Another Fear/Concern

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 12/13/2009 12:25 PM (GMT -6)   
Again, I've been very honest about expressing many of my fears/emotions, even at the risk of a tad bit of "ridicule" (that's not quite the right word). I know: ("calm down," "take a step back," etc.).
 
Anyway, here is my concern. I will probably have to undergo a bone scan and maybe a CT Scan. With these scans, I suspect all kinds of things will light up (I've had back problems and other issues -- I'm sure all kinds of arthritis). Hence, more uncertainty and further tests (will they be invasive tests?).
 
I'm just not looking forward to that!
 
For those of you who have had bone scans, did it reveal uncertainties that required further investigations or did it reveal stuff that they knew was not a problem (ie: this is definitely a bone spur or chip or arthritis). I got to believe that at our age there would be plenty of degenerative stuff showing up.
 
Anyway, that's my concern at the moment. At least things are moving along a bit. I will be leaving for UMICH in a bit over 3 hours.
 
 
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/13/2009 12:34 PM (GMT -6)   
Hey Mel, is there ever a time you don't worry? lol, you are going to put yourself into an early grave. I have had 3 bone scans in my life, none were invasive, and all they ever showed up was a touch of arthritis in places I wouldn't have needed a test to tell me, i.e. knees and hips. No surprise there.

I will be glad for you when you have these meetings and tests behind you, then you will have a good spectrum of data and opinions to start finalizing your primary treatment upon. I am sure you will do well with all of it.

Good luck.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 12/13/2009 12:36 PM (GMT -6)   
Careful now... Don't have an accident in the snow.

The bone scan will show any injury that is actively healing. My scan showed a hot spot on my shoulder. The Uro reviewed it with me and we identified it as the spot where my rifle touches the shoulder. I had been shooting before the test. Who knew? They did a retest a week later and the spot was gone. The squirrels got their revenge I guess.
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8. Start 2 weeks of Cipro to rule out protatitis.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
. 9/27 2 months: Still 3 pads per day.
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day Experimenting with Nyquil.
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04 undetectable.


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 12/13/2009 12:45 PM (GMT -6)   

David:

 

In answer to your question, no there was never a time I didn't worry after my PCA-3 test.

Before that time, and especially before my August physical that revealed a jump in my PSA, I RARELY worried. I always believed hard work and preparation alleviated worry. In fact, I strongly believe that luck is when preparation meets opportunity.

Unfortunately, of late, I have made up for a lifetime of non-worries, I guess!

 

Mel

 


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


zachattack
Regular Member


Date Joined Dec 2009
Total Posts : 97
   Posted 12/13/2009 12:47 PM (GMT -6)   
Mel, The only thing invasive about either one is a shot or a couple drinks of contrast.please don't worry your self about the little things!

Zach
age 55dx 12-2008,psa at biopsy 8.6
biopsy 12/12 gleason 3+4=7
da vinci surgery 6-09 by DR. John W. Scott (my hero)
Hospital 3 days cath 7days still leaking from cough(bad lungs)
still have ed may be the hormones.
9-09 psa 2.2 hormone inj
10-09 nuclear bone scan no results yet I will have gold markers placed 12-29-09
start rad 1-10-09
organ confined
extracapsular seminal vesicle involvement
lymph node involvement


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/13/2009 12:48 PM (GMT -6)   
Jeff, that will teach you to be a squirrel killer, lol.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 12/13/2009 1:01 PM (GMT -6)   
My husband had a number of hot spots. On discussion all determined to be the result of his "biker" days, as well as degenerative areas from previous spinal surgery. No there were no invasive tests for him, however no further assessment was requested either of any areas at the time. He did however discover that he did have an old break (upper arm) which was intact (not displaced), and which he had felt at the time, but not had treated (Didn't think it was broken). The most significant hot spots however, were those arising from previous surgery (lower back and ankle). It was all clear, but the worst part was receiving the results verbally from the Doc (we waited and collected them mid afternoon). He said (slowly.....)... "Well as you would be aware that prostate cancer often spreads to the bones which is often indicated by these sorts of spots (points...).... (pause....) however in your case and with your history, it appears it hasn't".

There was a quick clarification from us of what this (poorly expressed statement) actually meant "Hasn't what? Hasn't spread? Hasn't showed up? Hasn't worked? What are these then? etc etc"... After realising after discussion, that the hot spots were all from previous injuries, we literally RAN out of the place. So yes, it is a concern, and I am not sure how you would determine/assess suspicious spots Compiler yourself, but people reading the scans should be able to answer your questions if you can examine your scan with them at the same time. Question everything, depending on your past and knowledge of what may show in terms of previous injury and arthritis etc. We were satisfied with the interpretation and later checked it (report) with another specialist but I am not sure what you would ask/do if you were not satisfied with the explanation - sorry and hope you get some further answers on that.


Creed_three (Lana) - with husband "CJ" now aged 52 yrs (49 years at diagnosis).
PSA (2002) 2.1. (2006) 3.5.  1 x 5% core of 12 positive at biopsy. Open Radical Prostatectomy with nerve sparing April 2007 Sydney, Australia. Gleeson 3 + 4 = 7. 2 small multifocal lesions. Contained. Undetectable <.1 PSA since: June 2007-0.01, Oct 2007-0.02, April 2008-0.02: Oct 2008-0.03, Nov, 2008-0.02, April 2009-0.03. Next PSA April 2010.


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 12/13/2009 1:10 PM (GMT -6)   
Zach:
 
By invasive I was referring to follow-up tests when the invariable hot spots show up in the scans.
 
But it sounds like most of the time they can read the hot spots and draw a favorable conclusion without having to look further. At least based on the 1-2 answers posted here so far!
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 12/13/2009 1:29 PM (GMT -6)   
I think it helps if you tell them in advance about the potential hot spots you know about. It keeps the doctor from getting all worked up and saves you some heartburn too. I have a whole list of aches, scars, and issues that I tell them about up front.
Diagnosed at 54
PSA 8.7 Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7 Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09 Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence Pad free week 5
PSA 6/6/09 <0.1 PSA 9/10/09 <0.1


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/13/2009 4:06 PM (GMT -6)   
The bone scan will show up hot spots which as others have pointed out could be tumour or healed breaks or injuries or even that favourite of advancing years, arthritis. The inflammation which occurs when arthritis develops causes the body to lay down new material as a response to the inflammation (sometimes you can feel this new material as lumps 'n' bumps when it is on the fingers etc). I believe that the isotope in the bone scan is very quickly taken up by cells recently laid down as repair or by tumour growth. Further tests, if you can call them that, which are used to look at the "hot spots" following the bone scan are standard x-ray and CT scan. These can for the most part differentiate between tumour and healing injury.
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
PSA December 09 <0.01

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


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 12/13/2009 5:31 PM (GMT -6)   
Mel,
The CT and bone scan most likely will show nothing. Don't worry about it. It is a simple painless test. With your biopsy numbers it is doubtful that anything bad will show up.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 12/13/2009 6:51 PM (GMT -6)   
In order for anything to show up on a bone scan your psa would have to be in the 100's. PC 1st spreads to the lymphnodes at which only a tumor that causes the node to be more than 10mm will show up on a CT scan. This equates to billions of PC cells. Then it moves from the lymphatic system to the bones, by that time there are usually multiple lymphnodes tumors that are growing that are each generating a lot of psa, by the time it gets to the bones and is growing, psa is usually in the high hundreds or thousands.
 
Save your time and money, because as long as your psa is less than 20  you will only get false positives. This is purely defensive medicine at the best and ignorance of PC at its worst.
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


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 12/13/2009 6:57 PM (GMT -6)   

yES, IT IS clear that neither Walsh nor Strum are advocates of these scans although they indicate they have their place under certain circumstances (high PSA or Gleason). But I suspect Umich will still want to do the tests (defensive medicine). If my G-score was 3+3 it would be a different story.

 

Roads were okay. We got here quickly and had a nice leisurly dinner. Fun starts tomorrow early.

 

Mel


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


cocrgolfer
Regular Member


Date Joined Oct 2009
Total Posts : 171
   Posted 12/13/2009 8:06 PM (GMT -6)   
My urologist got me a CT scan. (with a radiologist and machine that were part of the groups practice.) It was neg. When I went up to Moffitt they almost sneered and said they would't have given me one.

Steve

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/13/2009 8:22 PM (GMT -6)   
Good luck Mel you probably will not have time to ask all those questions you posed. They will be dealing with assessing your medical data, DRE or two before they get to any questions. You've got a very, very inquisitive mind so I think you will weigh it all well before making any quick decisions. Remind me to hire you if I ever have to do another major treatment, you would have more up front questions than me....(and I thought I had fair number of them-LOL).

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 12/13/2009 8:43 PM (GMT -6)   
Mel, my husband's Gleason at biopsy was 3+4 and PSA was 6.4. Urologist said bone scan is useless if the PSA is under 20 but he did order a CT scan. The bone scan was done when John's PSA jumped up a bit in August. Both the urologist and rad onc didn't feel the bone scan would show anything but decided together that it wouldn't hurt to do it. It showed a hot spot on his right collarbone. A CT scan of the area was ordered - it was clean. Turned out the hot spot was caused by swinging a tennis racket. The radiation oncologist told us that they frequently see these types of hot spots when there is heavy, repetitious movement (tennis, golf, someone swinging an ax, etc.). The test themselves are nothing to worry about.
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!


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 12/13/2009 9:57 PM (GMT -6)   
I had to have a follow-up x-ray of my foot after the CT scan. My left leg looked like a war zone because I was recovering from a major infection in my femur.

Otherwise, the Ct and Bone Scan are pretty routine.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections

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