TV report about Mets localised in one Lymph gland

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English Alf
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Date Joined Oct 2009
Total Posts : 2218
   Posted 5/11/2011 6:13 AM (GMT -6)   
I changed channels on Dutch TV a couple of days ago and caught a tiny bit of a report about PCa.
(I have tried to find out more details but could not, but with some calculated guesswork I thought I could fill in most of the gaps.)
I've started a thread about it as even the bit I saw was revealing, as it showed a guy getting a combination of Good news/bad news, so I will try and explain what I think it was about in case anyone else can provide more details,

It was in a Dutch hospital/clinic where a Dutch consultant was talking to an American male patient (who had his wife with him).
Patient and doc were both grey/bald and in their sixties, but I did not catch any names.
The patient had had an unexplained PSA level and it was said that he had already had treatment suggesting that he had already had surgery and SRT.
He had now had some kind of full body scan with markers as they were looking at a computer screen on which all you could see was his lymph system.
The doc explained how all but one of the 200 or so lymph glands showed up green. The exception was a single red one in the pelvic region. He said that this indicated that the mets that were causing the PSA were likely to all be concentrated in that one gland and not spread thinly over his entire body.
The good news was thus that the doc said that the guy could take the image on the scan to any (good) surgeon who could use it as a map to navigate to the gland concerned and remove it, with every chance that the result would be a big drop in PSA.

Now I may of course have missed some vital part of the story, but this would seem to show how the right type of scan at the right time can help, and provide yet another option when someone thinks that they have exhausted all the possibilities.

Alf
Age dx 48
Apr 09 PSA 8.6
DRE neg
Biop 2/12 pos
Gleason 3+3
Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
Nov 09 PSA 0.1
Mar 10 PSA 0.4 sent to RT
13 Apr CT
RT 66Gy ends 11 Jun 10
Tired + weird BMs
Sep 10 PSA <0.1
Jan 11 PSA <0.1
Apr 11 PSA <0.1
Erection OK

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 5/11/2011 7:31 AM (GMT -6)   
I wonder what kind of scan that was. That would be as awesome tool for Dr to use before surgery to see it the PCa has moved to the lymph system. Interesting for sure.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/11/2011 7:36 AM (GMT -6)   
Probably USPIO or Combidex scan can analyze lymphnodes way better than the junk we have normally given to us patients. You can laproscopically remove a lymphnode from what I gather (not an expert), so 'IF' you knew where to shop for it...yeah might be worth doing. Some minor risks in lymphendectomies to consider and doc could fill you in on that depending upon where and how many type of thing.

You can get the USPIO right now in Florida...expect to see others jumping to see Dr. Bravo for this superior technology. Competition hopefully prevails.

Makes you wonder again...about serving PCa patients or servicing PCa patients...it is big business. On their side of the ledger 100% they got it all works for them. I am nasty but hey this is what is going on.

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 5/11/2011 8:51 AM (GMT -6)   
Feraheme is the Ultra Small Particle Iron Oxide (USPIO) used at Sand Lake Imaging near Orlando. With a 3 Tesla (LARGE) magnet it can sometimes identify nodes affected which can be treated with radiation, occasionally surgery, and sometimes with excellent results. The similar Combidex technology was specific to Holland until it was terminated a year or so ago due to costs. The Feraheme follows a similar technology. The contrast agent is not approved in the US so its 1000$ cost is borne by the patient. Other imaging and treatment costs should be insurance covered.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 5/11/2011 11:28 AM (GMT -6)   
Alf,
This was the Combidex scan given by Dr Jelle Barantsz in Neigemagan NL. I have the video of my own lymphnode system and it is exactly as you describe. Combidex was discontinued last year because the manufacuturer of the imaging agent stopped producding it because of the cost of getting it approved through the FDA. This was the worst blow to PC patients world wide as the scan was 96% effective in identifying individual lymphnodes that are infected. The Sandlake imaging is now the best we have but it's accurracy is not as good as the Combidex.
JohnT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/11/2011 12:29 PM (GMT -6)   
John do you have the Barantsz CD video of the (brochure idea) proceedure or info type CD, Dr. Dattoli was giving them out at his office I heard, a guy I contacted is sending me his CD on this for quick learning. Might get it in a week or less.

This same guy Tom I just talked to had the USPIO done recently and had to pay the $900+ fee for the agent feraheme out of pocket otherwise insurance covered the rest. In his case it found 2 lymphnodes positive and is a big freakin deal, his local doc answered his question...do you think if I went to M.D. Anderson they could have found it also??? Doc said I don't believe they would have. He is having those radiated I believe.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 5/12/2011 1:16 AM (GMT -6)   
So I guess once they find the holy grail, total cancer cure, if its too expensive, tough luck!!! Thats a possibility I never thought of before.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 5/12/2011 5:19 AM (GMT -6)   
John - I thought it might be Dr Barentsz at Nijmegen. (And another search for images on Google would suggest that the man I saw on the TV was indeed Dr B)

If you are right that they have stopped Combidex altogether, then I wonder if the programme I saw was a repeat or if they ahve started it again or started it using something different(or cheaper)

Hopefully I (and as many of us as possible) will stay in the zero club for ever, but should we not then it would be nicer to think that there was still such an accurate tool available.

Odd you say it's stopped becasue on the 16th March 2011 the Dutch Prime Minister opened the new "Prostate MR Centre of Excellence" at St Radboud's Universirty Medical Center in Nijmegen where Dr Barentsz is based.

further "reading" see the medical centre's info in English:

www.umcn.nl/Research/Departments/Radiology/Pages/default.aspx

and
www.umcn.nl/Zorg/Afdelingen/Radiologie/Documents/MRI%20in%20PCa%20PCRI%20Insights%20short%20(2).pdf

There is a video (in Dutch) at the site, but you might find it informative, even though they only show a few short clips of the imaging. (The reporter uses the anaolgy of how Dutch Customs officers use scanners to search suspect containers for weapons and explosives)
And you can all enjoy listening to them speaking Dutch.turn

Key comments by Dr B in the report are that he can use the new scanner to more accurately aim biopsy needles and also to find mets if they are bigger than 3mm in diameter.
The report also says that he has recently been given a subsidy and that this will allow the scanning procedures to be "exported" to other hospitals in Holland.

Hope this is interesting.

Alf

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 5/12/2011 11:55 AM (GMT -6)   
Alf,
I spoke to Dr Barantsz for about two hours and he is a very interesting guy. He is the head of the International Radiological Society and decided years ago to concentrate his research on Prostate Cancer, developing better imaging devices to identify where the disease is through various forms of MRI imaging.
St Radboud is an amazing hospital, it's huge. I was impressed with the Dutch heath care system as it is semi private and everyone must have health insurance. After my initial consultation with Dr Barentsz, he wanted to continue the converstation and he said he would administer the imaging agent instead of the tech, so I got to spend another hour with him as he explained all the different things he was working on and contributed a lot to my knowledge base on PC. He is a regular guy and doing the work that a tech should be doing impressed me. If you want to know anything about MRIs or detection of PC he is definately the guy to go to.
JohnT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.
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