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!

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 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.

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.

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

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

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