Mx post-op.
Thankfully, he is treating at Sloan with Dr. Scher and Dr. Zelefsky and just read Dr Myers book. We called today for an appt with him and waiting for call back. I started BF on cancer diet and supps from get-go and thankfully, it complements what Dr. Myers says in book. Going to get the right supplmements that he suggests though. What can you recommend going forward? What testing should we ask for? We are researching but naive!!! Thank you again for your insight and help!
Boyfriend dx at age 44 with Stage 4 PC on 11/09. Gleason 4+5, 11 of 12 cores +; PSA 51.34
DaVinci surgery on 12/09

Gleason 4+5 confirmed. Lymph and vesicle invasion, right nerves spared.

HT: Casedox and Lupron started 1/10

PSA 1/13/10 23.15 2/8/10 .37 3/18/10 <.05 5/14/10 <.02

Bone metastasis

Radiation: 42 sessions ending 6/10


JerryB-UK
Regular Member


Date Joined Jul 2009
Total Posts : 39
   Posted 5/28/2010 3:24 AM (GMT -6)   

John,

10 days ago I had a high-resolution MRI scan combined with a gadolinium contrast agent. The scan was carried out in London, UK.

I'm not sure how this differed from a Combidex scan? Maybe they are both similar?

I understand the resulting images have an additional clarity that help the radiologist to identify possible tumours. As always, I believe the skill and expertise of the radiologist is absolutely critical in interpreting the results. I guess it's much the same as having a very experienced surgeon carry out treatment.

I had hemi-ablation HIFU treatment in October last year. Although my first two PSA results were very satisfactory, I had a nagging doubt in the back of my mind because I had a conflict in diagnoses between my original National Health Service biopsy which showed five Gleason 7 cores on the right side, and a subsequent multi-core template guided biopsy carried out privately, which showed the right side to be clear. My NHS MRI scan had also showed tumours on both sides of my prostate with possible left extra-capsular extension.

I think I can now feel reasonably confident that the NHS biopsy and MRI scan were incorrect. However, it is very puzzling, because I can accept the possibility of a false negative, but a false positive is rather more difficult to understand. I'm hoping there isn't a man out there somewhere who was told that he was clear when in fact he has Gleason 7 in the right side of his prostate.

The letter from my consultant following this latest MRI scan said - "Please find attached the MRI study. You will see that this is completely clear. The necrosis has completely resolved and there is no MR evidence of any residual tumour in the treated left side. The untreated right side, as we would expect, also shows no evidence of any tumour. I hope you find this reassuring."

I do realise that MRI scanning can only go so far in identifying smaller tumours, but it's an encouraging start.

Cheers,

Jeremy


Age - 67
PSA – 7.8 ug/L. in February 2009
Gleason – 7 (4+3).  T stage – 2b.   Prostate size - 52 cc
July 2009 - ADT (Prostap) for 3 months to shrink prostate with a view to brachytherapy
September 2009 - prostate reduced in size but flow still to slow to allow brachytherapy.  Told that surgery is only option
30th October 2009 - Focal HIFU with Mark Emberton in London UK


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 5/28/2010 6:29 AM (GMT -6)   
Jerry, I have also had a MRI wll gadolinium contrast. Used to determine if a lesion on my spine was PCa. This was given after a bone scan and regular MRI were inconclusive.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10  .50

Aril 10 MRI and Bone Scan show lesion on lower spine, false positive. 
 
Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

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