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How Accurate is the 3T MRI at detecting cancer

tonycue
Posts: 39
Joined: Aug 2016

Hi Guys, I'm new here, Live in the UK (hope this is OK here this being a US site). Currently awaiting a biopsy and just wondering if anybody here has had this experience or knows the answer to this question re: 3T MRI scanners..... 
Briefly: 58 Years old, Live in UK so under NHS, been referred by GP and having tests at hospital for a sudden rise in PSA from regular 3.1 to 7.5 after a 14 month gap between tests.....Whilst waiting for hospital to get in touch went to a private clinic for a new PSA test with "Free PSA".....This test came back at 4.3 PSA and a free PSA of 23%.(2 weeks later)....Also had a consultation with private consultant from this clinic who specialise in prostate health and problems. This guy is a well known Professor of urology with an international reputation, many books and papers published etc....40 minute consultation and DRE and he tells me "No Cancer"....."Great" I thought and skipped off.....I was happy to call it a day and cancel the upcoming hospital appointments My wife although pleased had other ideas and insisted I stick with the program. 
 So since then I have been called to hospital, had a cystoscopy (Tests clear)...a CT Urogram and a 3T MRI....They wanted to give me a biopsy, but in light of the lowered test result and the "diagnosis" from the Prof I asked my hospital consultant (via his secretary as I have yet to meet him) if I could swerve the biopsy and see what the MRI threw up...He agreed. ....Hospital appointment yesterday to discuss results with urology dept. Doctor called me in, never introduced himself, was a bit stand offish, not unpleasant but very business like, asks why I did not have the biopsy? (he isn't the consultant obviously) I explain my reason and he asks to see the lowered test results, I show him. He explains that the MRI is showing "something" and it is small. I ask him if it is confined to the gland (it is) ....But they need to do a biopsy to see what it is. I say that I thought that a 3T MRI could tell the difference between something nasty, something benign or inflammation....He says that this is not the case, his words were something like: "PSA means nothing, Free PSA means nothing, Scan means nothing only a biopsy can see what this is" 
He did say that if I wasn't worried I could leave it until the next PSA reading to see what has happened, but I don't have that kind of personality. 
I now feel like I have shot myself in the foot as I have now booked a biopsy for 2 weeks time and the results 2 weeks after that, so instead of finding out yesterday I now have another 4 weeks to sweat before I get a (maybe) definitive answer.......Basically my question is this: Has anybody had the experience where an MRI scan has shown up something which turned out to be nothing to worry about....or is the doc just not being 100% straight with me? 
    Thank you in advance 
         Tony 

VascodaGama's picture
VascodaGama
Posts: 2989
Joined: Nov 2010

Tony,

Welcome to the board, however, keep in mind that you have not been diagnosed with prostate cancer yet.

From what you write, I have to agree with the assertions of your unpleasant hospital attending doctor (typical of busy urologists). At present times, only the biopsy can diagnose the cancer. All other tests and exams (image studies) are complimentary to the biopsy results and will be essential when judging/determining the status of a patient. These can predict the clinical stage (advancement) of a positive case. In other words, all the data collected is necessary and important. Keep a file with all copies.

Regarding the MRI tesla 3 (3T), we know that it provides better image (higher resolution) clear to identify disturbances, but as your doctor commented it does not distinguish cancerous cells from benign. Some radiologists are highly experts in interpreting the image study leading guys into avoiding a biopsy but nothing can be 100% assumed correctly. Those dark spots in image could be cysts or calculi non cancerous. However, if a sample is taken from these tissues (guided biopsy) and found by a pathologist to be cancerous then the patient would be declared positive and the image exam would provide the extend (size) of the tumour.

I understand you being worried, but the high PSA and the 23% free PSA is indicative of probable cancer. Surely, the PSA can be high due to other causes and a blinded biopsy can miss affected cancerous tissues but in the end, the biopsy may provide you peace of mind.

Here are some links that may be interest to you;

http://www.cancernetwork.com/articles/percent-free-psa-test-may-prevent-unnecessary-biopsies

https://www.webmedcentral.com/article_view/3463

Best wishes,

VGama

 

tonycue
Posts: 39
Joined: Aug 2016

Hi VGama, Thanks for replying.....I was under the impression that although not brilliant, a free PSA of 23% wasn't a terrible figure....In fact the British association of Urological surgeons use a figure of >22% as most likely benign....My lab test stated > 23% (so guess I'm on the cusp)....that and the fact that my first test of 7.5 dropped to 4.3 within 2 weeks ....(does this sound like a man clutching at straws?)

I have already read the free PSA article (in the last 5 weeks there probably isn't a PCa web page that I haven't read)...a lot of people use a cut of of 25% but I have read a lot of scientific research where 23% is used.....(whoops there goes another straw Frown)   The other article I shall digest later thanks

Since my consultation with the grumpy urologist I have learnt about the PI-RADS scoring system for MRI imaging....(wish I'd had this info before)....Just wanted to know really if the doc was not telling me the whole truth for whatever reason

Thank you for your informative post and for taking the time to reply

   Tony 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3280
Joined: May 2012

Welcome to our Board, Tony.

We have contributors from all over the world. In no sense are we restricted to the US.  I myself herald from the US state of South Carolina, founded by English aristocrats in the 1600s.  I love the UK, and as a US submariner visited Portsmouth, England once, Dunoon, Scotland many times, and Faslane (Her Majestie's Naval Base and lead submarine facility)  once or twice.

As Vasco noted, neither the free PSA or conventional PSA testing proves anything.  The UK may have protocols which suggest 'probabilities,' but I have not heard of such in America. But either way it remains a subordinate bit of data, to assist after a biopsy is in hand.

Your conventional PSA rise, or 'vector' (also called 'Doubling Rate') was significant, but it also does not 'prove' anything.  In your particulars, I would go ahead and get a biopsy,   Prostate cancer ("PCa") is virtually always very indolent/slow moving, so the two week delay that you mentioned will be completely irrelevant, of no significance.

max

tonycue
Posts: 39
Joined: Aug 2016

Hi Max, Thanks for your welcome, If I'm honest I'd have rather not received the invite Yell but Hey such is life.....

Always nice to meet an Anglophile, and a Submariner at that....Many years ago I used to train with a group of Royal Marines based in Portsmouth (two of whom were old schoolfriends) They always managed to whip my butt no matter how fit I thought I was

As far as my diagnosis is concerned....I'm all over the place with that.....When it jumped to 7.5 from a 3.1 14 months previously, I thought "Oh S**t"...then after the drop 2 weeks later, I thought that maybe I was out of the woods....My private guy in London (who ironically had his prostate removed 3 years ago by robotic surgery) told me "You are fine" ....I now am wondering whether he was just "playing the odds" although what he would have to gain from that I fail to grasp....I have spent the last 6 weeks in a bit of a daze, and have come to the conclusion that I am not the kind of guy you would want to be sharing a foxhole with (or a submarine come to that)....I have done nothing but trawl website after website, looking for clues, hoping that I'm going to find a loophole in the law.....Nothing thus far......plus, although my hospital doc has said that whatever is on the image is small and is confined to the gland, I have been having some hip pain in the last 3 months, and am now starting to worry even more.....My wife who is notoriously upbeat (or she's doing a damn fine acting job on my behalf) says that the hip pain is just my age.....I hope she is right, but I'm seeing all kinds of "Monsters" under the bed.

Unfortunately I have an OCD personality and therefore all these awful scenarios keep playing on a continuous loop in my head, even though I know it's a waste of energy.....Can't teach an old dog new tricks I guess. Just got to suck it up and see what the next few weeks brings.

I think that guys in the USA are much more health/prostate aware than we in the UK. I have read that nearly every man over 50 in the US knows his PSA "score"....probably a bit of an exaggeration...but certainy more than us Brits...The NHS don't have a dedicated screening service...they will offer you a PSA test if you're over 50, or if you're in a high risk group....but they don't advertise the fact (they only have a finite amount of money).....It's down to the couple of large cancer charities who are left to get the message across re: screening.....My GP wanted to refer me to the hospital 2 and a half years ago with my 3.1 (cut off for my age group is 3).....Like a typical man I put my fingers in my ears and sung at the top of my voice and pretended that all was well.....got tested every 6 months after that (always 3.1) got complacent waited 14 months and then got a big surprise 6 weeks ago, and here we are.....(If I have let this cat out of the bag I will have no choice but to kick my butt until it is black and blue)

    Anyhoo sorry for rambling on......Thanks for the welcome and best wishes

                         Tony

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3280
Joined: May 2012

I loved the English group Led Zeppelin's early hit Ramble On. All manner of rambling is welcome...

OCD can really jerk a guy around. The trick is to just do the clinically advisable things and remain informed regarding what the results show.  The thing to do now is get a biopsy.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

The results of the biopsy is the critical information. Although important the PSA can be looked at, only  as a trend, the individual points can be affected by a multitude of things: inflamation, sex before the PSA, exercise (especially bike riding) before the PSA, a digital rectal exam or massage before the PSA..even a hard stool.

Even after the results of the biopsy, there are cancers (Gleason score measures aggressiveness) that are indolent, that is not likely to spread.....this is fairly common, and can very well happen in your case.....it may be  a good idea for you to do research about "Gleason Scores" at this point.

At any rate you received good answers from the other posters. 

Let us know of developments in your case...we will do our best to give input.

tonycue
Posts: 39
Joined: Aug 2016

Hi, thanks for your reply.....I can assure you that in the last 6 weeks I have become a prostate cancer "expert" I could probably even take my own prostate out at a push.....So I'm well aware of the gleason scores and staging (although I'd rather not be)

Biopsy week after next. Results 2 weeks later.....just got to wait.....nothing else to do....

 Regards   

VascodaGama's picture
VascodaGama
Posts: 2989
Joined: Nov 2010

Tonny

I admire your high spirits through wards the problem. I recall my times when confronting a similar situation after receiving the PSA results. It was high and worrisome and my grumpy urologist’s explanation did not help me at all. I was concerned and wanted to do things rightful not missing anything. I did all sorts of tests all negative with the exception of the PSA. The biopsy followed and it was positive in all needles. Denial was my first stance. I could not believe in the results and had an extra two needles taken out at a separate institution to confirm my wishes,………... I was wrong. I had cancer and everyone was correct.
We see in this forum many reporting the same dilemma over and over again. The tendency is to think that cancer is of someone else. We are the good ones and have done nothing bad.

My experience with the biopsy was a simple painless affair. I would recommend it to everyman at the first sign indicating probabilities to cancer (including those multiparametric MRIs). I take it as a means of screening but there are responsibilities involved and one should be prepared in advance in regards to its results. For instance, one should secure an insurance that would cover treatments before been diagnosed positively (NHS is free but conditional to certain exams and therapies). It is a mental night mare and even if the cancer is found to be none aggressive, we must find the courage to live with it.

Several prefer to have the situation obscured and conduct their life as usual. They could follow the matter with periodical exams and tests (MRI, bone scan, PSA, etc) even knowing that the probabilities are high for having the cancer growing uncontrolled. Symptoms would rule an intervention which could occur after many years of quality living (avoiding the risks from treatments). This is what your private guy in London may have implied.
The hip pain/sensation may be a neurological affair. Your mind may be playing tricks on you (it did with me too). The MRI can check on it.

Whatever decision you may take, please do not rush. Do things coordinately and timely.

Best,

VG

 

tonycue
Posts: 39
Joined: Aug 2016

Hi VG.....If by High spirits you're referring to my singing with my fingers in my ears....That wasn't high spirits it was denial....I first got a DRE and PSA in 2004 at age 46, because of needing the toilet when out more regularly than my peers.....I had a vague idea about the prostate then, but wasn't really aware of it's role.....The DRE and the blood test were a total surprise.....I never realised that there was a test for this stuff.....I called the surgery a few days later and they said that my test was OK.....(I was happy to put the phone down and walk away)....I've only found out recently that my PSA then was 1.2....Not high but probably more than the median for my age group.......The problems never really went away, but I just got used to them.....adjusted my behaviour accordingly etc.....Only presented myself to the GP in April 2014 at age 56 when the problem started getting me up at night.....PSA now 3.1.....Cut off for my age 3.0  GP wants to refer me to hospital..... In my ignorance I assume that 3.0 is a "safe" level so what harm can 3.1 do? (bit like cholesterol).....Not realising as I do now that people under 2 can have PCa.....Maybe the Doc should have been firmer, but I can't blame her.....I took the decision to pass....Just asked if I could be checked every 6 months....She agreed and that's how it was for a few readings (always 3.1) so got complacent and left it for 14 months and then got my unpleasant surprise....I went mainly because my hip started aching, plus a bit of back ache that comes and goes.....and that is now what is freaking me out.....I may be noticing them more than I would usually.....Hell I may even be exaggerating them, but I'm not imagining them....I wasn't avoiding the biopsy because of the needles.....needles don't bother me, although I'm not looking forward to the procedure...I really thought that after what my private guy said (and he was unequivocal here) he looked at my new lowered test results done at his clinic's lab, he asked me some basic questions, gave me a DRE and said "No Cancer"....I hasten to add that this is not some back street butcher.....This guy specialises in the Prostate, he's a professor of Urology, has done some 950 Robotic surgeries, has written many books and scientific papers on the subject, collaborating with American doctors and professors at Sloan Kettering, John Hopkins etc.

  I had done enough research at the time to "know" that a DRE won't show anything suspicious a lot of the time....So when I questioned him about his confidence he said "I have felt thousands of Prostates....You do NOT have cancer...Now go and take your wife to lunch"......I still fail to see what he had to gain by this statement unless he genuinely believed it. Of course I wanted to believe him, so skipped out of his office and bought the most expensive lunch I have ever bought, and happy to do it. As I mentioned in my earlier post I was all for cancelling the hospital appointments (that denial thing again), but my wife is the one with the common sense.....So here we are....The hospital doc says this thing is small and it's still contained within the capsule, but I know small doesn't necessarily mean not nasty and I guess that unless they do other tests they wont know about any spread....This is what I am freaking about at the moment....Think this is called the "bargaining phase"...I'm still cheerleading for the Prof, but I think that my mind is leading me down other paths......None of them Rosy....To say I'm not taking this well would be an understatement...I agree when you say that we can't believe that it is us that have been picked on.....I have always tried to make light of stuff like this (all the time aware that both my mother and father were taken with cancer at reasonably young ages  70 and 65) ...I've always maintained a healthy weight, kept fit....Could have probably eaten a few more vegetables, but other than that....I now walk down the street and see older or obese men and say why me....guess that's natural......Anyway enough whingeing.....Thanks for your post and your kind words

    regards   Tony 

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Tony,

Things will work out for you......recomend that you take your wife out for another lunch...make it  today.

I was diagnosed in March 09, I am enrolled in an Active Surveillance protocol....still have not had any Active treatment.......by the way, like you, I have just had another 3 T MRI and am awaiting a biopsy......(always apprehensive before any of these tests, but does not interfer with living and enjoying life)

Best

 

tonycue
Posts: 39
Joined: Aug 2016

Hi Hopeful and optimistic, Too late for lunch here in the UK, it's dinner time....But know what you mean......I have now realised that when the going gets tough, I'm not only a glass half empty kind of guy, I'm the glass is half empty and there's a dog poop in the bottom of it kind of guy....On the emotional roller coaster at the moment and they wont let me get off.Frown Perhaps I should change my moniker here to hopeless and pessimistic Laughing

I don't know if I could do the active surveillance thing....I don't think I have that kind of personality glad it's working for you

  Good luck with the biopsy, hope it all works out for you

      Best wishes     

 

hopeful and opt...
Posts: 2224
Joined: Apr 2009

....is the smart way to go..............the possible side effects of the various treatments, especially surgery can be  very severe..

 

ed.......

tonycue
Posts: 39
Joined: Aug 2016

Hi H&O, I'm of course hoping that I don't have to make that decision....but my pessimism is getting the better of me. The Doc at the hospital said that if I "wasn't bothered" I could wait for my next PSA check and see what was going on. Well Doc I wasn't worried until you told me that your £2m machine has spotted something "suspicious". Now I'm very worried. I suppose I should take solace from the fact that he was willing to give me the option, but then again it's not his life. I don't have the personality to be told there's "something" there and not have to know what it is......That' s the trouble with PCa there are no hard and fast rules, even the best doctors can't predict outcomes it would seem. I'm now 58, still feel fit (apart from the twinge from the hip mentioned earlier). If a doctor could state unequivocally that I could keep an eye on this "thing" for the next x number of years, without the danger of it suddenly "ambushing" me between tests and getting up to mischief then I might contemplate it, but I don't imagine any Doc is going to guarantee that.....Therein lies my personal problem, maybe in time I could be persuaded, but for now I know I couldn't go down that road.....I'm very pleased that it is working for you.....Thanks for replying. Regards, Tony

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Tony, If you click my name to the left , you will see what tests I have done in my active surveillance program. Additionally I listed information that you may find useful

Here is a quote from my page, that is  based on research for the logic that supports Active Surveilance

"Active Surveilance for delayed treatment

is a very viable treatment decision for low risk prostate cancer, since 97 percent of men with LRPC are likely to die of something other than prostate cancer. The pathologic stage of patients who are closely monitored, is similar to initally treated patients with LRPC, so the treatment decisions will be very similar. I selected Active Surveilance as my treatment decision in March, 09 . I plan to continue with this treatment option for the rest of my life if I can. If not I feel that I will still be able to seek any necessary treatment. "

tonycue
Posts: 39
Joined: Aug 2016

Hi H&O....Interesting statistics, obviously you had very low involvement, and got onto a research project, and they seem to be throwing all manner of tests your way.....I'm glad that it is all working out right for you....I'm 8 years younger than you were when you got your diagnosis (nice birthday present) not that that makes any difference.....66 is the new 40 right?......Maybe if the docs were to give me a 25 year guarantee along with the free servicing I might (only might) sign on the dotted line......I wonder that when you're going for one of your regular scans, psa tests etc. whether you now take them in your stride, or is there always a sense of trepidation while awaiting for the results?.......Although I realise that with surgery, radiotherapy and all the other treatments there are follow up tests that I guess cause a few sleepless nights for everybody.....Unless you're made of stone....(I realise that I am not....My family crest is two white feathers  Surprised

    Regards   Tony

hopeful and opt...
Posts: 2224
Joined: Apr 2009

ony,

When I was first diagnosed I when through all of those intense negative feeling. This continued for several months. I was afraid that the cancer would spread outside the prostate.  At that time Active Surveillance was not very popular, while radical surgery and some forms of radiation was pursued by the vast majority. Since then there have been studies that have been done that reinforced that Active Surveillance is the best choice under the circumstances.

During this time that I have enjoyed a quality of life (7 1/2 years so far) I have had time to investigate various Active Treatment types. Additionally new drugs, technology and methods of localized treatment such as SBRT aka Cyberknife have been done and are fairly mainstream which are now available.

Many men when first diagnosed, are shocked and afraid, and simply want to get the cancer out of their body. This is a natural reaction, however it is a wrongful one, since the side effects from these radical treatments are very substantial. In fact for low level cancers the long time prgression of disease  are similar between those who have had surgery and those in an Active Sureillence program. Also now-a-days techology for AS are improved with better results. 

To emphasize in the usa, and  the regulations for administering PSA have changed a couple of years ago, so there are less diagnostic psa's for many, thus resulting in less men being diagnosed and less radical treatments (these guideline were most likely changed because of the overtreatment among those with low level disease.....by the way many do not believe that a gleason 6 is a cancer, and the term cancer should not be used to describe a gleason 6.  

There is a man who was less than 35 when diagnosed the prostate cancer who is in the same program as I am. He has been in this program for years, and recently fathered a child. He continues in this program. I am treated in a top tier center of excellence. There are also other centers of excellence that run Active Surveillance programs for men. This treatment type is not a fly  night treatment and is considered valid.

Tony, you do not know if or if not you have any cancer at this time, but if you are diagnosed with a low aggressive, low volume disease this can be a consideration. 

In my own case, my level of apprehension has declined in the last 7 years. When I am waiting for the results of my tests or have to make a decision now my level of apprehension is a one or two out of ten...........When I was diagnosed my level was 30 on a 10 point scale. This lasted for several months.

I hope that this helps

tonycue
Posts: 39
Joined: Aug 2016

Hi H&O, You're absolutely right of course.....It's just that I have realised that I am not the right personality type to cope with any kind of disease.....I've never been a good patient, even with a head cold. When a doc tells you that "something" has shown up on an MRI scan a cold clammy hand grabs at your innards and won't let go...(I lost both my parents to cancer so am always aware that genetically I'm in the losers corner). You don't mention if you are married, but if you are I wonder if your relationship "changed" at all? My wife has been amazingly supportive..and positive....I have been finding myself acting very badly towards her....(I know it's the fear). I even found myself "blaming" her for not making me go to the hospital 3 years ago when the GP wanted to refer me....(how unfair and bitter is that?). I imagine everyone reacts differently, but I'm not proud of myself for acting so bitterly....I'm sure that everybody here has found that the waiting for results is the hardest part.....I only have myself to blame for that part of course "mea culpa"

   Thank you for taing the time to post....It does help to talk to someone who has experienced some of the same emotional turmoil.....

      Keep on keeping on     Regards    Tony

Swingshiftworker
Posts: 1013
Joined: Mar 2010

When my PSA rose 3x's in a row about 1 1/2  years after treatment and a recurrence was considered possible, I was given an MRI/MRSI (magnetic resonance spectroscopic imaging) scan that detects for the presence of choline which is a marker for cancer.  The scan determined that I was clear for cancer and the rise just turned out to be the typical radiological bounce and my PSA level has dropped consistently ever since.

The MRSI scan is the only one that I know of (other than the similiar but yet different PET-Choline scan) which can actually detect for the existence and location of a cancer.   The following is a study of the use of the MRSI scan in prostate cancer dectection conducted at UCSF Medical Center where I was treated:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1578527/

tonycue
Posts: 39
Joined: Aug 2016

Hi Swingshiftworker, That PSA  rise must have been a major worry? ....Glad it worked out for you.

I have heard of the MRSI scanners that use spectroscopy to detect chemicals found in cancer, but I must admit to being a bit confused, are you saying that the mpMRI cannoct detect cancer? Ever since asking this question on several forums a few days back I have now been educated a bit more, and directed to various web sites and I am now under the impression that the mpMRI with a good radiologist has a pretty good sensitivity in detecting tumors...using the PI-RADS score they could even have a pretty good guess at staging said growths.....My doc says that the "something" on my scan needs investigating and only a biopsy will tell....I was wondering if he was just being "Coy" and maybe not trying to worry me unduly at this stage....I'm of course hoping that they genuinely don't know and that this is going to turn out to be something less nasty....Any further info you have from your experience would be greatly appreciated

   Thanks for taking the time to reply 

     regards    Tony

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3280
Joined: May 2012

Tony,

It's great that you are well-read, that you understand a great deal about PCa, that you are learning the options.

But no amount of speculating, no amount of worry or imagining, will give you definitive answers. Only the biopsy will do that.

Only when the specifics of the biopsy are back can informed, clinically appropriate treatment responses be tailored to your resuolts.

max

tonycue
Posts: 39
Joined: Aug 2016

Hi Max, What you say is true, but I have had this OCD thing since I was about 8 years old.....Can't unlearn 50 years of bad habits in 10 minutes, especially at times of stress....Plus I have an intensely curious nature......Most OCD types do, we need to "know" answers to questions....We don't let things lie. Ultimately all the research I have done in the last 7 weeks has amounted to a row of beans..But if nothing else I have "met" some very supportive people (yourself included) on this forum and other forums who have been happy to educate me and give me reassurance.....So for that I am truly appreciative......

   Regards    Tony

Swingshiftworker
Posts: 1013
Joined: Mar 2010

A mpMRI can highlight areas where a cancer mass "may" be present in the prostate and is a good diagnostic tool for determining what areas of the prostate should be biopsied but it cannot detect smaller, less obvious cancer sites.  It is almost routine to do a standard mpMRI scan for early PCa diagnosis.

On the other hand, a MRSI scan can pinpoint the exact location of any cancer within or near the prostate using a gadolinium dye, which is a very precise marker for cancer, as a contrast medium.  Between the 2, only an MRSI will show EXACTLY where (if any) cancer is located.

The MRSI scan is a VERY expensive procedure and normally is not used unless cancer is already known to have been present but there remains some doubt (as in my case) about its current existance and/or location.  It would probably not be approved by an insurance carrier for preliminary diagnostic  purposes.

tonycue
Posts: 39
Joined: Aug 2016

Thanks for the enlightenment......

    Regards

       Tony

VascodaGama's picture
VascodaGama
Posts: 2989
Joined: Nov 2010

Tony,

Regarding the efficacy of image studies in detecting prostate cancer (your main subject of this thread) my take is that they have high points of acceptance but not yet 100% correct. A biopsy is still the way to go when in doubt.
As far as I know, mpMRI is a valuable tool for those cases where a biopsy cannot be performed or it becomes unnecessary due to the evident advanced status of a patient (moving him straight to a treatment), or when a repeated biopsy is done under guidance (in a CT/MRI). The information gathered at the many clinics (in particular those involved with brachytherapy and guided biopsy) makes the PI-RADS score somehow acceptable but it is not a common substitute of a biopsy yet.

In fact, since 2000 that there have been increasing efforts to use the image studies to diagnose cancer; however, each expert involved in PCa used his own experience (acquired along the years of practice) to report findings but no effort was ever done to standardize the interpretation in a system that could be used by the whole medical community. The PI-RADS (Prostate imaging reporting and data system) comes from these tentative efforts. The European uro-radiology  “built” a score system based on the data collected from several respected physicians who use to predict cancer not diagnose it.

In 2010 I read a Chinese clinical study done by researchers in China that managed some evidence comparing image studies with post biopsy findings. The cohort was numerous but the image studies were from earlier CT and MRI machines, which image results would be out of date if used in building a “score” with more sophisticated equipment.

In the PCRI annual conference of 2013, Dr. Jelle Barentsz, a respected radiologist specialized in interpreting image studies of the prostate from the times of the “Combidex” exam, (radiology at Utrecht, Nederland) introduced his video-conference system for analyzing image studies live, which were sent to him from hospitals around the world. Everybody recognized then the gap among radiologist at interpreting an image study. He wanted to have it standardized or teach the many on a principle in a reading process. At the same annual conference of 2015, Dr. Dan Margolis (a radiologist at UC Los Angeles) introduced the PI-RADS score which ranged from 1 to 5 namely highly unlikely to highly likely. These wordings are of prediction and that’s how we should consider it, or....... Can we trust that radiologists are now more coherent in analyzing an image study and do score it properly?

I read with interest your cross discussion with Hopeful above. He is highly knowledgeable on the intrigues of AS. I also think that AS is the best initial option to consider in a PCa positive case, Surely AS is not for everyone but for those cases suitable for AS (low indolent risk), it provides quality living during many years till proper intervention becomes necessary, if any. Active Surveillance does not prejudice the benefit of a future treatment. One needs to learn how to sleep with the enemy in the same bed and still feel comfortable.

Your scheduled biopsy will unveil the mystery, and it will tell you if you are rightful for an AS program.

I hope they find the spots to be benign and that the seesaw PSA was related to a case of hyperplasia.

Best wishes,

VGama

 

tonycue
Posts: 39
Joined: Aug 2016

Hi VG, Thanks for replying with a very informative post....Of course when I asked the original question, I really wanted the repy....."NO! mpMRI's are c**p at spotting cancer, you may as well use a kaleidoscope!"......Unfortunately the more I learn the more I fear that this "something" might be what I'm dreading.....This after putting my details into the UT Health and Science centre of San Antonio's nomogram and getting 83 smiley faces out of 100 (meaning I had only a 17% chance of something sinister.....)....To quote a line from my favourite movie Some like it hot "Nobody's Perfect"

I remember saying to my wife just before we walked into the hospital urologists office...."If there are scans clipped onto light boxes I'm screwed".....I even jokingly  said to try to peek a look at my notes to see if there's a skull and crossbones drawn on them.....Black humour is the only form of protection when facing something like "hospital tests"

As for Optimistic and hopefuls helpful posts.....I guess that anything is possible, like I mentioned earlier I am not a good patient and hate taking pills and potions of any kind....the thought of the various treatments for PC just leave me very trepidatious....Could I sleep with the enemy? I suppose it depends how unpleasant the enemy is. Never say never

As for the PSA Seesaw I was thinking prostaitis although no one has mentioned this at any time.....as for BPH I know I have a large prostate My GP did the DRE and said as much, the professor said likewise, the doc doing the cystoscopy guesstimated it at 50cc....I imagine that they know for sure now after the MRI....That's of course what I was hoping for after reading about PSADensity I thought that a reading of 4.3 from a 50cc gland would be OK.....trouble is with this disease is there appears to be no rules, every case is different....

I'm still keeping my fingers crossed, thank you for your good wishes

Regards   Tony

 

 

     Regards    Tony 

Will Doran
Posts: 207
Joined: Sep 2015

Tony,

Sorry to hear of your concerns.  I went through the same thing with a Grumpy Urologist.  I had been in for surgery for a Melanoma and in the blood work it showed a PSA of 4.3 as with you.  My GP thought we should have an exam at Urology.  My GP did a DRE and said everything seemed OK but he thought I should get another opinion. I was a serious Road Cyclist, and it was thought that the cycling was causing a slight rise in the PSA.  That was mentioned earlier in this section by Hopeful & Optomistic.  I went in for a check up at Urology.  The doctor was awful.  He did a DRE and told me I had the smallest Prostate he had ever examined.  I was advised to not do a biopsy at that time by my GP unless they did an ultrasound and it showed an area of concern.  So, the urologist wanted to do a biopsy.  I refused and the doctor got mad and stormed out of the room.  I had no symptoms and thus I went on with my life.  11 years later I had an internal bleed, still no symptoms of prostate problems, and it was thought that I had a problem with an adrenal glad.  Turned out that was not the problem.  In the process of all this they found that my PSA was now at 69.  I went back to Urology and insisted on a different doctor.  MY GP Suggested a different doctor.  I went to him , and again my DRE didn't show much of a problem.  However this time we did the biopsy and I ended up with a Gleason of 7 with the PSA of 69.   If only I had gotten this doctor the first time.  However he wasn't in practice at that time.  So, in Dec. 2013 I had Robot assisted surgery , followed by two years of ADT (Lupron) and 8 weeks, 5 days per week of radiation as a clean up, post surgery.  Post surgery pathology showed I had 40% involvment of the Prostate.  I was listed as a Stage pT3bN1.  I had one very small spot in one lymph node.  That hadn't even shown up on my MRI's.  As of August 14th, I will be a three year survivor from the time of diagnosis.  They treated me as if I were an Advanced Stage 4.  It was rough, but I've made it this far.  In three weeks I will go through all my blood tests again and have my 4 month checkup with Urology.  They had my trestosterone knocked down to 17 with the Lupron.  I have been off the Lupron for 6 months now, and my Testosterone has started to come back up.  At my last checkup, it was up to 134.  That's still very low.  Normal is between 250 and 1,100.  As of now my "T" levels seem to still be coming back up.  At my last check up, my PSA still remains at <0.010, where it has been since two months post surgery. Time will tell next month.

So, My advice is get the biopsy.  Don't mess around with this beast.  I did and I am sorry.  If only that Grumpy Urologist (who is still at the Urology Department) had been like my present doctor, I woudln't be in the shape I am right now.  I'm still exercising daily with Physical Therapy , free weights and resistance bands and at least 80 minutes and up to 100 minutes per day on a Spinner Stationary Bike.  It's a long hard fight, but if you get ahead of it early you will be much better after the fact.

Best of Luck

Peace and God Bless

Will

tonycue
Posts: 39
Joined: Aug 2016

Hi Will, thanks for your post.....You appear to have been "through the mill" Sorry to hear that.....I'm likewise a keen cyclist although not a serious one....I haven't been out on the bike since all this madness began around 7 weeks ago, I haven't had the gumption.....I think I'm frightened of looking too slim in case I then convince myself that I'm losing weight due to something else.....It's amazing how suggestible we humans can be....we think we are sophisticated beings until faced with our own mortatility and then we become as superstitious as neanderthal man (or is it just me? Embarassed).....I have had so many aches and pains since this all began (all attributable to PC of course.....in no way related to my age Wink).....The one thing that is freaking me out at the moment is a grumbling hip pain....I have now convinced myself that this "Means" something....I'm now kicking my butt that I never went to the hospital 2 and a half years ago when my GP wanted to send me with my 3.1 PSA (I knew better...thought 3.1 being only .1 above the cutoff for my age was "SAFE"....Ignorance and denial will get you every time)

In life it pays to be born lucky.....You certainly have to be lucky overall with doctors....As you say things could have worked out so much differently for you had you got the right doctor first time round....The only thing I could really say is maybe my GP could have twisted my arm and "made" me go to the hospital back then, but overall it's not her responsibility....I'm an adult....she did agree to check my PSA every 6 months instead of annually, so I can't complain.....I'm in the UK so under the NHS and despite the fact that they get a "bad press" sometimes they have been excellent to me (so far)....The hospital urologist just surprised me really with his attitude.....Not unpleasant, just very businesslike.....never even introduced himself, I had to ask his name....Its always possible of course that some Doctors are not very good when faced with patients who they have to give bad news to......Maybe it's a kind of defensive mechanism....don't get too friendly in case the patient asks too many questions, and you have to give him some dodgy answers....Maybe I'm reading too much itno it...Maybe he's just generally an A**hole

   Back to you.....I may have missed something, and I admit to being on a very steep learning curve here, but in light of your staging I wouldn't have thought that surgery would have been an option for you, or did they think that all was clear at the time?

   Keep on hanging in there, and very good luck for your future.....

I'm in the UK and I don't know if you are familiar with a rhythm and blues group called "Doctor Feelgood"? they were big in the UK in the 70's....as I'm writing this I'm listening to the radio and there is currently an interview with their guitarist Wilko Johnson who was diagnosed with late stage pancreatic cancer 3 years ago,  he chose not to receive chemo.....He is now "cured" and has resumed his music career, played last year at Glastonbury, made an album with Roger Daltrey from "The Who" and so on.....Gives everyone a bit of hope I guess

   Best Wishes    Tony

Will Doran
Posts: 207
Joined: Sep 2015

Tony,

I was into cycling pretty heavy.  I was out on the road up to three hours per day.  Many times I was riding with the student cycling team members from the Pennsylvania State University Cycling Team.  We were even doing some high speed drafting practice.  I'm 6ft 2in tall, 200 lbs.  When I was in the front of the draft , I guess they liked it because I made a bigger "hole " in the air.  I could really fly.

I was 67 when diagnosed.  My doctor gave me the option of surgery or radiation treatments.  I was ready to do the surgery from the first day I found out I was dealing with this cancer. I wanted the cancer removed.   However my doctor wouldn't do it, until I talked to Radiation Oncology and learned about the radioactive seeds and that type of treatment.  After that appointment I thought I wanted to have the radiation instead of the surgery.  However for some reason, I changed my mind.  Dr. Miller (my urologist / surgeon) had told me that because of my physical condition and my "Youth" (at which I laughed until I cried) I was a good candidate for the Robotic Assisted Surgery.  Turned out, I was very glad I did the surgery.  When they got inside of me, they realized that I had a birth defect.  My Prostate had adhered to my bladder.  So, they wouldn't have been able to get the seeds into the postions they needed to be.  So, the radioactive treatments woudln't have worked.  But it turned out I had to have The Chemo (Lupron) to weaken any remaining cancer cells that might have been left behind and then I had the 8 weeks of Radiation, after being on the Lupron for two months prior. My surgery took 5 1/2 hours to complete.  It was to take 2 1/2 hours.  First they had trouble getting the robot through the mesh from a double abdominal hernia repair.  Then, when they got in there, they found the birth defect. They had to make an incision in my bladder to get the prostate removed.   Then, when they went to remove the lymph nodes. My leg muscles were so developed from the cycling that they couldn't find the lymph nodes in my right groin. Finally They got the robot moved to the lymph nodes.  Then Dr. Miller had the robot do a mirror image and it got to the lymph nodes on the left side.  Thank you Da Vinci.  He explained all this to me around 10:30 the night of the surgery.  I was sitting up in bed watching a Soccer Game (Your football).  I went home the next afternoon and was on a tread mill two days later.

I had some arthritis in my hips.  The one side is worse, because I was hit by a truck while riding bike.  I was left laying along the road.  It was a hit and run.  That has never been solved.  So, the Lupron caused leg muscle and bone and joint pain on top of the arthritis.  Then after I was off the Lupron my legs started to feel better.  Then, They did a bone density scan, and found that I had gained bone density everywhere in my body, except in my Femurs.  I had lost density in those bones.  That was the area where the radiation had hit.  So, they put me on Prolia for Bone Density to try and correct the problems the other treatments created.  The side effects for the Prolia are as bad or even worse than the Lupron.  Bone and joint aches and muscle weakness.  Please be aware of all the side effects from these drugs and treatments.  Make sure and check all that out on-line.  Look at web sites from actual medical facilities.  My doctors warned me about most of the side effects, but not into the detail you will find when doing your own research.

I was a Music Teacher and taught Instrumental Music in the public schools, plus an elementary & middle school band director.  I also worked with the High School Marching Band as Drum Line Instructor.  So, yes I know who "Doctor Fellgood" is.  We always have the Rhythm and Blues station on through our cable music system, and in the cars through the Sirius XM.  I have the surround sound fired up right now on Blues Station right now.  I hadn't heard about the situation with Johnson.  But yes, It does give a person hope.  However my doctors are very careful to never use the word cure.  They talk of remission.  They always keep it real and make sure I understand that the cancer could and probably will come back at some later time.  We already have plans talked through if that occurs.  As long as my PSA stays at "0", they tell me I'm doing well.  In fact, my doctors say they are very surprise that I have done this well, because of where I was at the beginning of this battle, three years ago.  Like I say over and over It's one hell of a fight.

Dont' mess around with this beast.  Hang in there and fight like hell.  Know that you are in my thoughts and prayers. 

Peace and God Bless

Will

tonycue
Posts: 39
Joined: Aug 2016

Hi Will, That's quite a story...I'm delighted that you are doing so well......My guess is your fitness from all the cycling will have helped in your recovery a great deal. A five and a half hour surgery is a marathon for everyone concerned....Hats off to your surgeon for having the stamina.....Funnily enough a couple of weeks ago I was sitting at the PC doing some Prostate research when I noticed a lumpy mass in my right side of my abdomen......I immediately freaked and thought...."Lymph nodes".....made an emergency appointment to see the GP......walked into the surgery, he said "trousers down, shirt up" had a feel....Inguinal hernia......Great! now how did I get that? the fact that I immediately thought Lymph nodes just means all this PC stuff is messing with  my mind.....I'm now down to speak to the hernia people in a few weeks time.....getting old isn't all it's cracked up to be Laughing

Thanks for your good wishes.....Hope your condition just keeps getting better and better and in the meantime find Dr Feelgood's "Milk and Alcohol" and crank it up to 11.....even better for you than Da Vinci Surgery

      Regards    Tony

Will Doran
Posts: 207
Joined: Sep 2015

Tony,

 I did as you suggested.  Located "Milk & Alcohol" on You Yube.  Turned it up full blast.  I like it.  Several live performances in the set.  Which one is Johnson?  The electric 6 string or the bass player.  These were videos from '79, so I assume prior to his diagnosis. 

To many Ab Crunches and heavy lifting.  That's what they told me. My Hernias popped out while I was carrying a ladder down a flight of steps from the back sun deck on the house. Then like an idiot, I went for a two hour bike ride and then came home and mowed the lawn.  The rest of that night I was at the hospital.   Be advised that if you have the hernia fixed, and they use a mesh over the entire front of your abdomen, as they did with me, that will cause some difficulties if you eventually would need surgery.  I have 60 titanium staples holding mine in place.  It can be done, but it just slows down the process. Dr Miller had to rebuild all that mesh after he was done doing the surgery.   And, yes every ache, pain and lump can put a person in a panic.  Even after three years I get those panic things at times. 

My doctor told me I wasn't to get back on a bike for 8 weeks, post surgery.  At 6 weeks I couldn't take it any more and bugged the hell out of him and ask him If I could try my trainer/spinner bike.  He said yes, and told me I'd know if I was over doing it.  It went fine.  I started building up time on the spinner bike to 100 - 120 minutes per day.  I'm still doing at least 80 minutes per day and up to 100 min per day, riding at a tempo of 100 - 120 beats per minute (with CD's going on a player) when I feel up to it.  Your physical condition is very important in the results from you treatments.  Other places on the site, you will see others who talk about physical condition. There are other cyclists and runners, One of us is even a body builder and is doing competitions.  So make sure and get yourself in the best condition you can and then get right back at it as soon as you feel up to it. 

Peace and God Bless

Will

tonycue
Posts: 39
Joined: Aug 2016

Hi Will, Glad you liked Dr Feelgood.....They're not to everybodys taste......They were a typical Pub Rock band who made good and then fell apart within a few years.....A bunch of working class (you'd say blue collar) boys from a very poor part of industrial Essex, called Canvey Island (about 30miles from London). Canvey Island was a port where Oil Tankers would pull in and offload their cargo to the local refineries.....It was a very bleak industrial part of the country...then fallen on hard times, which of course is always a good breeding ground for disaffected youth making Rock & Roll....I've looked at the you tube clip of Milk and Alcohol and can only see one version....If it's the same one you've seen then Wilko Johnson had left by then, There was an acrimonious break up in 1978. (The guys by that time were all abusing various substances and were constantly arguing). That song was written by Nick Lowe and was supposedly about his attendance at a John Lee Hooker concert.......The song  criticises Hooker ("Main attraction dead on his feet, Black man rhythm with a white boy beat").   

There was a brilliant documentary movie made about the band called "Oil City Confidential" by the Director Julian Temple.....If you love rock and roll you'll love this film....All human life is there

Also if you get the series Game of thrones then Wilko Johnson appears as Ser LLyn the kings executioner....Here he is in one of the bands early hits "Roxette"....He's the guy in black with the chicken neck moves......sure knows how to play the guitar though....even though he's an odd looking guy

https://www.youtube.com/watch?v=XaybV46MA6E

Got to admit to being impressed with your training regime.....Never mind the PCa .....You've kicked its ***....You'll live forever Laughing

    Best wishes

PS...I think he was diagnosed with pancreatic cancer in 2012.....He was given nine months to live at the time....Guess he's about your age now.....Not as fit I'll be guessing.

Will Doran
Posts: 207
Joined: Sep 2015

Tony,

They just played Milk & Alcohol on the Blues station on our TV / Music Cable.  I got the link you sent .  Johnson is not the guy I saw on the other videos.

I should also mention to you, that as you move along in you treatments and fight, be aware, than if you have had or are prone to Melanoma Skin Cancer, make sure you go often for check ups.  It' s just another problem that can arise, as your immune system is fighting.  I had Melanoma surgery about 13 - 14 years back, with lymph nodes removed.  I hadn't had problems for 11 years until I  was in the middle of all my radiation etc.  Then, 1 year into this PCA situation, My Chemo Oncologist, suggested I change Dermatologists.  I guess she saw something she was worried about.  She suggested a doctor.  Made appointment and turned out that the doctor was a former female student of mine.  I didn't realize it, because I didnt' know her married name. She walked in the first time and said "Hey Mr, D (that's what the kids called me), remember me?"  I about fell off the exam table.  My GP is also a former student of mine as are 3 others who have been helping me fight this battle.  So,  Sara ( Dr. Ferguson) has removed 11 Melanomas in 1 1/2 years, all have had to have follow ups surgery done.    My last three check ups have been clean with no surgery needed.  The side effects, etc from my treatments have "worn off" enough, so they say, that the Melanoma has gone back into remission.  However now, I go to a distant hospital to a Skin Oncologist for a checkup once a year.  I still go to my normal Dermatologist (Sara) every 3 - 4 months for a check up.  The doctor I see in Hershey, PA, USA is into heavy research into the relationship between Melanoma and other cancers. If I need more further surgery, it is done by another surgeon who comes to town once a week.  So, As Sara wanted, I have " three pairs of eyes" checking me over on a regular basis.  So, Please be aware that this problem could come about.  I'm a blue eyed, blond of German descent.  My dad had red hair. I was raised on a farm, out in the fields in the summer in as few clothes as were legal, and later in life spent lots of time at the beach with my wife.   All of these recent Melanomas have been caught in the "pre stage" of very early Stage 1.  So, for heavens sake, get checked by a good dermatologist on a regular basis.  It's just another pain in the butt, but please don't let anything like that slip in as you go along this fight.

Peace and God Bless

Will

tonycue
Posts: 39
Joined: Aug 2016

Hi Will, Now you're aware of Dr Feelgood, you'll probably keep hearing them "ad nauseum" from now on ....Synchronicity.....

How wonderful that your former pupils are helping you out in regards to your health problems.....Just as well you were nice to them, or you could find yourself getting biopsied on a weekly basis Laughing

Thanks for the "Heads Up" but I don't think melanoma should be a problem for me, I'm of Italian descent, so have very dark olive skin....never had to worry about the sun in the past.....But never say never I suppose....Don't need to be baiting the "Cancer Gods"

Hope your Melanoma stays in remission (good word that)

   Best wishes     Tony

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3280
Joined: May 2012

I am hearing a pop hit's refrain in my head. I have no idea why....it is from Adele; the line goes and it's round and around and around and around we go.....

tonycue
Posts: 39
Joined: Aug 2016

Hi Max, I don't know if the "round and around etc." is a gentle "dig" at me.....but Will and I were pretty much off the subject of cancer (well OK, Will was talking about melanoma but that's the least of MY worries)....we were, on the other hand discussing the merits of 70's R&B band Dr Feelgood....Completely off topic....except for the fact that their frontman Lee Brilleaux died at the age of 41, from of all things Lymphoma (talk about coincidences)....Their lead guitarist who Will and I were discussing because of his near death experience with Pancreatic Cancer is a wonderful character called Wilko Johnson.....As you are an anglophile and enjoy Led Zeppelin I heartily recommend you to expand your Brit Rock & Roll knowledge and find a documentary called "Oil City Confidential" directed by Julian Temple about the band Dr Feelgood....Sad, Funny, Poignant and Life affirming and some Kick-*** Rock and roll to boot....Plus as an ex-submariner they hail from a part of the world called Canvey Island famous for it's Oil Tankers and refineries.....(what's not to like?)

PS I'm name dropping here, but I work in the TV and film industry, and last year did a series of "commercials" with Adele for your very own "Target Stores"......She was absolutely lovely....Although she does not suffer fools gladly

Oil City Confidential....The Trailer: https://www.youtube.com/watch?v=7CZMLs8Ke40

Best wishes     Tony

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3280
Joined: May 2012

The ancient Greek philosophers of Plato's day would gather for all-night discussions of any topic whatsoever. These were called Symposia, from which they current English word symposium is derived.

It seems the only real requirement was that gallons of wine be present.  On the sub, many of us "coners" (guys working in the forward end of the ship) would do music trivia, so getting off track for a moment into the realm of music seems not like a serious offense to me.   My favorite English musician is the semi-retired Jeff Lynn, founder of ELO.    I can't get it out of my head ! :)

Old Salt
Posts: 720
Joined: Aug 2014

This thread has become unexpectedly interesting for music people; I am one of  them, but don't play anything (except CDs).

There's a connection to prostate cancer though.for me because when I went under the CyberKnife, I could listen to whatever.

tonycue
Posts: 39
Joined: Aug 2016

It Seems to me that what this board needs is more symposia.....All this talk of Prostate Cancer is getting a bit morbid Laughing

Jeff Lynne of ELO is an amazingly interesting guy......and Sooooooo Talented.....try and find a documentary that was made for the BBC called "Mr Blue Sky" which is Jeff's life from his working class childhood in Birmingham right up to the Travellin Wilburys and the resurgence of ELO.....At 19 I once "totalled" a sports car that I was immensely proud of whilst changing sides on an ELO tape cassette (New world record) that was on constant "hard rotation"

   More Symposia.....And more wine is the order of the day

VascodaGama's picture
VascodaGama
Posts: 2989
Joined: Nov 2010

Enjoying it too. Just toss the names.

Will Doran
Posts: 207
Joined: Sep 2015

To All,

I feel we must have other things on our minds than the fight we're all in.  So, Let the Music Play, let the Wine (or whatever) Flow, Get out there a drive your pants off in your favorite sports or muscle car, enjoy nature, and live every day like it's your last.

Old Salt,  When I had my Radiation Treatments, I could control the music in the room, as well.  Here in Central PA, they usually had Country Music going.  Many times I'd let it there, but sometimes change to Jazz or Blues, depending on my state of mind that day.  It helped, I think.  Especially when the Therapists (three or four women and one guy) would come dancing in the door when the treatment for the day was over.  I kept it "light" and that made them happy as well.  The guy who followed me every day, was having treatment for a very serious reoccuring cancer (head and neck) and that would set the tone for him as the days went by, and we got to be pretty good "buds".  He'd sit with my wife during my treatment and then we'd pass each day in the hall and give each other a "High Five", as we passed by each other.

Love & Peace and God Bless to all

Will

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