I wonder if we ever manage to identify and locate the tiny little buggers we call micrometastases. I would appreciate receiving opinions or any information you, ladies and gentlemen of this board, know or have found in your researches.
Unfortunately, I was again told that I have them and that, in my case, it will be difficult to radically eliminate the cancer with spot radiation as I have been hoping. I guess that now I may start using the term “oligomicrometastatic cancer”, to identify my case.
This week I had an 18F choline PET exam and was told by the attending Nuclear Medicine Physician Dr. Frederik Jonge (a 27 years veteran in the trade) that the whole body image does not identify cancer. He commented to believe that I have micrometastases which are hard to be found by radio nuclear isotopes (this comment surprised me). He proposed to give a second look but his final judgment on the images provided in the PET is that to be negative for adenocarcinoma.
Surely I will wait for his second looks but I also plan to get second opinions of other nuclear doctors. However, his comment gave me the impression that if the cancer does not spread wider I will never get a picture of the bandit. This is a big blow in my hope for an oligometastatic treatment to try and eradicate the bandit for good.
The first doctor diagnosing me with micrometastases was the oncologist Susan Slovin at MSKCC, back in 2002, but she was just guessing her opinion on my status. There was not much information or knowledge on the condition at those times. In fact the group of PCa specialists where she belonged was at that time engaged in qualifying the outcomes of salvage therapies comparing the results of earlier against latter attacks. Slovin was studying a series of recurrence cases all with different patterns of aggressivity and in one of her papers she defines the now famous term used by many physicians “6 months” as the longest period one could way till starting a salvage therapy.
She told me that micrometastases, even made up of low aggressive Gleason rates (<3), could be grouped with the worse cases in terms of difficulty to treat.
Many of the participants in this forum know about the details of my case from previous threads (links below). I will just add that along 2017, my PSA has risen reaching the value of 2.05 ng/ml (T=329), in the beginning of December (Sep; PSA=1.78 / T=306) which lead to the PET exam. This PSA level of 2.0 is recommended for 18F choline nuclear images if one wants to assure a positive image result. That was my aim this time and the reason for waiting the PSA to increase. Meanwhile, the cancer had a free ride but I will restart ADT and knock it down again. I got the impression that I failed and the bandit won.
My doctor wants to restart ADT with a PSA of 2.0 but I am tempted to allow extra time and let the bandit to continue in its frenzy parties of testosterone cocktails letting the PSA increase further to try again with a more sophisticated image exam such as the PSMA PET exam which I trust to be better than the F18 CH PET, but unfortunately, on this date this exam is not yet approved by the National Health (European) so that one would need to go private to have it, and this is not cheap. Another pitfall is that the exam may fail again because it depends on the characteristics of one’s case. So far many PSMA trials have been hold around the world (in the past 4 years) showing several isotope combinations that were better in delivering the PSMA (dotatate). One needs to choose the clinic using the modeling tracer (chelator of radionuclides) most appropriate to his own case. We need firstly to get a doctorate in the field for not erring.
My history of the past 5 years in these links;
Basic introduction of Image exams;
F18 presents better image in lower resolution PET machines. A comparison of two modalities in this link;
My next appointment is scheduled for October 2018 so that I have time to see how things unwind. Surely before that I will decide on something.
Best wishes for 2018 to all comrades of this forum,
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