prostascint scan

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gregory m helman
New Member


Date Joined Oct 2009
Total Posts : 16
   Posted 11/20/2009 8:15 PM (GMT -6)   
the oncologist ordered a prostascint scan and wondered if anyone  had one.
some say its a waste of time and not worth having it.also my uro/surgeon says don't have the hormone therapy because studies have not been complete.
anyone have thoughts on hormone therapy?.this scan detects prostate cancer. they inject you with radioactive material in your vein and then they take pictures using a gamma machine to take pictures.


  age 52
had rectal exam and found prostrate nodule detected.
psa was .097 before exam.
referred to urologist and also rectal exam , but couldn't feel anything.
we discussed about biopsy to be on safe side.
Final   Diagnosis of biopsy
specimen  is received in formalin in 8 parts labeled A-H.
 
 
 
A-G ------ no atypia or malignancy found.
H---- prostrate needle biopsy, left anterior horn:   Adenocarcarcinoma,
gleason score 3 + 4= 7,    4 mm in greatest linear dimension, involving approximately 20% of tissue from this site. less than 1ml cancer and less 1% of gland involved.
 
 
prostrate surgery done 7/29/2009 -- radical perineal surgery.
robotic was out of the question due to previous surgeries, hernia repair,gall bladder,had mesh put in.
 before surgery , psa was at 0.97.
09/2009 psa ---- 0.55
10/2009 ----- 0.39
11/2009 ------- 0.45
10 days with foley  cathereter
drain tube for 2  days
hospital stay--- 2 1/2 days
 had trouble with bowl movements constipated due to pain meds .
on stool softners
 after cath was out 2 pads a day
6 weeks later just 1 pad a day.
slight leakage , when lifting, sneeziing
 
post op pathology report
 
comment
Macroscopic
specimen type - radical perineal prostatectomy
specimen is intact
pre op psa level 0.97/ng/ml
other organs-seminal vesicle(s)
microscopic --tumor site-1 nodule
nodule#1- involves left lateral mid and left lateral
dimensions--0.6 x 0.2 x 0.6 cm
Histologic type------ Adenocarinoma
histologic grade---gleason
primary pattern is-grade 3 : single acini of variable size and seperation , cribriform and papillary patterns
Secondary pattern is: grade 4 : irregular masses of acini and fused epithelium , can show clear cells
gleason score (primary + secondary)  = 7 : Moderately poorly differentiated
 
Tumor Quantitation:
preportion of prostrate involved by tumor =<1 %
estimated tumor volume(% involved by tumor x prifixation vol) =< 1 ml
 
extraprostaic extention - absent
seminal vesicle invasion- absent
perineural invasion - absent
blood /lymphatic vessel invasion --absent
extent of invasion : pT2a: tumor involves < one half of one lobe
regional lyph nodes: NX; cannot be assessed
 
margins :
 
margins involved by tumor : anterior left lateral mid
margin involvement is extensive (> 1 HPF)
beingn prostatc acini are present at margins , not in area of tumor
 
 
 
 
 
 
 
 
 

Post Edited (gregory m helman) : 11/20/2009 6:40:51 PM (GMT-7)


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 11/21/2009 4:04 AM (GMT -6)   
Greg,
I have read that the prostascint scan can give both false positives and false negatives (doesn't everything associated with PCa?) Articles I have read seem to lean to the view that it is a more accurate indicator when fused with an MRI. There is a bit of reading here:

www.prostate-cancer.org/education/staging/Kipper_ProstaScintUpdate.html

Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm

Post Edited (BillyMac) : 11/21/2009 2:12:33 AM (GMT-7)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 11/21/2009 7:46 AM (GMT -6)   
Greg, we asked our uro/surgeon about this test when it looked like my husband might be facing a recurrence of his PCa. Doctor's response is too many false positives/negatives at this point so he doesn't use it.

Personally, I agree with Bill: when used with a more accurate test (such as an MRI), the Prostascint seems to have merit, especially for men with PSA after surgery (helps to image the prostate bed and provide better idea of where the PSA may be coming from).
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 11/22/2009 11:37 PM (GMT -6)   
Prostiscnt is fairly worthless with a low psa. It is a test to detect lymphnode involvement which is usually indicated by a high psa. Did your doctor say you have a varient that he suspected lymphnode involvement? A much better test is the Combdex MRI which is 96% accurate in eliminating PC, but does give some false positives which can be confirmed my location and or biopsy. With a psa of only .97 I would suspect a varient and you should have your oncologist test for one if he has not already done so.
I would listen to your oncologist regarding HT rather than your surgeon. Surgeons are mechanics whereas oncologists are better suited to understand the biology of the disease, and at this point you would be treating the biology and not simply cutting.
If your oncologist is not a specialist in PC and not familar with varients, then get an oncologist that specializes in PC as ths is something you don't want to fool around with. See the previous threads by Rienhiem on low PSA high tumor volume.
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/23/2009 12:04 PM (GMT -6)   
Right on with John T the prostatscint is not worth it, false positives=why bother then having these is a very good question.
 
 
 
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