Biopsy back- positive. Scans scheduled- urgent question about dye

Needle Placement
Worried,

Sorry to read of the diagnosis. When I had my bone scan the needle was through a vein on my hand. I don't know if this is common practice.

You will want a copy of the biopsy report. When you get it you should look for a couple of things such as PNI and ECE which suggest perineural invasion and extra capsular extension. These indications increase the likelihood that the cancer may have spread outside the prostate. You will also be interested to see the percent involvement in each of the cores. The higher the percentage the larger the tumor.

I suspect your doctor will recommend a couple of different treatment options. First I think he will want to do RP as your husband is younger and will likely tolerate surgery better than older men. There is a lot of controversy about whether surgery on a Gleason 9 patient is worthwhile since there is such a high probability that the cancer has already spread outside the prostate. Removing the prostate gland at this point will do nothing to curb the growth of cancer elsewhere in his body and runs a high risk of significant side effects in the way of ED and incontinence.

The other option is external beam radiation (IMRT) used in conjunction with hormone therapy. While the radiation poses less chance of long term side effects from the treatment, it too will not curb cancer growth outside the area of the prostate and the area that is radiated. The hormone therapy will slow the cancer growth but has its own set of side effects while on the drugs.

Best of luck in your follow on consultations.

K

Swingshiftworker said:

Bone Scan Dyes
I've read (but not commented on) your prior posts and am sorry to hear about your husband's advanced PCa diagnosis.

You could seek a 2nd opinion on the biopsy but, given the assessment, I doubt that the result (and it's implications for treatment) would be much different.

Even if he's reassessed as Gleason 8 vs 9, the degree of cancer present (in either case) significantly limits his treatment options. Obviously, the first thing to do is to try to determine whether and to what extent the cancer may have already spread.

I can understand your husband's fear of needles but, given the apparent nature of his cancer, it is more likely than not that he will be receiving hormone (and possibly chemo) therapy for treatment and he will eventually need to overcome his fear of needles because (as far as I know) those drugs are only administered intravenously.

In the meantime, you should ask if an ingested contrast dye can be used instead of an injection for the bone scan. It's been awhile since I had one (for a foot problem) but, as I recall, I drank the dye for that procedure. I did not receive a bone scan in connection w/my Gleason 6 PCa diagnosis -- only an MRI and CAT scan.

Good luck!

MRI is a better test than a cat scan
Hopefully you can find a faciliy that uses a 3.0 magnet . Best to be a a center of excellence, a major maedical center. Please feel to click my name to see details, or google mri versus cat scan.

ps Lately there are other threads at this site by men who have posted with a 4+5=9 that will be beneficial for you and your husband to read.

worriedabouthubby said:

More info
They just called and moved the scans to tomorrow. I asked and they will be able to inject the dye via his hand (in addition to his fears, he has very, very small veins in his arm, and they roll and tend to 'blow' easily). He'll ahve the CT scan first, and has to drink stuff for that. Then they'll do the radioactive dye injection. Then we get to 'go do something' for 3 hours. Real fun when most of Charlotte is shut down for the DNC!!! We even have to find an alternate route to the hospital! Then they will do the bone scan at 11. He's having it all done at Presbyterian Hospital. Excellent place. They have taken great care of my mother-in-law when she had her strokes, her heart problems and when she broke her hip last year. Plus, that's where our insurance wants him to go. I'm am going to research radio-oncologists, oncologissts, etc. now to help me prepare for more referrals. I don't think the urologist is going to recommend surgery- and even if he does, we will most likely say no- at least right now.
Thanks again for the support.

Worried about Surgery
I agree with Kongo. I had surgery, the reason, was that I had another medical issue requireing surgery. I was able to treat both items at the same time. If there are other options please research. Surgery was real rough on me. There will be ED issues, uniary issues, I also had bowel issues. Along with a loss of energy and stamina. My doctors informed me that it can take as long as 3 years for the body to heal. Use caution, but in the end the best method will be what you all feel will work. Other men has had this surgery and came right back with very little problems. Research all the treatment methods. Also please obtain the Pathology report, you have now entered into the zone. There is going to be a lot of information comming at you. This is my personal input on the subject.

Thank You, and I am sorry to hear about this. Cancer Sucks

worriedabouthubby said:

It's not just the fear. He
It's not just the fear. He has very very very small and deep veins (got them from his mother). They also roll and 'blow' or colapse very easily. I don't think anyone has been successful in drawing blood or giving him an IV in his arm - at least not in the 35 years we've been married. When he knows he's going to be 'stuck', his blood pressure goes SKY HIGH- like 190/92 at Dr.'s office 3 weeks ago. And there are always those in the medical field who are convinced that THEY will be able to 'get it' when no one else has. And he winds up getting stuck multiple times before they will use his hand (like we ask up front) and a few times they've had to use his ankle- very painful. Thus his 'attiude' about needles.

Blood draws
Just remembered something a nurse told me avout a year ago. My left vien disappeared. Right vien still prominent. She told me that my left vien had disappeared because of lack of exercise, or work. Does your husband exercise? Lift weights? It could be that this is why his viens have recessed. Just a thought.

Mile

worried about hubby
Sorry to hear about husband.Jan.2009 I found out my psa was 110 and after biopsy gleason score was 9.To make along story short no one wanted to do surgery that the cancer was out of the prostrate and would be to dangerous after bone scan was negative and mri and cat scan only showed a hump extending out of prostrate I agreed to have radiaton and took a hormone shot and was to wait 90 days for radiation.In the mean time a friends urologist calied me and said Ineeded to have the prostrate removed at all cost as if I had radiation and cancer returned there be little treatments left.He put me in touch with Dr.Seth Lerner at Baylor Clinic in houston.OnAug.29 2009 he removed the prostrate.After about ayear my psa had rose to .06 and said Ineeded to have salvage radiation and in june 20011 I took 35 radiation treatments.From Oct.2011 to aug.2012 my psa has been Leas than 0.01.I have had no side effects from any of the treatments and never took any pain medication.My case is about as serious as you could have diagnosed from beginning and Iam doing fine with findig the right doctors and alot of prayers.Main thing is donot rush into anything.Hope your husbands outcome is good.

Needle in the hand
Tell him to relax. I had the needle in the back of my hand. No problem. Test is no big deal, in fact I fell asleep. Relax Buddy