Advanced Cancer and waiting...

Hi Georges...thanks for the good wishes...yes, we'll see with the scan!

I continue to be blessed with world class research teams that are willing to work with me.  My visit this week was regarding my PET/CAT scans and they are weighing three options and interesting enough they want to do surgery and if you understand the below that is realistically the only option to move forward but we will see what the Gods decide in the next 2 months…

Net, net my cancer remains in the original space after surgery, radiation, Lupron and has started to block/invade my right Ureter.  The professor I am blessed to have an interest in me has never seen this from my understanding…

On a side note, Kaiser was my provider up to December 31, 2010 for the last 4 years.  All these items below were not identified( eg nodules in my lungs, sever calcification in my heart as noted, etc) Their care begs the question of their marketing term “thriving”…. 

 Impressions:

1.  Likely recurrence of disease within the right prostatectomy bed, as described. New mild dilation of the right collecting system may be represent invasion verses mass effect on the right ureter.  

 2. Solid nodules in the right middle and lower lobe measuring up to 8 mm, without increased radiotracer uptake. Continued follow up per oncologic guidelines.  

 FINDINGS: 

Prostate bed: Apparent new soft tissue lesion within the right prostatectomy bed, adjacent to the distal right ureter, measuring 1.6 x 1.4 cm (series 401image 240) with invasion verses mass effect on the ureter and associated increased radiotracer uptake. Regional lymph nodes: No evidence of pelvic lymphadenopathy. 

 Distant sites of disease:  

 Extrapelvic nodes: No evidence of extra-pelvic lymphadenopathy. 

 Bones: No evidence of osseous metastases.      

 Soft tissue metastases: No evidence of soft tissue metastases. 

CT findings:  

 Head and neck:   Physiologic radiotracer uptake is noted in the salivary glands.  No evidence of receptor positive metastasis.  

 Chest:   No foci of receptor positive metastatic disease.   

8mm solid pulmonary nodule along the right minor fissure (series 401, image 59) and solid 6 mm nodule (not definitely visualized in 2/17/2014) in the right lower lobe (series 401, image 82), without increased radiotracer uptake.  

Severe calcifications of the left anterior descending coronary artery. 

 Abdomen/Pelvis:   No focal uptake is noted in the pelvic or retroperitoneal nodes.   

Compared to 2014, new right renal pelviectasis and hydroureter. Adrenals unremarkable.  Normal uptake is noted in the kidneys as with expected prominent urinary excretion of radiotracer.  

 Interval changes compatible with radical prostatectomy and pelvic lymph node dissection. Scattered colonic diverticuli without evidence of diverticulitis. Mild to moderate calcifications of the abdominal aorta and its associated branches. 

 Musculoskeletal:   No foci of receptor positive osseous metastatic disease. 

 Level degenerative changes. Reversal of the normal cervical lordosis.

 FINDINGS:

Prostate bed: Apparent new soft tissue lesion within the right prostatectomy bed, adjacent to the distal right ureter, measuring 1.6 x 1.4 cm (series 401image 240) with invasion verses mass effect on the ureter and associated increased radiotracer uptake.

Regional lymph nodes: No evidence of pelvic lymphadenopathy.

 Distant sites of disease:

Extrapelvic nodes: No evidence of extra-pelvic lymphadenopathy.
Bones: No evidence of osseous metastases.
Soft tissue metastases: No evidence of soft tissue metastases.

CT findings:

Head and neck: Physiologic radiotracer uptake is noted in the salivary glands. No evidence of receptor positive metastasis.

Chest: No foci of receptor positive metastatic disease.
8mm solid pulmonary nodule along the right minor fissure (series 401, image 59) and solid 6 mm nodule (not definitely visualized in 2/17/2014) in the right lower lobe (series 401, image 82), without increased radiotracer uptake.
Severe calcifications of the left anterior descending coronary artery.


Abdomen/Pelvis: No focal uptake is noted in the pelvic or retroperitoneal nodes.
Compared to 2014, new right renal pelviectasis and hydroureter. Adrenals unremarkable. Normal uptake is noted in the kidneys as with expected prominent urinary excretion of radiotracer.
Interval changes compatible with radical prostatectomy and pelvic lymph node dissection. Scattered colonic diverticuli without evidence of diverticulitis. Mild to moderate calcifications of the abdominal aorta and its associated branches.

Musculoskeletal: No foci of receptor positive osseous metastatic disease.

Level degenerative changes. Reversal of the normal cervical lordosis.

IMPRESSION:

1. Likely recurrence of disease within the right prostatectomy bed, as described. New mild dilation of the right collecting system may be represent invasion verses mass effect on the right ureter.

2. Solid nodules in the right middle and lower lobe measuring up to 8 mm, without increased radiotracer uptake. Continued followup per oncologic guidelines.

VascodaGama said:

Consider being blessed

Hi,

Hilton

Your PET/CT results are similar to mine indicating malignancy at the prostate bed which was radiated during the SRT. I wonder what will be your doctors at UCFS suggesting in view of the previous RT attack at the area.

In my case, apart from the series of image studies they took also into consideration the results from colonoscopies and cystoscopies done along the years after radiation of Dec 2006. They identified cystitis and proctitis (scar tissues) caused by the radiation, turning down the possibility in having further radiation at the area. The PSMA PET did not specify any thing at the ureters or bladder because the image was blurred due to the radiotracer uptake expected in the urinary excretion, however, the 18F Choline PET scan done one year previous to this exam shown the area clean for the exception to the portion at the prostate bed identified by both PETs. My uro-oncologist exposed my case to the hospital's weekly reunion of Consensus Health Medical Group (in which he belongs) and their opinion was to not further radiate de area. My situation was then classified as systemic.

Surely not all guys following further treatment post SRT were found with malignancy at the areas previously treated. Many found spots at other locations and did the oligometastatic treatment successfully. But I know at least two survivors of this forum that radiated the same area of the SRT safely. I do not know what kind of consequences they can expect to occur in the future.

I hope you report again about the decisions taken by your team at the UCFS. In my opinion one should consider the quality of life not just the means for cure.

Best wishes in your continuing journey.

Thinking of you.

VGama

Hey VGama...Yes, amen to the quality of life and it appears you've done well in that area... I'll share what the committee recommends  with all.... as always, thank you for your input and time

VGama....yes, my surgeon is telling me this could be the better path based on my situation.  A couple of complications could be a potential blocking of  my right ureter due to the radiation scaring, which he would unblock with a balloon (minor surgery) or could require a reattached of my ureter higher up on my bladder...or worse case the radiation doesn't eradicate the cancer and he had to try and cut out the cancer, remove a piece of my bladder and reattach my ureter to my bladder with surgery...at the end of the day, having choices are a blessing... the only thing I don't like is the 4 months of lupron with branchtherapy... as always,, thank you for your feedback 

eonore said:

Thank you

Hilton,

I really want to thank you for sharing your journey with us.  I hope that this innovative approach does the trick!  Your case also shows how important it is to treat at a top notch institution.

Eric

Eric...everyone of us have a story to tell.  This site has been a great place for information and relationships...being treated at a teaching hospital is something I would recommend.  I've been cut, poisoned (lupron), radiated and blessed to be radiated again...If it weren't for VGama sharing a study with me, I never would have called UCSF to ask about a newer treatment...if I hadn't, I wouldn't known of my current complications and in process for a new treatment...as we all know, choices are good news in the cancer journey...you are also your best and biggest advocate..all the best in your journey...

bdhilton said:

Where oh where could the bandit be...

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  Hi VGama....my scan mix was gallium PSMA (Ga-68) and 
  

  
  
  
  
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  iohexoL (OMNIPAQUE)...my attending surgeon was surprised it wasn't in my closest lymph node(s) after the scan and I'm forwarding your study to his nurse.  This beast continues to be full of surprises and yes, a little disappointed it's  location hasn't been pinpointed...I'm not concerned about losing my medical team...I've got them baffled at the moment...thanks for the input and kind words...all the best to all of us-BDH

  
  

   

  
  
  
  

VGama...yes, another biopsy is being scheduled and they are pretty sure the cancer is there  but without a positive this next biopsy there will be no moving forward with anything but lupron...not to offen in life when you hope for a positive....