Could this be metastasis?

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clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2649
   Posted 12/2/2010 5:23 PM (GMT -6)   
I'm scheduled for an MRI tomorrow morning to find out what is causing my severe neck and shoulder pain, which has now lasted nearly 3 weeks, an which has progressed to the point that I cannot raise my right arm higher than my shoulder, or even use the arm to pass a dish at dinner.
 
I'm assuming that a disc problem is causing nerve compression, and not that many months ago I would have felt sure of that.  Now, however, having been treated for prostate cancer, the worry keeps creeping in that this could be metastasis to the cervical spine.  My family doc says that can't be, given my recent bone scan, my PSA score prior to surgery, and so forth, but I just can't avoid the worry about PCa.
 
Surely the cancer was developing in the prostate for years before the biopsy discovered it.  Could it have been shedding cells during that time?  Even though the post-op pathology and the pre-surgery bone scan give reason to believe this can't possibly be metastasis, I have to confess I'm nervous.
 
Has anyone ever known of someone with stats like those shown in my signature below who nevertheless developed mets shortly after the surgery?  The bone scan would have had to miss something, but it wouldn't require a very large tumor to cause problems in the cervical spine, where the channel for nerves is rather small.
 
I should have a definitive answer soon, but thought I'd post this and see what thoughts some of you more knowledgeable guys might share.  Thanks, Bill
 
Age 65
Dx in June 2010.
PSA gradually rising for 3 years to 6.2
Biopsy confirmed cancer in 6 of 12 cores, all on left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays all negative.
DaVinci surgery late August at Advocate Condell, Libertyville IL
Negative margins; negative seminal vesicles
Continence OK after 7 weeks. ED continues

Post Edited (clocknut) : 12/2/2010 5:04:13 PM (GMT-7)


cantexplain
Regular Member


Date Joined Jun 2010
Total Posts : 74
   Posted 12/2/2010 5:30 PM (GMT -6)   
 
As a fellow PCa travelor, I fear you have what I had (past tense) three years ago. Cervical compression of discs around C-4, C-5, and C-6 - had an anterior discectomy with removal of two discs and insertion of cadaver bone.  Let me ask:  you have pain in your neck, shoulder, arm:  but, I'll bet the thumb on the affected side is fine.  Right?  The pain came on (for me) over night and is really a mind bender.  Get the MRI and I hope I'm wrong.
Age at Dx: 56
DaVinci Prostatectomy: 10/28/09

Stage: T2C

Gleason - 3+4 = 7

Prosate: 52 grams

Incontinence - absolutely at first, better with time and kegels

ED - Indeed

Married, father of two (boys 19 and 18)

11 months later: member of the "zero" club, working on one "safety" pad for 24 hours. Took Cialis for 6 months (no apparent affect), Tri-mix works, though!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/2/2010 5:40 PM (GMT -6)   
@Bill,
Bill if you go back and edit your post you can add a topic. We need to have topics to know what a post is about. If you like I can do it for you, just tell me what you want the post to be called...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2649
   Posted 12/2/2010 11:50 PM (GMT 0)   
Cantexplain, the pain is in the neck, clavicle, and shoulder (right side) and in the very top of the arm.  At times it's at least a  nine on a scale of 10. Everything from the elbow on down works fine, grip is fine, I can "dead lift" as well as ever, but if I try to use the arm in any way that requires support from the bicep or other upper arm muscles, it just falls.  I can't hold the arm straight out, even with nothing in my hand, and I even have a heck of a time scratching my head or using a comb on the right side.
 
Luckily, I'm left handed :)
 
Tony, I'm sure I had originally included a topic, but must have deleted it somehow, so I took your suggestion and added one.
 
Thanks to both of you.

cantexplain
Regular Member


Date Joined Jun 2010
Total Posts : 74
   Posted 12/2/2010 6:58 PM (GMT -6)   
Clocknut:  the one thing I think you can be sure of:  it's not metastic cancer.  I didn't have any real loss of strength with my syndrome, so maybe I was too quick with my Dx.  Good luck with the MRI.
Age at Dx: 56
DaVinci Prostatectomy: 10/28/09

Stage: T2C

Gleason - 3+4 = 7

Prosate: 52 grams

Incontinence - absolutely at first, better with time and kegels

ED - Indeed

Married, father of two (boys 19 and 18)

11 months later: member of the "zero" club, working on one "safety" pad for 24 hours. Took Cialis for 6 months (no apparent affect), Tri-mix works, though!

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 12/2/2010 7:48 PM (GMT -6)   
clocknut said...
Cantexplain, the pain is in the neck, clavicle, and shoulder (right side) and in the very top of the arm. At times it's at least a nine on a scale of 10. Everything from the elbow on down works fine, grip is fine, I can "dead lift" as well as ever, but if I try to use the arm in any way that requires support from the bicep or other upper arm muscles, it just falls. I can't hold the arm straight out, even with nothing in my hand, and I even have a heck of a time scratching my head or using a comb on the right sid


Thanks to both of you.


I would bet your MRI shows some type of spinal compression and a pinched nerve. Your description of the pain sounds exactly like what I have and my MRI showed that it was cervical stenosis (narrowing of the spinal cord channel) from degenerative arthritis, with a spur between C4-C5 pinching the spianl column.

Sancarlos
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11/2009 + ADT3 (Lupron + Casodex+Avodart) + IMRT on Novalis, 45 gy, 3/2010.

PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0
12/2009 -- 0.56
5/2010 -- 0.15
8/9/2010 -- 0.06
11/2010 -- 0.013

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2649
   Posted 12/2/2010 10:02 PM (GMT -6)   
@Sancarlos.  Thanks. I think you're probably right.  Tomorrow's  MRI should tell the tale.  How was your problem resolved?  Are you OK now?  The pain is absolutely unrelenting.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 12/2/2010 10:32 PM (GMT -6)   
Clock:
 
This does not at all sound like the bone pain associated with the spread of PC.
 
I suspect you have frozen shoulder (I can't remember the technical medical term).
 
It sounds very much what I had about 10 years ago. It took some tough P/T but I fully recovered.
 
Let us know. If I'm right, I'll send you my bill.
 
Dr. Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06

Don K.
Regular Member


Date Joined Jan 2010
Total Posts : 74
   Posted 12/2/2010 10:47 PM (GMT -6)   
Clock:
My guess is a rotator cuff injury.
 
Be sure to let us all know what the MRI shows
 
Don

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2649
   Posted 12/3/2010 3:07 PM (GMT -6)   

Good news for me!  I had the MRI this morning and the images have already been looked at.  Diagnosis:  pinched nerve at C4/5.  No tumor, no metastasis, and doesn't look like it will require surgery.

I'll say this, though:  if pain can get any more intense than it was when I stood up out of bed this morning, I don't want ever to experience it. 

Thanks to those who offered reassurance.  The logical part of  my mind told me it couldn't be metastasis, but the emotional side wasn't convinced.  That extra stress has undoubtedly slowed heaing. 

 

 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 12/3/2010 4:30 PM (GMT -6)   
Pinched nerves can be miserable.
 
I've had back problems and sometimes it clearly involves the disk as evidenced by pain (sciatica) down my leg. That is the worst as touching or pressing down on it does nothing.
 
Fortunately, so far every time it eventually went away, usually after 3-4 days. One time it lasted a month
 
Mel

Aimzee
Veteran Member


Date Joined May 2010
Total Posts : 1401
   Posted 12/4/2010 2:08 AM (GMT -6)   

Bill, I am so happy your fears did not come true.  Will you require rehab?  Ron had back surgery BEFORE his surgery for PC.  His disc damage was C- 4,5, & 6.  He got a couple of rods and screws.  I am glad you won't need surgery!

Best regards,

Aimzee


Husband Ron, age 63
4/1/10 PSA 5.5 Prostate size = 50 grams
Biopsy on 4/20/10 12 samples... Adenocarcinoma: 3 positive on right side, one core left base (5% ` 0.5 mm) - two cores of left lateral mid
(20% ~ 2mm, 10%, 10% ~ 1mm) - No Perineural Invasion
Gleason 6 (3+3)
Bone Scan/CT Negative (2 lesions on liver)
8/18/10 - Da Vinci Prostatectomy
Post Op: Gleason 7 (3+4)
Negative surgical margins and lymph nodes
Both nerve bundles spared
Catheter - 13 days
ED / Day time incontinence.
Going to rehab to build up Pelvic floor
Post Surgery PSA 8 weeks - .01

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2649
   Posted 12/4/2010 8:03 AM (GMT -6)   
Aimzee, thanks for the good thoughts.  Our family doctor is setting up an appointment with a neurologist for next week. I still have absolutely no strength in my upper right arm and shouler, to the point that I can't even move my arm away from my body to put on deodorant.  I have to place the arm onto something using my left arm.  I can grip and squeeze and even do "curls" if my elbow is grounded, but if the movement requires the upper arm, forget it.
 
And I'm still wondering if the Cialis might have caused the original muscle contractions that pulled the upper spine out of alignment, causing it to pinch the nerve.
 
I would guess that if the nerve compression isn't relieved soon, physical therapy might be required.  Don't know.  I did manage to shovel the 3 inches of snow off the driveway this morning.

brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 12/4/2010 2:24 PM (GMT -6)   
Old medical truism: with shoulder pain that prevents one placing a hand on top of the head, look for a shoulder joint cause. With shoulder pain that does NOT worsen (may even fell best) with the hand on the head, look at a pinched nerve. Hate to tell anyone over 45-50, but x-rays, CT, or MRI will shown the normal degenerative joint changes that actually begin in the 30s or earlier. Don't operate on a imaging test. Make sure the picture and the symptoms correlate.
70 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0. RALP July 2009
PSAs 0 since

brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 12/4/2010 2:25 PM (GMT -6)   
Old medical truism: with shoulder pain that prevents one placing a hand on top of the head, look for a shoulder joint cause. With shoulder pain that does NOT worsen (may even feel best) with the hand on the head, look at a pinched nerve. Hate to tell anyone over 45-50, but x-rays, CT, or MRI will shown the normal degenerative joint changes that actually begin in the 30s or earlier. Don't operate on a imaging test. Make sure the picture and the symptoms correlate.
70 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0. RALP July 2009
PSAs 0 since

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 12/4/2010 10:13 PM (GMT -6)   
clocknut said...
@Sancarlos. Thanks. I think you're probably right. Tomorrow's MRI should tell the tale. How was your problem resolved? Are you OK now? The pain is absolutely unrelenting.


The problem has not been resolved. At this point the spinal cord channel has narrowed to about 7mm wide, where 15mm is normal. Since this is caused by a bone spur an operation will eventually be necessary, either to fuse C-4 and C-5 or to cut off the spur, but for now I am having a series of epidurals in an effort to temporarily relieve swelling.

Fortunately the pain I have is more of the aching kind that sharp and very painful.

Sancarlos
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11/2009 + ADT3 (Lupron + Casodex+Avodart) + IMRT on Novalis, 45 gy, 3/2010.

PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0
12/2009 -- 0.56
5/2010 -- 0.15
8/9/2010 -- 0.06
11/2010 -- 0.013
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