Totally New Guy - Biopsy or MRI

2»

Comments

  • mstoriop
    mstoriop Member Posts: 43 Member
    edited March 2017 #22

    Great news

    The result from JH lowers your risk for metastatic disease. At first look, CK may be enough in your case and you could schedule it definitively after receiving that final confirmation with the 3T MRI. I cannot see the point in extending the time to treat once you got the details in hand.

    While waiting, you may investigate on the benefits you could gain from a combination of HT plus S8RT. In such a case you should start HT at least two months prior to RT.

    Best,

    VG 

    HT Therapy

    Thanks for the input Vasco.  The first RO did suggest the possibility of a short course HT and inferred that decision would be looked at after the MRI.  I will pose the same questioning next week with the CK hospital's RO.  Since my post yesterday the Urologist office called and asked about scheduling an MRI and bone scan.  I told them that I was already on for the 3T MRI and was going to hold on the bone scan.  The RO did not think the bone scan was necessary at the moment.  Would it be your thought that since I am in the test/discover/decide mode that a bone scan would be beneficial?  For whatever it's worth I have absolutely no bone or body pains of any sort and no urinary probs.  I had to stretch to give myself a 3 on the AUA Symptom Score Sheet.  Thanks very much.  

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,803 Member
    Same

    ms,

    I'm glad things are moving along and that you are consolidating on your choice for Cyberknife.

    My Gleason was a 6 (on the cores that were positive), and my volume was limited, and both my surgeon and radiation oncologist told me that a bone scan would be a waste of  time and money, given my particulars.  Because I chose surgery, I received no MRI either, and the patholigist's report proved that there had been no need for that either. 

    "Pain," except in the UT, is virtually never encountered in PCa patients, unless they are highly involved with metastatic growth. My point is that the absence of pain, clinically, is not indicative of much in early-stage PCa.

    You have studied this a lot. Combined with your reasonable and calm attitude, you should be PCa-free soon, for life.

    max

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,339 Member
    mstoriop said:

    HT Therapy

    Thanks for the input Vasco.  The first RO did suggest the possibility of a short course HT and inferred that decision would be looked at after the MRI.  I will pose the same questioning next week with the CK hospital's RO.  Since my post yesterday the Urologist office called and asked about scheduling an MRI and bone scan.  I told them that I was already on for the 3T MRI and was going to hold on the bone scan.  The RO did not think the bone scan was necessary at the moment.  Would it be your thought that since I am in the test/discover/decide mode that a bone scan would be beneficial?  For whatever it's worth I have absolutely no bone or body pains of any sort and no urinary probs.  I had to stretch to give myself a 3 on the AUA Symptom Score Sheet.  Thanks very much.  

    .

    The American Urological Association does not recommend a bone scan for those who have a Gleason less than 8. 

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,339 Member
    edited March 2017 #25

    Same

    ms,

    I'm glad things are moving along and that you are consolidating on your choice for Cyberknife.

    My Gleason was a 6 (on the cores that were positive), and my volume was limited, and both my surgeon and radiation oncologist told me that a bone scan would be a waste of  time and money, given my particulars.  Because I chose surgery, I received no MRI either, and the patholigist's report proved that there had been no need for that either. 

    "Pain," except in the UT, is virtually never encountered in PCa patients, unless they are highly involved with metastatic growth. My point is that the absence of pain, clinically, is not indicative of much in early-stage PCa.

    You have studied this a lot. Combined with your reasonable and calm attitude, you should be PCa-free soon, for life.

    max

    .

    Max,

    By the way, I'm glad that that you are having zero PSAs, and everything went well with the surgery that you had, however, pllease note that a T3 MRI would have been appropriate for you before receiving sugery. The MRI is helpful in making the "best" decision.  

    Thanks for all the wonderful posts that you give to this forum.

     

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,803 Member
    MRI

    Thanks H & O.

    My doctors both viewed my case as quite minor and unproblematic. But it is a good corrective to know that an MRI is of value before even seemingly minor cases of PCa.

    Thanks again,

    max

  • VascodaGama
    VascodaGama Member Posts: 3,638 Member
    edited March 2017 #27
    Preventive purposes

    MS,

    I agree with your RO and the survivours above. Your data doesn't lead to think that you got PCa in bone. Most probably a bone scan this time would not identify lesions that could relate to cancer. However, any protuberance has higher probability of being identified when radiologists compare images with previous ones. A bone scan done now may signify little in your present diagnosis but it would be of great value in future occurrences, if any. Surely, the 3T MRI would be sufficient in such future image comparison of the pelvic area. Bone scans cover the whole body bones (including joints and diagnosis of arthritis). Substitutes are PET and CT scan (X-rays).

    I would add, that many of us (young fellas above the 65) think being fit, symptom less, etc, and become surprised when found with cases of bone loss (osteopenia/osteoporosis), cardiovascular deficiencies, liver and kidney impairments, etc. I think that PCa patients should undertake a series of cautionary tests and exams to ascertain of ones real health status in all fronts. In my case along the years with PCa, I was found with osteopenia, high blood pressure and most recently renal deficiency (stage 3). All these may interfere with PCa care. Many prefer to enjoy life and treat when the problem arises. I make part of that "silly group" that prefer to know in advance what to expect.

    Best,

    VG

     

  • mstoriop
    mstoriop Member Posts: 43 Member
    edited March 2017 #28
    Another Update

    Ok Fellas I'm back at the well again.  I had a consultation with another RO today.  Hopefully my last due diligence ordeal.  The RO was unbelievable with time and discussion, as was the first RO for that matter, but he was great spending over an hour with me.  As mentioned above this is the hospital that has cyberknife and that is and has been what I am leaning towards.  The RO has been there since 2007.  The hospital has had cyberknfe since 2004.  They have done "countless" procedures per the RO without really investigating.  He approximates at least 100 per year more all the time.  One question I have from the group here is equipment.  The cyberknife is original equipment (2004) but has all modernizations, mechanical and software as put forth by Accuray.  Not sure if this is an uneasy point or not.  Another cyberknife facility in my area has equipment only one year newer apparently so maybe I'm overthinking?  This hospital is building a whole new oncology facility and they are installing new state of the art True Beam.  The RO was terrifically honest talking about how money talks and that the cyberknife was not going to the new building but was staying where it is and active.  Except his honest thoughts on how money talks and he could see the cyberknfe going away sooner or later (fall maybe).  He also was honest about his preference for cyberknife over True Beam only to the extent of the massive amount of personal, industry and hospital data they have versus what they are going to.  Apparently there is work on using the True Beam for larger fractions smaller number of visits like cyberknife but not as much info on it.  He also said the CK treatments may be more like 2-3 hours not the one hour I keep reading about so opinions appreciated here what has been your experiences.  Also his pretty much general protocol is a diagnosis stage of CT scan and bone scan.  Then if all well for using CK place the fiducials.  After fiducials then another CT scan and an MRI to plan the treatment.  Seems reasonable but opinions inserted here please.  He then does 5 treatments pretty much every other day, which I like, using 36.26 Gy.  Other than any thoughts what I really would like to know is what anyone thinks about the 3TMRI I have scheduled for next Saturday 3/18/17 at the first hospital.  I asked if he could use their results and he said he could but going back to his basic protocol he does use MRI but in a different spot.  I am leaning towards cancelling this MRI and getting my ducks in a row for CK at this facility.  Thank you all once again for your time and interest.         

  • Airbornelarry
    Airbornelarry Member Posts: 1
    Post Surgery PSA 0.12

    Just found this cancer online support group and let me introduce myself. My first name is Larry, age 70, nad I was diagnosed with prostate cancer last August nad had robotic surgry on November 14, 2016. I was informed I had positive margins and would be scheduled for my PSA and the results were shared this week. Hoping for a "non-dectectable" but it was 0.12. My Surgeon/Urologist has scheduled a MRI and PET bone scan for next week. During the review of my PSA he did mention I may need hormone and radiation treatment. Not a fan of the proposed hormone treatment for the adverse side effects. May ask the doctor to conduct another PSA before rushing in for additional treatment but will wait for scan results. Anyone had elevated PSA similar after surgery and what option did you decide upon.

    Larry

    San Diego

    101st Airborne Vietnam Veteran

  • VascodaGama
    VascodaGama Member Posts: 3,638 Member
    Trust your instincts

    MS,

    I agree with Swing above. CK is good and the 3t MRI is a plus in the diagnosis that will confirm your status. Choline based contrast for the exam would still upgrade the image study. I wonder what did the RO told you that made you change your mind. He may be so confident on CK that turn blind to peripherals. Follow your intuintion.

    Best,

    VG

  • VascodaGama
    VascodaGama Member Posts: 3,638 Member
    Larry

    I would suggest you to start your own thread as this post may get lost in the middle. In any case, after failed surgery patients look for salvage treatments that typically involve radiation administered alone or in a combination of radiation plus hormonal. It all depends on one's case and status. Please read this link;

    https://csn.cancer.org/comment/1414101#comment-1414101

    Best wishes and luck.

    VG 

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    mstoriop said:

    Another Update

    Ok Fellas I'm back at the well again.  I had a consultation with another RO today.  Hopefully my last due diligence ordeal.  The RO was unbelievable with time and discussion, as was the first RO for that matter, but he was great spending over an hour with me.  As mentioned above this is the hospital that has cyberknife and that is and has been what I am leaning towards.  The RO has been there since 2007.  The hospital has had cyberknfe since 2004.  They have done "countless" procedures per the RO without really investigating.  He approximates at least 100 per year more all the time.  One question I have from the group here is equipment.  The cyberknife is original equipment (2004) but has all modernizations, mechanical and software as put forth by Accuray.  Not sure if this is an uneasy point or not.  Another cyberknife facility in my area has equipment only one year newer apparently so maybe I'm overthinking?  This hospital is building a whole new oncology facility and they are installing new state of the art True Beam.  The RO was terrifically honest talking about how money talks and that the cyberknife was not going to the new building but was staying where it is and active.  Except his honest thoughts on how money talks and he could see the cyberknfe going away sooner or later (fall maybe).  He also was honest about his preference for cyberknife over True Beam only to the extent of the massive amount of personal, industry and hospital data they have versus what they are going to.  Apparently there is work on using the True Beam for larger fractions smaller number of visits like cyberknife but not as much info on it.  He also said the CK treatments may be more like 2-3 hours not the one hour I keep reading about so opinions appreciated here what has been your experiences.  Also his pretty much general protocol is a diagnosis stage of CT scan and bone scan.  Then if all well for using CK place the fiducials.  After fiducials then another CT scan and an MRI to plan the treatment.  Seems reasonable but opinions inserted here please.  He then does 5 treatments pretty much every other day, which I like, using 36.26 Gy.  Other than any thoughts what I really would like to know is what anyone thinks about the 3TMRI I have scheduled for next Saturday 3/18/17 at the first hospital.  I asked if he could use their results and he said he could but going back to his basic protocol he does use MRI but in a different spot.  I am leaning towards cancelling this MRI and getting my ducks in a row for CK at this facility.  Thank you all once again for your time and interest.         

    Overthinking?

    FWIW, I think you are overthinking the process. 

    What your RO described is pretty typical of the CK procedure.  Not sure what you're talking about in terms of 2-3 hours.  The 5 treatments I had (as I recall) only took about 30 mins each, which fits w/in your 2-3 hr parameter if that's what you mean.

    Don't think it matters that the CK equipment was made in 2004, as long as the equipment has been properly maintaned and the software has been regularly updated, which I assume it has been done since the equipment it is being used regularly with apparent success.

    Not sure what your concern about the 3T MRI that you have scheduled.  If you don't have to pay for it yourself, it certainly can't hurt.  it will identify the location of the cancer and determine if any of it has leaked out of the prostate, which will tell you whether CK would be suitable for treatment or not.

    However, you will still need to do the MRI/CT scans before/after placement of the gold fiducials in your prostate because the program uses those to properly align and aim the equipment for delivery of the radiation.

     

     

  • mstoriop
    mstoriop Member Posts: 43 Member
    edited March 2017 #33
    Thanks

    Thank you Swing and VG.  The second RO didn't really say anything to change my thinking on the MRI.  I just thought that if an MRI was part of the protocol in the process and hospital I am choosing the first MRI at a different hospital may be redundant.  Thinking on it over the weekend and considering your thoughts also I think I'm going to go ahead and do it.  If nothing else it can serve as another chunk of good data.  I suppose I am reaching a little on the age of the equipment.  Not like a car or some other type of consumer commodity that wears out quickly.  As far as the 2-3 hours I did ask if this is per treatment as I was very surprised.  He did say that was per treatment and that in some cases they had to stop and change an iris and they could stop for bathrooom breaks whatever.  I'm not concerned about the time involved maybe he's talking from the time you walk in the door to leave.  I think when I heard equipment from 2004 and 2-3 hours it made me pause a little considering all that I have read. Has anyone found or heard anything about using the True Beam process with the higher fraction lower amount of visits i.e. CK?    

  • mstoriop
    mstoriop Member Posts: 43 Member
    CK versus True Beam

    Partially answered my own question for anyone searching similar.  Should have known I'd find good info right here.

    https://csn.cancer.org/node/299641

     

  • Old Salt
    Old Salt Member Posts: 1,284 Member
    mstoriop said:

    CK versus True Beam

    Partially answered my own question for anyone searching similar.  Should have known I'd find good info right here.

    https://csn.cancer.org/node/299641

     

    Good discussion

    The thread that mstoriop mentioned does present a good discussion of two instruments that can be used to deliver SBRT. The point that I want to make is that what is most important is the experience of the team associated with the 'machine', not the 'machine' itself.

  • mstoriop
    mstoriop Member Posts: 43 Member
    Update

    I hesitate to add many posts here as I have not had any treatments yet but I do hope this thread helps other new guys in their particular thought processes.  I did have the 3T MRI done and to the extent of it's precision have no evidence of lesion outside of the capsule and no evidence of lymph enlargement or involvement so reasonably good news.  As mentioned in so many posts here I heartily agree that second biopsy opinions and these types of tests should be done as part of your due diligence.  I have met with a total of 5 different doctors at four seperate hospitals, 2 Urologists and 3 RO's.  In my case all five were extremely unbiased and took great effort to explain all treatments and their effects.  One RO just about spent more time talking about surgery than his own specialty. It is time consuming but well worth it to get multiple answers to the same questions.  I am very fortunate to have two Cyberknife facilities of equal quality close to where I live.  Surgery for me was off the table from the get go unless absolutely warranted.  For me it came down to learning as much as I could about all of the radiation alternatives and comparing them to CK, which I had and still do have my bias to.  I have chosen CK and the facility.  Basic planning is underway but actual schedule of treatment not cut in stone yet and may be in mid June.  Thanks to everyone who has helped me to date.  If anyone who reads this feels I can help I most assuredly will.  Cheers.    

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    edited April 2017 #37
    mstoriop said:

    Update

    I hesitate to add many posts here as I have not had any treatments yet but I do hope this thread helps other new guys in their particular thought processes.  I did have the 3T MRI done and to the extent of it's precision have no evidence of lesion outside of the capsule and no evidence of lymph enlargement or involvement so reasonably good news.  As mentioned in so many posts here I heartily agree that second biopsy opinions and these types of tests should be done as part of your due diligence.  I have met with a total of 5 different doctors at four seperate hospitals, 2 Urologists and 3 RO's.  In my case all five were extremely unbiased and took great effort to explain all treatments and their effects.  One RO just about spent more time talking about surgery than his own specialty. It is time consuming but well worth it to get multiple answers to the same questions.  I am very fortunate to have two Cyberknife facilities of equal quality close to where I live.  Surgery for me was off the table from the get go unless absolutely warranted.  For me it came down to learning as much as I could about all of the radiation alternatives and comparing them to CK, which I had and still do have my bias to.  I have chosen CK and the facility.  Basic planning is underway but actual schedule of treatment not cut in stone yet and may be in mid June.  Thanks to everyone who has helped me to date.  If anyone who reads this feels I can help I most assuredly will.  Cheers.    

    Good luck!

    I obviously support your decision because it was the same as mine. 

    Glad that you came to that choice in your own way.  I hope that the outcome for you is as good as it was for me and others on this forum.  Keep us informed about your progress. 

    Good luck!

  • VascodaGama
    VascodaGama Member Posts: 3,638 Member
    An educated decision

    Many should follow your principles. Educate first then analyze options and decide.

    Crossing fingers in your favor. Best wishes for a successful outcome.

    VG