scans before surgery

whipple

My husband had a 4.6 psa and 4+3=7 gleason after biopsy. Surgery set for January 4th. The doctor said they wait 6 weeks after biopsy. The doctor does not think there will be any spread of the cancer, I guess based upon the 4.6 psa. He said if we wanted the cat and bone scan we could have it. I have a email to his primary doctor for his opinion and haven't heard yet. Looking for advice. Thanks

William Parkinson

The best scan you can do is
The best scan you can do is an endorectal MRI. It can show if the cancer is outside the prostate, in particular, if it has gone into the prostatic capsule or seminal vesicles. Given your husband's PSA number, the chance that his disease is systemic is quite low; hence I would expect that any bone scan would appear negative even if there was some minor spread. I insisted that I have one and it was a great feeling knowing that I was a true pT2 patient (that means that the cancer was confined to the gland itself and, therefore, that I could expect great results from the surgery). As mentioned by Ira in another post, there is also a MRIS test, where the ratio of certain metabolites, such as choline/citrate, can be measured. In prostate cancer, certain ratios are turned on their head and an MRIS can show that. Also, there is color doppler, which can show areas of greater blood flow in some areas of the prostate, which demonstrate that a more metabolically active area exists there, which in turn means a tumor is there. All in all, you really don't need anymore at this point than an endorectal MRI. As for waiting that is a must, for the prostate swells after the biopsy and the inflammation needs to subside. Make sure that your surgeon has done at least 250 prostatectomy operations and that he is presently doing at least 50 per year. As many world-class surgeons have commented on, a radical prostatectomy is one surgery that even the finest small details in surgical technique can make a huge difference. This is no appendectomy!!!!! Make sure the surgeon is the best you can get. If your husband has pT3 disease (i.e., the cancer is in the capsule, just beyond the capsule, or seminal vesicles), I would recommend going with the open procedure (this means no laparoscopic or robotic surgery). Having said that, the best option still remains to go with the best, most gifted, most experienced surgeon you can find, no matter what type of approach he uses. I hope this helps and I wish you and your husband the best in his treatment.
Cheers
Bill

2ndBase

Options
If your husband would talk to a radiation expert I'm sure he would find that his recommendation would be to use radiation rather than surgery. This treatment has much less problems with side effects and could be a better option especially if he is 65 or older. I had a psa of 24 and gleason of 9 and all the cancer in my prostate is gone. I knew it had spread before treatment and I my life is winding down now but it is not due to the original cancer that was in the prostate. My father had prostate cancer at age 68 and had radiation and lived to be 90 dying of Alzhimers. I would try to avoid surgery, too many side effects!

whipple

William Parkinson said:

The best scan you can do is
The best scan you can do is an endorectal MRI. It can show if the cancer is outside the prostate, in particular, if it has gone into the prostatic capsule or seminal vesicles. Given your husband's PSA number, the chance that his disease is systemic is quite low; hence I would expect that any bone scan would appear negative even if there was some minor spread. I insisted that I have one and it was a great feeling knowing that I was a true pT2 patient (that means that the cancer was confined to the gland itself and, therefore, that I could expect great results from the surgery). As mentioned by Ira in another post, there is also a MRIS test, where the ratio of certain metabolites, such as choline/citrate, can be measured. In prostate cancer, certain ratios are turned on their head and an MRIS can show that. Also, there is color doppler, which can show areas of greater blood flow in some areas of the prostate, which demonstrate that a more metabolically active area exists there, which in turn means a tumor is there. All in all, you really don't need anymore at this point than an endorectal MRI. As for waiting that is a must, for the prostate swells after the biopsy and the inflammation needs to subside. Make sure that your surgeon has done at least 250 prostatectomy operations and that he is presently doing at least 50 per year. As many world-class surgeons have commented on, a radical prostatectomy is one surgery that even the finest small details in surgical technique can make a huge difference. This is no appendectomy!!!!! Make sure the surgeon is the best you can get. If your husband has pT3 disease (i.e., the cancer is in the capsule, just beyond the capsule, or seminal vesicles), I would recommend going with the open procedure (this means no laparoscopic or robotic surgery). Having said that, the best option still remains to go with the best, most gifted, most experienced surgeon you can find, no matter what type of approach he uses. I hope this helps and I wish you and your husband the best in his treatment.
Cheers
Bill

Scans
Thanks for you information. My husband is 62. The surgeon at Northwestern in Chicago has done 350, more than anyone else at this hospital. He is having the robotic. You've been very helpful.
Best wishes to you
Jude

LBlanks

Here Was My Thought Process
I'm 66, PSA of 4.01 and Gleson score of 6 (3+3) Doc told me prostate cancer is very slow growing so no real urgency in moving forward, but I should do something within 3 months after the biopsy. That was in early October.

I looked into most all the options and based on my situation, chose surgery (robotic). This was done Dec 3rd.

My main reason was that I like to have a backup plan. If I had radiation & Seeds, then surgery was no longer an option. However, if I chose surgerical removal and there was any residual cancer cells, then radiation would still be available to clean up anything remaining.

From everything I've read, lower PSA and Gleson scores combined with the patients age is one of the main factors in making decisions on which process to follow. Basically, the younger the patient, then surgery is the best choice. Different decision process after age 70 and up.

The biggest problem with Prostate cancer is that there are too many options available to chose from. All that can be done is review each one, talk with at least two doctors (I talked with three) and then decide on what is best.

Good luck.

HIFUgal

LBlanks said:

Here Was My Thought Process
I'm 66, PSA of 4.01 and Gleson score of 6 (3+3) Doc told me prostate cancer is very slow growing so no real urgency in moving forward, but I should do something within 3 months after the biopsy. That was in early October.

I looked into most all the options and based on my situation, chose surgery (robotic). This was done Dec 3rd.

My main reason was that I like to have a backup plan. If I had radiation & Seeds, then surgery was no longer an option. However, if I chose surgerical removal and there was any residual cancer cells, then radiation would still be available to clean up anything remaining.

From everything I've read, lower PSA and Gleson scores combined with the patients age is one of the main factors in making decisions on which process to follow. Basically, the younger the patient, then surgery is the best choice. Different decision process after age 70 and up.

The biggest problem with Prostate cancer is that there are too many options available to chose from. All that can be done is review each one, talk with at least two doctors (I talked with three) and then decide on what is best.

Good luck.

wondering....if one does
wondering....if one does radiation and then gets a hernia or some other need for surgery in that area ~~ is it possible? I heard that's the reason docs don't prescribe radiation before age 70....that all surgery isn't possible after radiation. But is this right?

Husband had HIFU and all is great, wonder if you've checked into this option, no pain, no hospital time, very little chance of side effects (no incontinence threat, 19% ED rate - and ED only lasts a short while)

LBlanks

HIFUgal said:

wondering....if one does
wondering....if one does radiation and then gets a hernia or some other need for surgery in that area ~~ is it possible? I heard that's the reason docs don't prescribe radiation before age 70....that all surgery isn't possible after radiation. But is this right?

Husband had HIFU and all is great, wonder if you've checked into this option, no pain, no hospital time, very little chance of side effects (no incontinence threat, 19% ED rate - and ED only lasts a short while)

Clarification...
It's my understanding that "Prostate Surgery" is no longer an option after "prostate seeds and radiation".

I'm sure other necessary surgeries may be done.

gkoper

Scans
I am 65 and had the Davinci after my urologist told me it was organ contained. PSA 5.4.
Got a second opinion from radiation oncoligist. Guess what he recommended?
I like a plan B so I opted for the robot.
My urologist did not mention scans & in my haste, I just wanted it out.
The procedure itself is nearly painless with little blood loss & just a overnight hospital stay. Catherter for a week is a bit like an anchor but no biggy.
My 1st post surgery psa was .3. It should be undetectable. In a few months it was up to .7.

Then I did pet/ct scan that show a suspect spot in the right seminal vesticle area.
Bone scan clear.
I am now doing IMRT therapy.
With my 20/20 hindsight, I would probably go for the HIFU even though it would mean high cost & travel to another country. However, I heard of a local urologist who has done these as a clinical trial. I for sure would have had the scans done before making the big decision. The MRI the gentleman spoke of appears the best available.
With your psa not being so bad............you should have time to really examine the options.....take the time...surgery is permanent.......there are serious side effects.

Do your homework and things will workout well for you.

hopeful and optimistic

bone scan
If I remember corectly , bone scans are not recommended for those with gleasons under 8 by the national urological assoc.....basically the chances of it spreading to the bone is very low........many times doctors recommend this test to those who really do not need it....the MRI/MRS will show if there is any nodule involvement and stage your husbands cancer...by the way the spectroscopy is investigational and not covered by medical insurance...it runs, say 1,000 extra over the MRI along........I had both done at UCLA and I had to pay an exra 900...which was alright with me....it confirmed the treatment option that I took.....Active Surveillance

Ira

biopsy 3/09, 3=3=6, 2 cores positive , less than 5 percent involvement in each. age 66
PSA's 1/09 2.2, 7/09 2.5, 11/09 2.6
4/09 MRI/MRS no nodule involvement, Stage T1
Appr. 9/09 Aureon - Molecular test for aggressiveness analyzed with other factors compared to those who have had prostectomy 8 years out.......shows 97 percent chance that cancer will not spread in eight years time........(this test is an indicator only, since there is a low specificity of detecting aggressive tumors)

randy_in_indy

hopeful and optimistic said:

bone scan
If I remember corectly , bone scans are not recommended for those with gleasons under 8 by the national urological assoc.....basically the chances of it spreading to the bone is very low........many times doctors recommend this test to those who really do not need it....the MRI/MRS will show if there is any nodule involvement and stage your husbands cancer...by the way the spectroscopy is investigational and not covered by medical insurance...it runs, say 1,000 extra over the MRI along........I had both done at UCLA and I had to pay an exra 900...which was alright with me....it confirmed the treatment option that I took.....Active Surveillance

Ira

biopsy 3/09, 3=3=6, 2 cores positive , less than 5 percent involvement in each. age 66
PSA's 1/09 2.2, 7/09 2.5, 11/09 2.6
4/09 MRI/MRS no nodule involvement, Stage T1
Appr. 9/09 Aureon - Molecular test for aggressiveness analyzed with other factors compared to those who have had prostectomy 8 years out.......shows 97 percent chance that cancer will not spread in eight years time........(this test is an indicator only, since there is a low specificity of detecting aggressive tumors)

Hopeful & Opt
I am just now leaving for my Endorectal MRI, I will let everyone know how the results come out after the test and answer any questions one might have.

later

Randy

hopeful and optimistic

randy_in_indy said:

Hopeful & Opt
I am just now leaving for my Endorectal MRI, I will let everyone know how the results come out after the test and answer any questions one might have.

later

Randy

good luck
the test is a good one, and will show where you stand; staging, where there is a cancer in the prostate where is it,one lobe or two, any nodule involvement, etc.

The test itself is an experience as you will find out.

the best
Ira

HIFUgal

gkoper said:

Scans
I am 65 and had the Davinci after my urologist told me it was organ contained. PSA 5.4.
Got a second opinion from radiation oncoligist. Guess what he recommended?
I like a plan B so I opted for the robot.
My urologist did not mention scans & in my haste, I just wanted it out.
The procedure itself is nearly painless with little blood loss & just a overnight hospital stay. Catherter for a week is a bit like an anchor but no biggy.
My 1st post surgery psa was .3. It should be undetectable. In a few months it was up to .7.

Then I did pet/ct scan that show a suspect spot in the right seminal vesticle area.
Bone scan clear.
I am now doing IMRT therapy.
With my 20/20 hindsight, I would probably go for the HIFU even though it would mean high cost & travel to another country. However, I heard of a local urologist who has done these as a clinical trial. I for sure would have had the scans done before making the big decision. The MRI the gentleman spoke of appears the best available.
With your psa not being so bad............you should have time to really examine the options.....take the time...surgery is permanent.......there are serious side effects.

Do your homework and things will workout well for you.

gkoper,
Bummer....and yes,
gkoper,

Bummer....and yes, HIFU can treat the seminal vesticle area. You could have had HIFU now too. After my husband had HIFU our doctor told me that if he had seen cancer outside the gland he would have treated that as well. No one sees cancer during surgery.

good luck

gkoper

HIFUgal said:

gkoper,
Bummer....and yes,
gkoper,

Bummer....and yes, HIFU can treat the seminal vesticle area. You could have had HIFU now too. After my husband had HIFU our doctor told me that if he had seen cancer outside the gland he would have treated that as well. No one sees cancer during surgery.

good luck

HIFU
Why does the FDA drag its feet on approval for this procedure that has helped so many?

Going to Mexico or the Bahamas and spending $30,000 or so out of pocket puts this out of reach for many.

randy_in_indy

hopeful and optimistic said:

good luck
the test is a good one, and will show where you stand; staging, where there is a cancer in the prostate where is it,one lobe or two, any nodule involvement, etc.

The test itself is an experience as you will find out.

the best
Ira

It was yes...an Experience!
Ok, the test was not as easy as I expected....having just done an MRI on my hip two months prior....Mostly due to their lack of Fan...I was sweating like crazy and found out they had the fan at the other end of the machine because thats the way you usually enter...duh...they should have moved the fan. Additionally, I coughed or moved just SLIGHTLY and they punished me by calling a do-over on that 4.5 minute scan. I was so close to squeezing the ball for an alarm to say...hey what ever pictures you have will have to be good enough I'M OUTTA HERE!!

Well I made it through it and probably will be glad. I already know I have a nodgle..it's Palpable and was felt by three of four people who tried to find one...way too much DRE's going on here.

Expect a call perhaps from my surgeon over the weekend...we'll see....I have a feeling that the tumor has escaped the organ capsel....but hoping not!

hopeful and optimistic

randy_in_indy said:

It was yes...an Experience!
Ok, the test was not as easy as I expected....having just done an MRI on my hip two months prior....Mostly due to their lack of Fan...I was sweating like crazy and found out they had the fan at the other end of the machine because thats the way you usually enter...duh...they should have moved the fan. Additionally, I coughed or moved just SLIGHTLY and they punished me by calling a do-over on that 4.5 minute scan. I was so close to squeezing the ball for an alarm to say...hey what ever pictures you have will have to be good enough I'M OUTTA HERE!!

Well I made it through it and probably will be glad. I already know I have a nodgle..it's Palpable and was felt by three of four people who tried to find one...way too much DRE's going on here.

Expect a call perhaps from my surgeon over the weekend...we'll see....I have a feeling that the tumor has escaped the organ capsel....but hoping not!

mri experiences
several years ago, I had an mri of my neck, so I was inside the machine and felt very confined so I was very apprehensive before I went for endorectal mri exam.......and I took two valiems (sp)...i was zonked out....as it turned out my head was out of the machine so I was really alright as far as that goes.

My joke is , please excuss my rudeness, is that I had to pay nine hundred dollars so I could have the priveledge of having a tube rammed up my behind, be put in an MRI machine and be zonked out for the day.

Interesting, I just had MRI for my lumbar region, which is a lot simplier than the endorectal.....apparently I have spinal stenosis - lumbar region, basically I have a lot of debilitating pain (when I walk or stand) in my left foot....Right now I'm going for physical therapy, and am doing research to figure out how best to handle this. I just saw a neurosurgeon who I will see again in 6 weeks. Fortunately he is talking about sending me to a pain management doc for shot if the physical therapy does not work, hopefully I will not have to be operated on.

Ira

Ira