Oligomicrometastatic cancer

Josephg

Where do You Stand

Thank you for your detailed update, Vasco.  It is ALWAYS great reading your though-provoking content, anytime that you post to this forum.  I share your disappointment regarding the non-definitive results of your latest PET scan.  I know that you were hoping for more definitive results, and the lack thereof must be truly frustrating to you. 

I believe that we travel parallel journeys in our PCa lives, so I am particularly interested in reading about your experiences on your PCa journey, and how they may reflect upon my journey.  When the time comes for me to have the PET scan, perhaps I will have greater success in locating the hiding place(s) of the bandit, due to my higher Gleason score (4+3).

Keep the faith, Brother!

VascodaGama

Thanks for the comments

Hi there,

Thanks for the comments.

Cushions; Surely I will continue ADT intermittently until something new is discovered or the situation becomes worse requiring a continuous approach. Last December I meet the new onco-urologist that is now the doctor following my case and we discussed on the protocol. I will get bicalutamide plus leuprolide shots to lower the PSA to values of less than 0.05 ng/ml, stopping the drugs when such condition has been maintained for one full year. Then I will be again on vacation from the drugs till the PSA increases and reaches to 2.5 ng/ml level. This new doctor also gave me the papers to have the  68Ga-PSMA PET, so that I got two requests from the NHS, free of charge. I used one and will return the extra when we meet in May. It seems that the EU urological associations under the NHS reached the consensus that PET diagnosis is the new norm in prostate cancer. I wonder if the same is happening in England.

Lighterwood67; Thanks for the link on the new isotope 18F-PSMA. The paper I read regards the results from just one patient with a very low PSA of 0.08 ng/ml and with a Gleason score of 7 (4+3). In other studies on this isotope researchers concluded that the Fluorine-18 (18F) is better than the Gallium-68 (68Ga) because it doesn't excrete via the urinary track so that the image of closed lymph nodes (inguinal) can be well interpreted. 68Ga is excreted turning the ureters bright. This is where some of the critical lymph nodes are set. In fact, all the studies confirm that lower Gleason rates (3 and less) fair poorly in PSMA detection, independently of the tracer in use; 18F or 68Ga. In poorly differentiated cases (Gr 4 and 5) both tracers provide similar capabilities in terms of the number of positive detections. In any case, 18F may be more appealing in initial diagnosis where lymph nodes detection are crucial.

It seems to me that this revolutionary PSMA has started a war on the tracers. The 18F has been around for much longer than the 68Ga and its use gave rise to the construction of costly facilities for cyclotrons to produce the 18F tracer. Gallium-68 needs a simple generator so that it is much easier to be acquired by the flourishing image clinics around the word. However, clinically speaking the advantages of 18F against 68Ga are not that strikingly different. In this respect Fluorine 18 risks to lose the market and that is not acceptable by the pharmas. I recall the case of Proton beam that even being better than photons in delivering radiation, it requires special facilities very costly so that a very few number of those facilities exist around the word.

Here are the links;

https://www.clinical-genitourinary-cancer.com/article/S1558-7673(16)30375-5/fulltext 

http://jnm.snmjournals.org/content/58/11/1805.full

http://jnm.snmjournals.org/content/60/3/362.full

https://pubs.rsna.org/doi/full/10.1148/rg.2017170035

Josephg; I hope you get cured and that the image exam never becomes required to locate any bandit. Interestingly, the patient of above link presented by Lighterwood refers to a patient of Gleason score 7 (4+3) with a similar clinical abstract RP (pT3a, N0, M0; Gleason score 4+3; positive margins) Adjuvant RT (60 Gy in 30 fractions), PSA level decreased from 5.3 before to 0.03 ng/mL after surgery followed by gradual increase of PSA to 0.08 ng/mL. You may be interested in reading that article.

Best wishes for all of you.

VGama

 

lighterwood67

Maybe

Maybe the technology to accurately identify Micrometastases is just not here yet.  I think we will always wonder are we really 100 % cured.  I really do not know enough about this to comment.  I guess I would look at it as trying to find the needle in the haystack.  I am not going to look for that needle long.  Especially, if I already have plenty of needles.  Anyway, thanks for all the comments to this site.  You are certainly a great resource to this forum.  I did find this article.  You have probably already seen this.

18 F-PSMA-1007 PET / CT Detects Micrometastases in a Patient With Biochemically Recurrent Prostate Cancer

• Frederik L. Giesel, Claudia Kesch, +5 authors Boris Hadaschik
• Published 2017

To date, several radioactive tracers for imaging primary and recurrent prostate cancer are undergoing active investigation. In this case report fluorine-18 (F)eprostate-specific membrane antigen (PSMA)-1007 positron emission tomography (PET)/computed tomography imaging was performed, to our knowledge, for the first time in a patient with biochemical recurrence (prostate-specific antigen [PSA] 0.08 mg/L) after radical prostatectomy and adjuvant radiation. Seventeen lymph nodes with increased tracer uptake along the retroperitoneum and iliac arteries were detected. Therefore, early treatment with intermittent androgen deprivation was initiated instead of locoregional salvage therapy. Hence, F-PSMA-1007 PET imaging at very low PSA levels provided critical information to correctly restage disease. 

VascodaGama

Update on my clinical stage

Update on my clinical stage

Friends,

My uro-oncologist and the radiotherapist at the same hospital have finally commented that I am fighting a systemic case. This ends my wish in using radiation to eliminate the bandit for good.

As you may follow above, this thread has been about my experiences in trying to identify oligometastatic disease which would be attacked with spot radiation but the latest image exams together with previous clinical histogram did not localize metastases at areas feasible enough for safe radiotherapy. The results identify occurrences at the same place radiated 11 years ago (68Gy), which together with the identified radical proctitis in the colon and cystitis in the urethra and bladder, have ruled out such a possible delivery of rads over rads.

I managed a consultation with the nuclear doctor (Prof Durval Costa) from the Champalimaud research hospital who did my last 68 Ga PSMA-PET exam. He certified that PET results are not fully trustful in diagnosis because people’s cells do not react equally to the same radiopharmaceutical and cells may be similar but not equal in individuals. PSMA isotopes may not react to high SUV if such cells express little membrane antigens. Apart from that he told me on the possible fact that the image is blurred at certain areas where the radiopharmaceutical is seen (high SUV) but not in absorbed form. He agrees that the bladder may lead to inappropriate judgment in areas close to the prostate gland.

Accordingly, I have given up in getting additional image exams to locate the bandit at this timing. My last PSA has increased to 1.88 ng/ml keeping the plateau started in April of 2017 with ups and downs in the range of +/- 0.20.
I do not know when the ADT’s trigger threshold of 2.50 ng/ml is reached and do not know if my case gets worse for continued period with no treatment (7 years on off-drugs already). I wonder if there is any information regarding guys with systemic disease that stayed out of treatment during many years. What do oncologists think on the fact? I would like so much to get an opinion from Dr Myers or a similar expert.

Adding to my update, I want to inform that I have had more hematuria cases (three times this year). I have experienced urine retention due to blockage of the urethra by a blood clog which had to be forced (using kegels muscles) to be spit out. It cleans later but the frequency of the occurrence is worrisome. I know that the cause is the chronic cystitis (a wound that never cures totally). The body makes it to bleed to oxygenate the area and when it is too much leads to forming clogs.

This is a late side effect from my salvage radiotherapy (2006). There is no proper treatment apart from the Hyperbaric oxygen therapy (HBOT) followed by some PCa survivors but I think it to be risky in systemic disease.
Prostate cancer needs newer blood vessels to survive and grow, and the HBOT works by helping in forming newer blood vessels (not what we want to have locally) to supply plenty of oxygen to the wound. Well, I wonder if my urologist (an expert in HBOT) got an opinion on the issue on our next meeting.

With this post I may end this thread and will provide updates in a newer thread. Though, I will continue replying to opinions or questions on the matter here.

Best wishes to those fighting this disease that never ends.

VGama

 

vendetta

VascodaGama said:

Update on my clinical stage

Update on my clinical stage

Friends,

My uro-oncologist and the radiotherapist at the same hospital have finally commented that I am fighting a systemic case. This ends my wish in using radiation to eliminate the bandit for good.

As you may follow above, this thread has been about my experiences in trying to identify oligometastatic disease which would be attacked with spot radiation but the latest image exams together with previous clinical histogram did not localize metastases at areas feasible enough for safe radiotherapy. The results identify occurrences at the same place radiated 11 years ago (68Gy), which together with the identified radical proctitis in the colon and cystitis in the urethra and bladder, have ruled out such a possible delivery of rads over rads.

I managed a consultation with the nuclear doctor (Prof Durval Costa) from the Champalimaud research hospital who did my last 68 Ga PSMA-PET exam. He certified that PET results are not fully trustful in diagnosis because people’s cells do not react equally to the same radiopharmaceutical and cells may be similar but not equal in individuals. PSMA isotopes may not react to high SUV if such cells express little membrane antigens. Apart from that he told me on the possible fact that the image is blurred at certain areas where the radiopharmaceutical is seen (high SUV) but not in absorbed form. He agrees that the bladder may lead to inappropriate judgment in areas close to the prostate gland.

Accordingly, I have given up in getting additional image exams to locate the bandit at this timing. My last PSA has increased to 1.88 ng/ml keeping the plateau started in April of 2017 with ups and downs in the range of +/- 0.20.
I do not know when the ADT’s trigger threshold of 2.50 ng/ml is reached and do not know if my case gets worse for continued period with no treatment (7 years on off-drugs already). I wonder if there is any information regarding guys with systemic disease that stayed out of treatment during many years. What do oncologists think on the fact? I would like so much to get an opinion from Dr Myers or a similar expert.

Adding to my update, I want to inform that I have had more hematuria cases (three times this year). I have experienced urine retention due to blockage of the urethra by a blood clog which had to be forced (using kegels muscles) to be spit out. It cleans later but the frequency of the occurrence is worrisome. I know that the cause is the chronic cystitis (a wound that never cures totally). The body makes it to bleed to oxygenate the area and when it is too much leads to forming clogs.

This is a late side effect from my salvage radiotherapy (2006). There is no proper treatment apart from the Hyperbaric oxygen therapy (HBOT) followed by some PCa survivors but I think it to be risky in systemic disease.
Prostate cancer needs newer blood vessels to survive and grow, and the HBOT works by helping in forming newer blood vessels (not what we want to have locally) to supply plenty of oxygen to the wound. Well, I wonder if my urologist (an expert in HBOT) got an opinion on the issue on our next meeting.

With this post I may end this thread and will provide updates in a newer thread. Though, I will continue replying to opinions or questions on the matter here.

Best wishes to those fighting this disease that never ends.

VGama

 

VascodaGama, I just want to

VascodaGama, I just want to say that you are an amazing champion not only for yourself, but for the countless others that actively participate on this forum and for the lurkers like myself. Please keep up the good fight as you have been and I pray that someday in our lifetimes that they put a noose around this beast's neck.

Georges Calvez

Never say die

Hi Vasco,

Never say die and I know that you won't until the bandit has you in a death grip.
You have a PSA of less than two and no evidence of metastases outside the pelvis.
Really it is hard to pin anything down from your last results, I would guess that you have at least five good years in the bank if nothing else gets you.
So have a glass tonight.
I have just bought a Mini Countryman 143 ch, SD, ALL4, top speed 200 km/h, 0 - 100 km/h in 9 seconds, woo hoo!!!

Cordialment,

Georges

lighterwood67

Look forward

Look forward to reading your new thread.  Systemic case is just another group of words to something we already know.  Yes, we have prostate cancer.  As with all other treatment in men with prostate cancer, a thorough assessment of health and comorbidities, as well as patient goals and wishes, plus the best available biological predictors of tumor behavior, need to be considered in formulating an effective treatment plan. Given the frequency of this clinical problem, and the associated financial and human costs of therapy, this remains the best path forward.  "It ain't over 'til the fat lady sings."  So with that said, I wish you luck on your journey and I am truly grateful for your total devotion to keep folks informed on this site.  Thanks.

Josephg

Update

You are a fighter and an incredible source of information, experience, and perspective to us here on this Forum.

For me personally, as we have previously discussed, we may be on parallel paths in our encounters and fights with the Bandit, so I remain highly focused on your journey, and welcome your continuing to share your journey information with me.

Our thoughts and best wishes are always with you.

Max Former Hodgkins Stage 3

VascodaGama said:

Update on my clinical stage

Update on my clinical stage

Friends,

My uro-oncologist and the radiotherapist at the same hospital have finally commented that I am fighting a systemic case. This ends my wish in using radiation to eliminate the bandit for good.

As you may follow above, this thread has been about my experiences in trying to identify oligometastatic disease which would be attacked with spot radiation but the latest image exams together with previous clinical histogram did not localize metastases at areas feasible enough for safe radiotherapy. The results identify occurrences at the same place radiated 11 years ago (68Gy), which together with the identified radical proctitis in the colon and cystitis in the urethra and bladder, have ruled out such a possible delivery of rads over rads.

I managed a consultation with the nuclear doctor (Prof Durval Costa) from the Champalimaud research hospital who did my last 68 Ga PSMA-PET exam. He certified that PET results are not fully trustful in diagnosis because people’s cells do not react equally to the same radiopharmaceutical and cells may be similar but not equal in individuals. PSMA isotopes may not react to high SUV if such cells express little membrane antigens. Apart from that he told me on the possible fact that the image is blurred at certain areas where the radiopharmaceutical is seen (high SUV) but not in absorbed form. He agrees that the bladder may lead to inappropriate judgment in areas close to the prostate gland.

Accordingly, I have given up in getting additional image exams to locate the bandit at this timing. My last PSA has increased to 1.88 ng/ml keeping the plateau started in April of 2017 with ups and downs in the range of +/- 0.20.
I do not know when the ADT’s trigger threshold of 2.50 ng/ml is reached and do not know if my case gets worse for continued period with no treatment (7 years on off-drugs already). I wonder if there is any information regarding guys with systemic disease that stayed out of treatment during many years. What do oncologists think on the fact? I would like so much to get an opinion from Dr Myers or a similar expert.

Adding to my update, I want to inform that I have had more hematuria cases (three times this year). I have experienced urine retention due to blockage of the urethra by a blood clog which had to be forced (using kegels muscles) to be spit out. It cleans later but the frequency of the occurrence is worrisome. I know that the cause is the chronic cystitis (a wound that never cures totally). The body makes it to bleed to oxygenate the area and when it is too much leads to forming clogs.

This is a late side effect from my salvage radiotherapy (2006). There is no proper treatment apart from the Hyperbaric oxygen therapy (HBOT) followed by some PCa survivors but I think it to be risky in systemic disease.
Prostate cancer needs newer blood vessels to survive and grow, and the HBOT works by helping in forming newer blood vessels (not what we want to have locally) to supply plenty of oxygen to the wound. Well, I wonder if my urologist (an expert in HBOT) got an opinion on the issue on our next meeting.

With this post I may end this thread and will provide updates in a newer thread. Though, I will continue replying to opinions or questions on the matter here.

Best wishes to those fighting this disease that never ends.

VGama

 

Years

V,

I suspect that even if you reach a HT treatment trip-point with your PSA, you will continue to be a winner and best this disease for many years to come.  In terms of knowledge shared, attitude, and spirit, the PCa Board has never before seen your equal,

max

VascodaGama

Thanks fellas

Vendetta, Georges, Lighterwood, Josephg and Max,

Thanks for the positive comments. I am hopeful that the continuing hormonal treatment gives me the control over the bandit for a long period of my remaining life. I would be satisfied with those 5 years pointed by Georges so that I can watch again man on the Moon but this time in color. Unfortunately I doubt that ADT can keep me till 2034 to see man on Mars.

Sincerely I hope that Josephg has a different path other than a systemic course. Something with a successful end knocking down the bandit for good. Meanwhile I will dream on the 0 - 100 km/h in 9 seconds Mini of Georges. I had a Mini Cooper S in my university times (1970th) also clamming the same 9 seconds but never reached.

Best to you all.

VGama

Georges Calvez

Minis, now and then

Hi Vasco,

Just had a look and your Mini S could have had a one litre engine developing 70 cv and weighed about 700kg, mine will have a two litre engine developing 143 cv and weigh about 1400kg.
So the Mini has got a bit bigger, but it is not a roadster, they weigh a lot less, more like your Cooper S and they have bigger and more powerful engines.

Best wishes,

Georges

Max Former Hodgkins Stage 3

Georges Calvez said:

Minis, now and then

Hi Vasco,

Just had a look and your Mini S could have had a one litre engine developing 70 cv and weighed about 700kg, mine will have a two litre engine developing 143 cv and weigh about 1400kg.
So the Mini has got a bit bigger, but it is not a roadster, they weigh a lot less, more like your Cooper S and they have bigger and more powerful engines.

Best wishes,

Georges

Minis

The current Minis are moderately popular in the US today. I don't know who makes them, but they are distributed via BMW dealers, so the quality is believed in.  Unlike the other microcar available in the US, the Fiat 500, which has a horrible reputation as junk. Also the Smartcar for Two, by Mercedes:  has never sold, and always evaluated by professionals as a miserable driving experience, and even gets relatively poor milage, the ultimate irony.

The Abarth Fiat 500 version, however, is moderately successful among "tuners" and kids without sufficient funds to buy a used Nissan Z, Camaro, or Mustang.

Georges Calvez

Baby Beamers
Hi Max,

The marque is now owned by BMW but are put together in the UK.
Mine shares quite a few bits with the Audi Q3 as it is basically the same thing, a sports 4x4.
It is not really comparable to any of the microcars that you quote as a new one will set you back about EUR 30 - 40,000.
They also go up to 300 cv in the roadster version which is twice as hot as a Fiat Abarth 500 but that is an old man's car and even then you need deep pockets as they drink fuel and the insurance want plenty of cash to insure one.
You can buy a second hand Nissan Z, etc quite cheaply here and I could insure it for a not unreasonable amount but if I was under thirty it would be more than a bit scary, coupling one of those with a girlfriend / fiancée / wife that wanted holidays could result in periodic bouts of ear aching as she watched me write a cheque that would pay for a fortnight in the sun for two for the annual insurance!
This is the latest and greatest version of mine in diesel.
https://bmw-quimper-latitude-automobiles.espacevo.fr/annonce/69104867736/

Best wishes,

Georges

Georges Calvez

Sundowner
Hi VdG,

How authentic is this?
Being a chemist I could easily adapt the recipe for one, two, four, etc.
Make it in the shaker or stir over ice and pour.
https://www.theguardian.com/food/2019/jul/26/cocktail-of-the-week-casa-do-frango-portuguese-punch-regional-limao-e-laranja

Best wishes,

Georges

VascodaGama

If you like it, then make it to all of us

Hi Georges,

This cocktail using rum is not typical of Portugal. We have similar ones but instead of rum (Brazilian cachaça) it is used a sweet liquor distilled from herbs and seeds (Licor Beirão) or fruits initially made into “aguadente” (eau de vie) like Medronho (arbutus fruit), Ginginha (wild Cherries) and Figs.In regards to rum, the Portuguese prefer Caipirinha (a Brazilian eau de vie made with cachaça).

However, I noticed that the drink is served in a Portuguese restaurant (Casa do Frango) in London where the menu is typical from the Algarve (southern region of Portugal), more precise, from the place where I live close to Albufeira. The Frango piripiri (spicy chicken) is claimed to have started in village Guia, and then turned famous among the millions of tourists visiting the area (winery of “Sir” Cliff Richard). I offered to the locals a roundabout representing the Frango piripiri, which is mentioned now in tourist guides as the “Guia Chicken and Wine Roundabout”. They placed my name on it. http://guia.pt.algarve-portal.com/

Well, you can prepare the cocktail there in northern France (and invite us) or come down with your Mini and get the original here with Medronho at my place. It is 2,000 Km of test driving.

VG

 

Georges Calvez

Long trip

Hi Vasco,

I am not promising anything but I may be able to get the wife and the cat to agree to a trip to Portugal.
Nothing is certain yet but you never know.
I hope that you manage to keep the bandit under firm control and have a Merry Christmas and a healthy New Year.

Best wishes,

Georges