Bad News :-(

hopeful and optimistic said:

chronic prostatitis???
Swing, Here is a discussion from the cyberknife.com web site that I hope is applicable to your situation. I think that I remember that your psa moved around before treatment.

http://cyberknife.com/Forum.aspx?g=posts&t=4818#jumptobottom

Also you might want to post at cyperknife site for inputs.

My thoughts and prayers are with you

fightn9er said:

Fight
Swing,

Be sure to utilize all your resourses as nessecary. Good luck, and always KTF and fight.

Mike

VascodaGama said:

What Next ?
Swing

I think that your next step will be to find a reason for the increase.
Surely many things could be the cause including an infection of the prostate or urethra. Cancer is also possible but difficult to find. Continuous PSA tests are the solution in cases of small size tumours that produce the serum.
You shouldn’t discard any way to find the cause but I would recommend you to follow the best and latest techniques.

I had RT in 2006 and in 2008 I experienced a case of stricture requiring Dilation. I had similar symptoms as those of yours but there were no significant increase in PSA (I have no prostate). An endoscopic test found it and checked latter for cure.
Regarding image studies, they all have limitations of what data they can provide. In 2000 there were must fuse about Prostascint and PET scan, however, these techniques used poor contrast agents that caused many false positives.

After my surgery recurrence became apparent and I wanted to locate the cancer for a hit-radiation. I consulted several specialists at MSKCC, JH and in Japan and were told about the limitations of the equipments. The specialist at MSKCC informed that PET would confuse cancer with the nodes at the spinal so that many false positives were detected in the lower abdominal.
With the resent trials on newer contrast agents and the fusion of systems it has been possible to reach to better outcomes in image studies (lesser cases of false positives).

In saying that, when the aim of the test is to look for small tumours the resolution of the machines become the most important factor for a successful detection. Crisscrossing of information (images) can provide better outcomes. In the combi of PET with CT, PET provides the functional data and the CT (or MRI) provides the anatomical data.
Your test with two MRI is just that. They will crisscross the data to get a better outcome. In any case, the technique is classical and the newer ones are giving better results. PET is more specific than MRSI but it needs representation of the location of the result. CT or MRI can provide that, being MRI better.

http://www.medicalnewstoday.com/articles/154877.php

I believe you will find the reason on the rise of the PSA. I am surprise for your comment that you “haven't given it much thought” but it is and it will be the marker for your treatment success, or for the start of salvage treatment.
As commented in my previous post, image studies may be erroneous in a case of low serum or high but with micromets. A continuous increase in PSA will provide a hint in your status.

There is also another image technique you should explore with C11 acetate. This is reported as being better than the C11 choline to identify PCa. The tracer trial has been conclusive of that and I would recommend you to read about it. Here are the words of the doctor involved and the trial which you could try to participate;

http://www.healingwell.com/community/default.aspx?f=35&m=2217367&p=2
http://clinicaltrials.gov/ct2/show/NCT01304485

About C11 choline PET;
http://www.health-forums.com/alt-support-cancer-prostate/c-11-choline-pet-scan-192202.html

Best.
VGama

VascodaGama said:

Similar but different
Mrs PJD

As far as I know the contrast agents C11 acetate and C11 choline in PET scans have been on study for the past ten years. These are substances that have shown to be more reliable than the traditional FDG PET based on glucose metabolism to detect prostate cancer in tissues (soft and bone). Even the F18 fluorocholine has not performed as well as the similar substance C11 choline.

It is hard to say that one is better than the other because the results differ from patient to patient. C11-Acetate is a radioisotope tagged nutrient that prostate cancer cells take up to feed their growth.
This is an uptake tracer that responds well in cases where radiosensitive tumours favour oxidative metabolism. It is a good agent for differentiation in low levels of PSA. Choline seems to work better in cases where hormonal ablation took place. Do not ask me why.
In Swings case, the former seems to be better in my lay view.

Here is a very comprehensive presentation on “Molecular Imaging of Prostate Cancer”, done by Dr. Hossein Jadvar, Associate Professor of Radiology and Biomedical Engineering in the University of Southern California;

http://www.wrsnm.org/presentations_v2/oct22/Hossein Jadvar MD 2.pdf

In one study they say this; “Kato et al. recently presented results with 11C-acetate not only in prostate tumors but also in normal prostate glands and benign prostate hyperplasia (12). Interestingly, the authors emphasized that normal accumulation occurred in the normal prostate gland of patients”
This is contrary to a positive recurrence and it could indicate a false positive, but it would indicate the area in conflict and provide a target for further biopsy.
http://jnm.snmjournals.org/content/44/4/556.full

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129631/


Multitracer studies using C-acetate and F-choline are on the agenda by many researchers. In fact they all recommend such approach which should include genetics. (How?)

In this site they explain details about PET C11 acetate;
http://www.ob-ron.org/2012/05/tidbits-about-c11-acetate-petct-and.html

Here is a book on PET scans using the several contrast agents; http://books.google.pt/books?id=dZIBbLhTOoQC&pg=PA205&lpg=PA205&dq=c+11+choline+vs+c+11+acetate&source=bl&ots=SWcSXiCU2W&sig=Af8rqc0cflPGqQfHv5ktULBNZh4&hl=en&sa=X&ei=2MNcUKDYM4WThgeVzICAAg&redir_esc=y#v=onepage&q=c 11 choline vs c 11 acetate&f=false

Regards.
VGama

VascodaGama said:

Cell’s chemistry and Trial’s rates
Mrs PJD

It will require some expertise in biotechnology and chemistry to fully satisfy your question. As a layman on the matter I can just tell that PET using the tracer acetate seems to have better outcomes in RT failed cases with well differentiated type of cells. However the answer is subjective to the chemistry in one’s cell’s structure. It would help if you consider in obtaining an explanation from the people (biologists) involved in the studies or reading and trying interpreting their reports.

Just like other methods and techniques in testing with contrast agents, the preferences for something fall in past experiences of similar situations. The highest rated is usually taken as the appropriated method. You may lay down the number of successful cases in both PET tests and get an average rate. This is the way doctors explain about their preferences and it is the bases of my understanding.

Regarding the C11 tracers, you may be surprised for the huge number of varieties and known results in their chemistry. The Molecular Imaging and Contrast Agent Database (MICAD) from the American National Center for Biotechnology Information (the same author, Kam Leung, PhD) writes this in 2004;

“Acetate is readily taken up by cells and is activated to acetyl-CoA in both the cytosol and mitochondria by acetyl-CoA synthetase. Acetyl-CoA is a common metabolic intermediate for synthesis of cholesterol and fatty acids, which are then incorporated into membrane (1). Acetyl-CoA is also oxidized in mitrochondria by the tricarboxylic acid (TCA) cycle to carbon dioxide and water. Some of the acetate is converted to amino acids. In normal myocardium, acetate is metabolized to CO2 via the TCA cycle as the dominant pathway. In contrast, tumor cells convert most of the acetate into fatty acids by a key enzyme fatty acid synthetase (FAS), which is over-expressed in cancer cells (2). Acetate is predominantly incorporated into intracellular phosphatidylcholine membrane microdomains that are important for tumor growth and metastasis (3). [11C]Acetate are used as a positron emission tomography (PET) tracer for studying myocardial oxidative metabolism and regional myocardial blood flow (4). [11C]Acetate is a promising PET tracer for renal, pancreatic, and prostate tumors (5)”.

“Choline is an important component of phospholipids in the cell membranes. Tissues with increased metabolism will lead to an increased uptake of choline. Choline is phosphorylated by choline kinases (CHK) to phosphorylcholine within cells, and, after several biosynthetic processes, finally is integrated into phospholipids (1). Because tumor cells have a high metabolic rate, choline uptake is high in order to keep up with the demands with the synthesis of phospholipids in their cellular membranes (2). Positron emission tomography (PET) with [11C]Choline has been reported to be useful for the detection and differential diagnosis of brain tumors, prostate cancer, lung cancer, and esophageal cancer (3, 4), whereas [18F]2-fluoro-2-deoxyglucose (FDG) lacks of specificity or sensitivity (3).

Here is the list of contrast agent’s data base. Search for C11 (11C) for details;
http://www.ncbi.nlm.nih.gov/books/NBK5330/

I hope the materials can lead you to a satisfying conclusion.

Be well.
VGama