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Low Gleason, not aggressive, mets to bone?

Tdoyle
Tdoyle Member Posts: 36

Hello, new here. I am 53 years old and in June I had my yearly check up and found to have a PSA blood test of 5.56. Was refered to a urologist and she wanted to do a biopsy. This biopsy showed 1 of 12 cores positive with a gleason score of 3+3 .... After finding this out I went to my doctor again to keep him up to date. Me being paranoid about the spread of cancer after losing 2 friends in the last year, my doctor refered me to an oncologist that scheduled me for a ct and bone scan....well the radiologist findings have multiple sclerotic lesions consistant with bony metastasis... After this wanted a 2nd opinion and another doctor did a biopsy of 24 core and 7 were positive with all being a gleason score of 3+3 and not an aggressive cancer.... so now waiting on a pet scan result.....Question, can it spread to the bone at those low readings ?? Like I said I'm confussed on all this as I am sure everyone has been and just can't stop worring and wondering what the future holds....Anyway thank you all for taking time to read my rambling

«13

Comments

  • Clevelandguy
    Clevelandguy Member Posts: 711
    More tests??

    Hi,

    I would think you would want to run more tests to verify that the lesions are cancerous.  From what I read briefly some lesions can be cancerous, some not.  Need to get a definative diagnosis before moving forward.  To answer your question I guess it could spred to your bones but a 3+3 is not very agressive.  A MRI might also help pinpoint what the lesion is.

     

    Dave 3+4

  • Pathology

    Tdoyle,

    Do you have a copy of your biopsy reports ? If not, get them.  

    The report will state whether capsular escape appears to have occured. It will also state if there is perineural involvement (potential escape inside the sheathing around the nerves in the gland).   If both are negative with a saturation 24 core biopsy, then the lesions being cancerous is profoundly unlikely with your low Gleason and PSA.  As Cleveland noted, your case demands additional testing,

    max

  • VascodaGama
    VascodaGama Member Posts: 3,429 **
    Be positive

    Tdoyle,

    I think you should wait for the PET report and probably get a second opinion on the BS results. Can you tell the location of the lesions (which part/s of the body)?

    What did the urologist comment on the DRE?

    This is a scared moment that we all PCa survivors also have experienced. You will overcome it. Be positive. By tradition, surgery and radiation are the recommended therapies in contained cases (cancer whole within the gland). When it is localized but not contained (for instance with confirmed mets in bone) then radiation is the best to assure cure. Some guys decide on a palliative approach for avoiding the risks and side effects of the radicals. Hormonal treatment is recommended when the spread is wide.

    Let us know about the contents of the reports to provide you with better advices.

    Best wishes,

    VG

  • Tdoyle
    Tdoyle Member Posts: 36
    edited October 2017 #5

    More tests??

    Hi,

    I would think you would want to run more tests to verify that the lesions are cancerous.  From what I read briefly some lesions can be cancerous, some not.  Need to get a definative diagnosis before moving forward.  To answer your question I guess it could spred to your bones but a 3+3 is not very agressive.  A MRI might also help pinpoint what the lesion is.

     

    Dave 3+4

    MRI

    My doctor has scheduled a MRI in Feb. for just the prostate because he said right now it would be full of blood nd could'nt tell anything about it....I am still waiting on results from the PET scan from last Thursday.

  • Tdoyle
    Tdoyle Member Posts: 36

    Pathology

    Tdoyle,

    Do you have a copy of your biopsy reports ? If not, get them.  

    The report will state whether capsular escape appears to have occured. It will also state if there is perineural involvement (potential escape inside the sheathing around the nerves in the gland).   If both are negative with a saturation 24 core biopsy, then the lesions being cancerous is profoundly unlikely with your low Gleason and PSA.  As Cleveland noted, your case demands additional testing,

    max

    The biopsy report says. No perineural invasion, No Tumor in the extraprostatic adipose tissue is identified......Do not see anything about capsular escape.  Hoping to hear back from the doctor on pet scan today.

  • Tdoyle
    Tdoyle Member Posts: 36
    edited October 2017 #7

    Be positive

    Tdoyle,

    I think you should wait for the PET report and probably get a second opinion on the BS results. Can you tell the location of the lesions (which part/s of the body)?

    What did the urologist comment on the DRE?

    This is a scared moment that we all PCa survivors also have experienced. You will overcome it. Be positive. By tradition, surgery and radiation are the recommended therapies in contained cases (cancer whole within the gland). When it is localized but not contained (for instance with confirmed mets in bone) then radiation is the best to assure cure. Some guys decide on a palliative approach for avoiding the risks and side effects of the radicals. Hormonal treatment is recommended when the spread is wide.

    Let us know about the contents of the reports to provide you with better advices.

    Best wishes,

    VG

    Trying to be positive

    I have had like  2 urologist and a prostate urologist do a DRE in the last 2 months and all say everything is good, they dont feel anything wrong and it isnt enlarged... The sclerotic lesions were  on a couple ribs and sternum and 2-3 mm seen in L5 and L1 , the radiologist said the spots are to small to do a biopsy.

  • Clevelandguy
    Clevelandguy Member Posts: 711
    Rib lesions

    Hi,

     

    If you look into bone lesions they can come from old injuries also, so that could be the ones in your case(I hope).  Just a thought.......

    Dave 3+4

  • Tdoyle
    Tdoyle Member Posts: 36
    edited October 2017 #9
    update

    Got the call from my oncologist about the pet scan. they are curious about a spot on the right 9th rib...They said it doesnt add up and they think like yall do about a previous injusy...But he is going to scheduke me an appointment with an orthopidic oncologist to maybe do a biopsy of that rib to find out for sure....so holding of  on treatment for prostate cancer until those results. So hopefully it is good and I can breath again... Thanks for all replies , its comforting hearing from you guys

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 **
    Of course follow through by

    Of course follow through by doing a biopsy based on the results of the pet scan......be advised that the American urological association does not recommend a bone scan for patients with a Gleason under ,8, since it is very unlikely for prostate cancer to spread to the bone

     

     

    In the cores that were positive with a Gleason 6, I wonder what was the involvement for each core, that is what percent of each core was cancerous.

     

    Many do not consider a Gleason 6 to be a cancer, and Gleason 6 ,does not metastasize , however more significant cancer can be found when there is a large amount of gleason 6 cancer found.

     

  • Tdoyle
    Tdoyle Member Posts: 36

    Of course follow through by

    Of course follow through by doing a biopsy based on the results of the pet scan......be advised that the American urological association does not recommend a bone scan for patients with a Gleason under ,8, since it is very unlikely for prostate cancer to spread to the bone

     

     

    In the cores that were positive with a Gleason 6, I wonder what was the involvement for each core, that is what percent of each core was cancerous.

     

    Many do not consider a Gleason 6 to be a cancer, and Gleason 6 ,does not metastasize , however more significant cancer can be found when there is a large amount of gleason 6 cancer found.

     

    percentage

    of the 7 positive cores 2 were 40% , 1 at 15% ,  3 at 10%  and 1 at 2%

  • ASAdvocate
    ASAdvocate Member Posts: 164
    Your 7 cores out of 24 equate

    Your 7 cores out of 24 equate to about 29 percent of the total. Because the original guidelines used only six core biopsies, there are newer criteria that use the percentage of total cores that are positive, not the actual number. I have seen active surveillance criteris that specifiy selection if under 34 percent.


    So, you may have a low risk case of prostate cancer, and not be in any rush to treat it.

    Were all the positive cores on one side of the prostate, or both?

  • Tdoyle
    Tdoyle Member Posts: 36
    edited October 2017 #13

    Your 7 cores out of 24 equate

    Your 7 cores out of 24 equate to about 29 percent of the total. Because the original guidelines used only six core biopsies, there are newer criteria that use the percentage of total cores that are positive, not the actual number. I have seen active surveillance criteris that specifiy selection if under 34 percent.


    So, you may have a low risk case of prostate cancer, and not be in any rush to treat it.

    Were all the positive cores on one side of the prostate, or both?

    cores

    right lateral and right apex and right mid

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 **
    Second opinion on pathology by world class expert

    Determining Gleason scores and the amount in each core are subjective....there is a difference between the skills of,  and facilities that pathologist use.

    Here is a very recent discussion with a man under similar circumstances as you.

    Second opinion of pathology is important when low risk disease is found.

    He was advised to have a second opinion with Johns Hopkins.

    https://csn.cancer.org/node/312499

  • Tdoyle said:

    The biopsy report says. No perineural invasion, No Tumor in the extraprostatic adipose tissue is identified......Do not see anything about capsular escape.  Hoping to hear back from the doctor on pet scan today.

    Different terminology

    Tdoyle, 

    The statement "No tumor in the extraprostatic adipose tissue..."  in effect means "no capsular escape," just different terminology.

    I read through to the bottom of your thread today, and more and more it seems likely that you have a mild case of early stage PCa, with no metastasis.  We are not doctors, and cannot give medical advice. But impressionistically, this makes sense.

    Continue with all of the tests. I wish you continuing good reports,

    max

  • Tdoyle
    Tdoyle Member Posts: 36
    edited November 2017 #16
    update

    After having the PET scan the results showed a suspicious spot on my right 9th rib and I went to a bone oncologist taday and he is sending me to a radiologist for a biopsy of this small spot on my rib.. They say its possible to spread with such a low gleason of 3+3 and my psa 5.56...but still need to find out what is going on with this rib....also I forgot to say that the first opinion I got from local oncologist and urologist was that it has spread to the bone and my urologist started me on a 4 month Lupron shot....wasnt sure whether to take the shot at that time or not because I was going for second opinion in Little Rock........the urologist and oncologist I go to now in LR say that the Lupron is ok to have taken

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 **
    edited November 2017 #17
    .

    Hi Troy,

     

    Troy,

    I am responding to your question at the thread that you started, since I believe that there is a synergistic effect at this site among those who post here.  

    I suggest that you attend local support group(s).  ustoo.com supports local support groups worldwide, so google them for a location if available.

    You need to research, read books, internet searches, continue to ask questions here.

    Knowledge will allieviate some of the stress that you are experiencing..

    You need to wait until the Nov 20 to see the results of the bone biopsy. If nothing found, you need to get another image test, the 3T MRI which may show extracapsular extension, and suspicious lesions within the prostate; one lobe or two, the radiologist will rank the suspicious lesions be potential aggressiveness...as you mentioned this will be done in February......so no treatment until after the MRI.

    Your urologist recommends surgery (Well is there a bias from the urologist ...urologist do surgery....additionally if you decide to do surgery...there is a difference among surgeons......and outcome.......

    Read about and Interview doctors iof various specialties to include but not limited to radiation onclologist (ask about SBRT---this would be my choice of an active treatment), etc. Speak with a doctor at major center of excellence who specializes in Active Surveillance for an opinion.

    At any rate READ, READ and READ...ask questions here...we are here for you.

     

    "Hello, My name is Troy and you have replied and been helpful with some of my concerns, I have 7 of 24 cores that are a 3+3 gleason score my last psa was 5.56....I had a pet scan done out of my own fear...It showed a suspicious spot on a rib, well I am scheduled for a bone biopsy on the 20th of this month...My urologist I go to said that if the bone biopsy comes out good....He still would recommend removing the prostate... I was wanting your opinion on my situation.....this has all hit me in June of this year and my head swims with what ifs and what needs to be done...I know all cases are different but would like an opinion from someone living this aweful stuff...

    Thank you for your time

    Troy"

  • bassoneman
    bassoneman Member Posts: 58
    Head swiming in what ifs...

    Head swiming in the what ifs..  Wow that is a song I think we all sing here.. 

  • VascodaGama
    VascodaGama Member Posts: 3,429 **
    What are the full PET results?

    I think that by now you already got the bone (9th) biopsy result, but I wonder about the full report on the PET exam. Can you print here their conclusion? Where did the PET locate the highest SUV suggestive of PCa? Also what was the radiopharmaceutical used for the PET exam. Was it PSMA?

    The results from above exams will provide you a conclusive clinical stage from which you can decide on a treatment. Surely the Lupron is OK and would not affect any option on a radical.

    Best wishes in your journey,

    VG

     

  • Tdoyle
    Tdoyle Member Posts: 36
    edited November 2017 #20

    What are the full PET results?

    I think that by now you already got the bone (9th) biopsy result, but I wonder about the full report on the PET exam. Can you print here their conclusion? Where did the PET locate the highest SUV suggestive of PCa? Also what was the radiopharmaceutical used for the PET exam. Was it PSMA?

    The results from above exams will provide you a conclusive clinical stage from which you can decide on a treatment. Surely the Lupron is OK and would not affect any option on a radical.

    Best wishes in your journey,

    VG

     

    PET Results

    Here are the PET scan results, the bone biopsy is to be done the 20th

     

     Impression

    Intense radiotracer activity fusing to right 9th rib sclerotic changes,
    consistent with metastatic disease.


    ------------------------------------------------------------------------
    --------------------------------------------------
    FOR THE PATIENT:
    PET/CT STUDIES ARE COMPLEX, STATE-OF-THE-ART EXAMS WHICH PROVIDE BOTH
    FUNCTIONAL AND ANATOMICAL INFORMATION. THE REPORT BELOW HAS BEEN
    PRODUCED BY THE NUCLEAR MEDICINE PHYSICIAN TO COMMUNICATE IN MEDICAL
    LANGUAGE THE DETAILS OF YOUR FINDINGS TO YOUR DOCTOR. THE RESULTS ARE
    IMPORTANT, BUT ONLY A PART OF YOUR COMPLETE CLINICAL PICTURE. YOUR
    PHYSICIAN CAN BEST HELP YOU UNDERSTAND THEIR SIGNIFICANCE.
    WE ARE HONORED TO PARTICIPATE IN YOUR CARE. THANK YOU.

    THE DIVISION OF NUCLEAR MEDICINE, DEPARTMENT OF RADIOLOGY, UAMS




    Electronically Signed by: Xiaofei Wang on 10/19/2017 at 17:18:14

    Narrative

    EXAM DESCRIPTION:
    PET-CT (NAF) SODIUM FLUORIDE BONE SCAN

    COMBINED PET/CT SCAN:

    10/19/2017

    CLINICAL INDICATION:
    53-year-old gentleman with history of prostate cancer, Gleason score 6,
    initial staging

    RADIOPHARMACEUTICAL (F18-FDG), INJECTION SITE, INJECTION TIME AND SCAN
    TIME, BLOOD SUGAR, HEIGHT, WEIGHT, AND CT RADIATION DOSE (CTDI - MGY),
    DLP (MGY*CM):
    Dose PT 1->13.77mCi NAF; SITE PT1->RAC; INJ Tm-> 2:20 PM; SCN Tm-> 3:20
    PM; BS ->99MG%; HT ->5'8; WT ->175LBS; Oral->Yes; CTDI PT1->2.30; DLP
    PT1->439.37

    PROCEDURE:
    Approximately 60 minutes after intravenous administration of
    18F-FDG, a non-IV-contrast CT was obtained from the Skull vertex to the
    Feet for use in attenuation correction and anatomic localization
    of radiotracer activity. Emission scans were obtained over the same
    anatomical regions. Images were reconstructed and reviewed in the axial,
    coronal, and sagittal planes.

    A low dose CT scan protocol is used for this exam.

    DEVIATIONS FROM STANDARD PROTOCOL:
    No

    COMPARISON:
    No

    CURRENT PET/CT SCAN FINDINGS:
    SUV measurements presented are based on lean body mass unless specified.
    Background metabolic activity with a mean SUV of 0.5 measured in the
    liver.

    Intense radiotracer activity fusing to right 9th rib sclerotic lesion,
    consistent with metastatic disease.

    Moderate radiotracer activity fusing to left 5th and 6th ribs laterally
    with linear pattern, likely post-traumatic changes, correlate patient
    history or evaluate on followup scan.

    Moderate radiotracer activity fusing to left medial epicondyle cortex
    region without definite sclertic changes, nonspecific

    Intense radiotracer activity fusing to right side nasal sidewall,
    nonspecific, likely related to posttraumatic changes.

    Attenuation CT: No suspicious for nodules. No pericardial or pleural
    effusions. No lymphadenopathy. Enlarged prostate. Mild
    atherosclerosis changes.

     

  • VascodaGama
    VascodaGama Member Posts: 3,429 **
    Tdoyle said:

    PET Results

    Here are the PET scan results, the bone biopsy is to be done the 20th

     

     Impression

    Intense radiotracer activity fusing to right 9th rib sclerotic changes,
    consistent with metastatic disease.


    ------------------------------------------------------------------------
    --------------------------------------------------
    FOR THE PATIENT:
    PET/CT STUDIES ARE COMPLEX, STATE-OF-THE-ART EXAMS WHICH PROVIDE BOTH
    FUNCTIONAL AND ANATOMICAL INFORMATION. THE REPORT BELOW HAS BEEN
    PRODUCED BY THE NUCLEAR MEDICINE PHYSICIAN TO COMMUNICATE IN MEDICAL
    LANGUAGE THE DETAILS OF YOUR FINDINGS TO YOUR DOCTOR. THE RESULTS ARE
    IMPORTANT, BUT ONLY A PART OF YOUR COMPLETE CLINICAL PICTURE. YOUR
    PHYSICIAN CAN BEST HELP YOU UNDERSTAND THEIR SIGNIFICANCE.
    WE ARE HONORED TO PARTICIPATE IN YOUR CARE. THANK YOU.

    THE DIVISION OF NUCLEAR MEDICINE, DEPARTMENT OF RADIOLOGY, UAMS




    Electronically Signed by: Xiaofei Wang on 10/19/2017 at 17:18:14

    Narrative

    EXAM DESCRIPTION:
    PET-CT (NAF) SODIUM FLUORIDE BONE SCAN

    COMBINED PET/CT SCAN:

    10/19/2017

    CLINICAL INDICATION:
    53-year-old gentleman with history of prostate cancer, Gleason score 6,
    initial staging

    RADIOPHARMACEUTICAL (F18-FDG), INJECTION SITE, INJECTION TIME AND SCAN
    TIME, BLOOD SUGAR, HEIGHT, WEIGHT, AND CT RADIATION DOSE (CTDI - MGY),
    DLP (MGY*CM):
    Dose PT 1->13.77mCi NAF; SITE PT1->RAC; INJ Tm-> 2:20 PM; SCN Tm-> 3:20
    PM; BS ->99MG%; HT ->5'8; WT ->175LBS; Oral->Yes; CTDI PT1->2.30; DLP
    PT1->439.37

    PROCEDURE:
    Approximately 60 minutes after intravenous administration of
    18F-FDG, a non-IV-contrast CT was obtained from the Skull vertex to the
    Feet for use in attenuation correction and anatomic localization
    of radiotracer activity. Emission scans were obtained over the same
    anatomical regions. Images were reconstructed and reviewed in the axial,
    coronal, and sagittal planes.

    A low dose CT scan protocol is used for this exam.

    DEVIATIONS FROM STANDARD PROTOCOL:
    No

    COMPARISON:
    No

    CURRENT PET/CT SCAN FINDINGS:
    SUV measurements presented are based on lean body mass unless specified.
    Background metabolic activity with a mean SUV of 0.5 measured in the
    liver.

    Intense radiotracer activity fusing to right 9th rib sclerotic lesion,
    consistent with metastatic disease.

    Moderate radiotracer activity fusing to left 5th and 6th ribs laterally
    with linear pattern, likely post-traumatic changes, correlate patient
    history or evaluate on followup scan.

    Moderate radiotracer activity fusing to left medial epicondyle cortex
    region without definite sclertic changes, nonspecific

    Intense radiotracer activity fusing to right side nasal sidewall,
    nonspecific, likely related to posttraumatic changes.

    Attenuation CT: No suspicious for nodules. No pericardial or pleural
    effusions. No lymphadenopathy. Enlarged prostate. Mild
    atherosclerosis changes.

     

    PET/CT (18)F-FDG is not proper for all types of PCa

    Tdoyle

    You need that bone biopsy for a final conclusion on your diagnosis. Unfortunately, the PET/CT (18)F-FDG you did above may not provide the full truth on your PCa case. The Fluorodeoxyglucose (FDG) is not well metabolized by prostate cancer, in particular in cases with confirmed low grade Gleason type which seem to be your case. Your doctor’s choice in this exam may have been to rule out aggressive tumour. On the other end, FDG is superior in diagnosis of very advanced metastasized cases with castrate resistant type of cancers. A 99mTc-labeled-methylene-diphosphonate bone scan may seems to be better for a Gleason 6 patient, when checking for bone metastasis.

    I agree with ASAdvocate comment above. You should not be in any rush to treat without a proper diagnosis. You may even be eligible for AS (active surveillance), postponing a treatment, if such is advisable by a AS specialist.

    Please read below links for better understanding my opinion on the PET/CT exam;

    “…Currently there is no established role for 18F-FDG PET/CT in the assessment of prostatic cancer, since it has a low accuracy owing to the relatively low metabolic rate of the tumor as well as the interfering adjacent urinary excretion of the tracer. However, other new PET radiotracers such as 11C-choline and 18F-fluorocholine have shown promising results in the management of prostate cancer.”

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101722/

    “…(18)F-FDG uptake overlaps significantly between malignant and benign prostatic conditions. Subsequent patient management was not affected by the reporting of incidental focal prostatic uptake in this cohort.”

    https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/99800-clinical-significance-of-prostate-18-f-labelled-fluorodeoxyglucose-uptake-on-positron-emission-tomography-computed-tomography-a-five-year-review.html

    http://emjreviews.com/wp-content/uploads/Role-of-Positron-Emission-Tomography-with-Fluorodeoxyglucose-in-Prostate-Cancer.pdf

    https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/79099-18-f-fdg-pet-ct-and-18-f-naf-pet-ct-in-men-with-castrate-resistant-prostate-cancer-abstract.html

     

    Best wishes,

    VGama

     

  • I had a Gleason score 9 & had

    I had a Gleason score 9 & had open surgery radical prepubic prostatectomy with pelvic lymph node dissection and seven weeks of radiation therapy treatments for cancer spread into my bladder and bone scan and mri of my spine and my radiation doctor said that he thought they looked okay.

    Cat scan and bone scan before removal surgery was supposed to be okay also and the lymph nodes that were removed were negative.

    I want to request a pet scan. That's what everyone tells me to ask for.

    My veterans administration urologist retired last week without notice and gave me prescription for Percocet 10 mg , 150 pills for 30 days and I called for refill like he told me and that's how I found out he retired and they contacted my primary care physician at the local VA outpatient clinic and they refused to write a request for refill and I have been going through withdrawal for three days.

    Hopefully the radiation oncology clinic will request the pet scan because I don't know when they will be getting another urologist at the Chillicothe VA hospital that I go to.

    My psa before removal was only 4.9 & biopsy was Gleason 9.

    So I would say that you probably don't have prostate cancer in your bones but I don't know anything and your doctor will find out for you.

    My Gleason score year before was 4 & that is the cutoff for normal and I must have had the cancer then and since the VA doctor don't do digital rectal examination and only the psa tests caused my cancer to get aggressive and fortunately I hope doesn't come back or spread to my bones.

    I probably had the cancer even longer than that psa test the previous year and my radiation doctor said that he can't determine if I am cancer free using the psa test and my recent psa test was < .01.

    But it was also the same < .01 after removal and before radiation therapy treatments when I still had the cancer in my bladder.

    I know someone who had PSA 2.7 & his biopsy was Gleason 9 aggressive cancer. PSA is not accurate for detecting existing prostate cancer and it takes the biopsy to confirm positive for cancer.

    Thanks and good luck. My life is miserable and I wish it was detected sooner and I could have had radiation therapy instead of the radical prepubic prostatectomy.

    Open surgery gave me a 12 inch incision with over twenty staples and blood clots and fluid in my lungs and hospitalized for two months.

    I wish I could have had the davinci robotic surgery but the Wright Patterson Air Force Base Hospital didn't have one.

    All we can do is hope and pray.

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 **
    Rodger

    Please start a new thread so we can direct our responses to your case only and not infringe on this thread

  • Tdoyle
    Tdoyle Member Posts: 36
    Bone Biopsy

    Got my results back from the bone biospy from the suspicious spot on my rib and it did not show any cancer there...So I am at the point of the decisionof what to do with my 7 of 24 core of a 3=3 gleason score.....Time to do my reading and research on my best option...

  • Old Salt
    Old Salt Member Posts: 834 **
    Great news!

      No metastasis!

  • contento
    contento Member Posts: 75
    wow !

    Tdoyle, what an emotional  turnaround  for you ! Given that new info essentially  all the treatment options ( or not ) are open to you. Like you said research hard so you could make the best choice for your givin situation.

    Does the doc want to rescan in a few months ? or is he/ she satisfied with the biopsy results ?

  • VascodaGama
    VascodaGama Member Posts: 3,429 **
    What to do next?

    I am glad for the news. I like the way you taking in dealing with the problem. At 53 years old you are risking your well being and quality of life. I hope newbies reading your story follow your style.

    I wonder about the location of the seven positive cores identified in the pathologist's report. They are many for the 24 units taken but these could be cores from the same place where the previous biopsy located the solo (1 out of 12) positive core. In such a case your cancer may be a single large tumour (probably a colony of micrometastases for the high PSA they produce), that could be whole contained in the gland (T1c/T2).

    In any case you should consider other important information to incorporate in your final judgment. Can you tell us what made you to have the PSA checked/ Was there any symptom like difficulty in urinating or pain? Have you done a DRE? What was the result? Did the pathologist identify any hyperplasia to justify the high PSA? What is the size of your prostate?

    The low Gleason patterns provides low risks for existing metastases. Gleason rate 3 could also be a lower rate (ex: rate 2) indicating still a lower aggressive type of cancerous cells. With this diagnosis you may chose to treat or follow AS (active surveillance) postponing the treatment while continuing checking the bandit for any progression. At your age I would take the treatment side effects seriously into consideration. Research the details and consequences and involve your family in the final decision.

    Best wishes and luck in your journey.

    VGama

  • Tdoyle
    Tdoyle Member Posts: 36

    What to do next?

    I am glad for the news. I like the way you taking in dealing with the problem. At 53 years old you are risking your well being and quality of life. I hope newbies reading your story follow your style.

    I wonder about the location of the seven positive cores identified in the pathologist's report. They are many for the 24 units taken but these could be cores from the same place where the previous biopsy located the solo (1 out of 12) positive core. In such a case your cancer may be a single large tumour (probably a colony of micrometastases for the high PSA they produce), that could be whole contained in the gland (T1c/T2).

    In any case you should consider other important information to incorporate in your final judgment. Can you tell us what made you to have the PSA checked/ Was there any symptom like difficulty in urinating or pain? Have you done a DRE? What was the result? Did the pathologist identify any hyperplasia to justify the high PSA? What is the size of your prostate?

    The low Gleason patterns provides low risks for existing metastases. Gleason rate 3 could also be a lower rate (ex: rate 2) indicating still a lower aggressive type of cancerous cells. With this diagnosis you may chose to treat or follow AS (active surveillance) postponing the treatment while continuing checking the bandit for any progression. At your age I would take the treatment side effects seriously into consideration. Research the details and consequences and involve your family in the final decision.

    Best wishes and luck in your journey.

    VGama

    7 of 24

    The 7 cores all on the right mid and right side of the prostate.. The urologist thought like you that it is probably a tumer on that side.. I went for my yearly check up and when they did blood work they found my PSA was around 6, I had them check it again a few days later and it was still a 5.6... thats when this all started..I have had a DRE done by 4 differnet doctors along this journey and all said it was normal..I have had non what so ever problems with urination and everything is normal in that area. 

    And thank you VGama for the kind words. I am really considering everything and I am involving the whole family in this. I have to stay around a while. I have 2 daughters ages 16 and 22 that I have to see get married and one graduate high school....

  • VascodaGama
    VascodaGama Member Posts: 3,429 **
    You will be around not just for your children but grandchildren

    Tdoyle,

    Let's be realistic. PCa may be a killing cancer but it takes long and the patient must be in a very advanced status to real get problems from it. This impression comes from the real statistics. One may well expect to die from other causes when his cancer is low aggressive and indolent. In my 17 years as a survivor I have come across of so many cases in all varieties, colors and shapes which makes me to opinion as I do in this forum. Once diagnosed one should try identifying his real status, be vigilant and treat when necessary. Doing nothing is no good and treating thinking that such will close the bad chapter of one's life is a mistake. The bandit is now our unwanted guest. One must do something, done intelligently, timely and in no rush, even if his case is quite advanced.
    Some guys die earlier because of the treatment effects. These effects are real and they did not exist before an intervention. Many times we see us caring more for the effects of a treatment than the cancer itself. It is imperative therefore to know the details of what we are involving in our case.

    Your added information supports my comment in the above post that you may have a contained case. Negative DRE makes it a T1c and the location of all positive cores turns the initial biopsy results (of 1 in 12 cores positive) and the confirmed Gleason 6 as a leading result to recommend AS as the best approach. Active Surveillance implies a vigilant period in a sort of military disciplinary regiment of testing along the patient's life to check on the bandit's developments. It is like our annual health check up but it involves additional testing in shorter periods. It is not easy for those that do not like to sleep with the enemy in the same bed but it avoids the risks and consequences of an intervention without prejudice on the outcomes of a latter attack. Our families will need to educate on the matter too so that no one is apprehended for the fact of having the bandit in the house.

    With the data in hands, any options you chose seem good. I hope you find that peace of mind so deserved after the dramatic period of the diagnosis.

    Best wishes,

    VGama 

     

  • Tdoyle
    Tdoyle Member Posts: 36
    edited December 2017 #30

    You will be around not just for your children but grandchildren

    Tdoyle,

    Let's be realistic. PCa may be a killing cancer but it takes long and the patient must be in a very advanced status to real get problems from it. This impression comes from the real statistics. One may well expect to die from other causes when his cancer is low aggressive and indolent. In my 17 years as a survivor I have come across of so many cases in all varieties, colors and shapes which makes me to opinion as I do in this forum. Once diagnosed one should try identifying his real status, be vigilant and treat when necessary. Doing nothing is no good and treating thinking that such will close the bad chapter of one's life is a mistake. The bandit is now our unwanted guest. One must do something, done intelligently, timely and in no rush, even if his case is quite advanced.
    Some guys die earlier because of the treatment effects. These effects are real and they did not exist before an intervention. Many times we see us caring more for the effects of a treatment than the cancer itself. It is imperative therefore to know the details of what we are involving in our case.

    Your added information supports my comment in the above post that you may have a contained case. Negative DRE makes it a T1c and the location of all positive cores turns the initial biopsy results (of 1 in 12 cores positive) and the confirmed Gleason 6 as a leading result to recommend AS as the best approach. Active Surveillance implies a vigilant period in a sort of military disciplinary regiment of testing along the patient's life to check on the bandit's developments. It is like our annual health check up but it involves additional testing in shorter periods. It is not easy for those that do not like to sleep with the enemy in the same bed but it avoids the risks and consequences of an intervention without prejudice on the outcomes of a latter attack. Our families will need to educate on the matter too so that no one is apprehended for the fact of having the bandit in the house.

    With the data in hands, any options you chose seem good. I hope you find that peace of mind so deserved after the dramatic period of the diagnosis.

    Best wishes,

    VGama 

     

    Thank you

    Thank you for your input, you put it in a way I can understand... I spoke with the nurse of the Oncologist that ordered the Pet scan and he wants me to just come back for the MRI of the prostate that is scheduled in Feburuary. He thinks they got a good sample from the suspicious rib on the bone biospy and confirmed what he thought from the beginning that it was rare for my stage to spread. 

    Its been a journey from going from a Oncologist and Radiologist here in my town to do the scans and say "well you have bone cancer and we are sorry"  to the point I am now... And also I am on Lupron hormone 4 month shot, and will be very glad for this to wear off...and I am looking serious into AS for now...

    Again thank you

  • Tdoyle
    Tdoyle Member Posts: 36
    Bone biopsy results

    Here are the results from the radiologist on the bone biopsy done on 11/20/17

     

     

    Case Report


    Clinical Information
    53 yo M with hx of prostate cancer, presents with 9th right rib lesion.
     
    FINAL DIAGNOSIS


    A. Bone, right 9th rib, biopsy:

    - Abundant woven bone formation and fibrous stroma, negative for carcinoma in this sample; see comment.


    Electronically signed by Matthew R. Lindberg, MD on 11/22/2017 at  1:10 PM
    Comment
    Immunohistochemical stains for pancytokeratin, PSA, and PSAP are performed with adequate controls and found to be negative, providing no support for metastatic carcinoma. However, there is abundant new bone formation suggestive of an osteoblastic process, and given the reported history of prostatic adenocarcinoma, an osteoblastic metastasis cannot be ruled out from this sample. If clinical concern for malignancy persists, additional sampling is recommended.
     
    Gross Description
    Specimen A is received in formalin, labeled with the patient's name, Troy D Doyle, medical record number, 003304000, and 3/2/1964.  The specimen consists of three fragment of tan bone measuring 0.6 x 0.6 x 0.2 cm in aggregate.  Specimen A is submitted entirely inside a yellow biopsy cassette A1.  

    Tierra Holland 
    11/20/2017
     
    Microscopic Description


    Performed if applicable.


     
    Attestation
    Matthew R. Lindberg, MD 
    Electronically Signed on 11/22/2017, 1:09 PM 

    I have reviewed the pertinent gross findings, any and all microscopic slides and the Resident’s/ Fellow’s interpretations.  I have made appropriate editorial changes and have rendered the final diagnosis.