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PCa with bone met? can somebody please help/advice

Frank-1964
Posts: 20
Joined: Aug 2020

I am 56 yeras and had a PSA of 5.1 (30. may) took MRI on 11. august and TRUSP on 17. august with 4 samples taken (from suspecsious area). I live in Norway.

Unfortunately, I am realizing now that I have had almost all of the PCa symtomps starting 2019 without taking any actions.

For making the long history short here is what I've got from the hospital:

MRI: shows a little PIRADS 4 change in the right middle part. no more suspecious area in the right side.

DRE: enlargment with no cancer-suspecious changes

TRUSP (SKE0BK/KEB06K) used for taking prostate biopsy samples: no clear hypo-echogen changes. a spot in the middle part and probably a hypo-echogen area without increase in viscosity.

volume: 52

PSAD: 0.09

 

PSA taken after above examinations: 28 (17.agust)

 

I have now waiting to get the answer from histology which is expected on 3. sept.

About a week now, I have constant pain in my knees, legs, feet, hands, arms and some minor pain in shoulders and back 24/7. I have heavy night sweets. sleeping only a couple of hours and taking usual pain medicine which helps very little.

My pain do not go away and I am afraid that they have not yet evaluated the MRI results completely and they want just to calm me down til 3. september when histology results are coming.

I know, from MRI PIRADS 4, that there is high probability of clinically significant cancer, and I know that I have PCa, but what is the chance having cancer sperad to bones?

Can anyone please help me?

 

 

Georges Calvez
Posts: 464
Joined: Sep 2018

Hi there,
Have you had a bone scintigraphy with Technetium, that is the standard way of finding bone metastases?
https://en.wikipedia.org/wiki/Bone_scintigraphy

Best wishes,

Georges

Frank-1964
Posts: 20
Joined: Aug 2020

TX Georges for quick respond

unfortunately here is not so straightforward to take the bone scintigraphy. I have to be refered by hospital, so waiting and waiting.

Frank

Georges Calvez
Posts: 464
Joined: Sep 2018

Hi there,

With a PSA of 28 there is some chance that you may have metastases but it is not certain by any means.
There have been a lot of studies comparing PSA levels with the presence of bone metastases and there is a correlation between increasing PSA and their presence but it is not absolute.
http://www.cancerjournal.net/temp/JCanResTher15839-5012356_135523.pdf

Best wishes,

Georges

Clevelandguy
Posts: 593
Joined: Jun 2015

Hi Frank,

What was the Gleason score from your biopsy?  How many cores were positive for Pca?

Dave 3+4

Frank-1964
Posts: 20
Joined: Aug 2020

the PSA of 28 taken 3 hours after TRUSP, so the dr said this value is not reliable. took a new PSA yesterday and right now I've got the new value 8.8.

I measured also CEA (1.4) and CA125 (13) but these are OK values. About GS I have not recieved any information. I have to wait for the result of histology 3. september (LONG time waiting and so much pain, so I am not sure how to manage). I dont know how fast will bone met grew, so it will depend on GS, I think.

 

Following tests after 3 hours TRUSP: which seems to be normal especially CRP < 1 but PSA was 28.5

 

B-Hemoglobin:14,1 B-Leukocytter:5,7 B-Nøytrofile granulocytter:4,1 B-Lymfocytter:1,1 BMonocytter:

0,44 B-Eosinofile granulocytter:0,1 B-Basofile granulocytter:0,0 P-Ferritin:81 S-Glukose:7,3*H (4,0- 6,0) P-CRP:< 1 P-Kreatinin:71 Nyre-estimert GFR CKD-EPI Kreatinin (overfl.=1,73m2):100 S-Natrium:142 SKalium:4,5 P-Kalsium:2,40 P-ALAT:40 P-ALP:76 P-GT:14*L (15 - 115) P-Amylase, total:43 P-Albumin:47 PPSA:28,5*H (< 4,0) P-TSH:1,08 P-T4, fritt:15,3

 

 

 

Georges Calvez
Posts: 464
Joined: Sep 2018

Hi Frank,

I am sorry but you are going to have to wait, tell the doctors that you are in pain and they may speed things up a bit!

Best wishes,

Georges

hopeful and opt...
Posts: 2266
Joined: Apr 2009

Unless there is microscopic, a MRI can show extracapsular extension. Fortunately in your case this did not occur

I wonder if you had psa's in the past. If so please indicate with dates

There are many factors that elevate the psa, sex bike riding, a hard stool, an inflammation,  a biopsy...an enlarged prostate that lays on the urethra thus secreting more psa

Generally at first a patient  shows nosigns of prostate cancer...I was diagnosed 12 years ago, no signs

A pirad of 4 only indicates the likelihood of significant cancer, Gleason 7 or above.....for the most part is intermediate and very treatable

You have not been diagnosed with PC ...so far you do not belong to our club

even if you are diagnosed pc is for the most part it is very very slow growing 

If you want to be proactive just in case do some research about Gleason that indicates aggressive of cancer

Be positive go for a walk get the endorphins going

 

 

Frank-1964
Posts: 20
Joined: Aug 2020

Dear hopeful and opt... I agree pirad 4 and gleason 7 or above most probably treatable, if the cancer has not spread in the bones. I had PSA 3 in 2017 and no test til may this year which was 5.1.

I am not afraid of dying since I lost my daughter 25 days after she was born in 1990 and my brother on 11. june 2019. He diagnosed with colon cancer stage 4 in nov. 2017. So now is my turn. 

I have done much research and reading about GS and will continue to do that. many thanks for your advice. I am positive but the pain in all my joints and bones, night sweets that I need to change everything every 2 hours is giving me a hard time and sometimes untolerable.

Unfortunately there is no private hospital or medical center in Norway that can do bone scintigraphy, only public hospitals. therfore I have to wait maybe 3-4 weeks from now to take this. I am not sure how will the cancer grew with which rate, as I already in much pain. I think I am loosing a precious time and the worst is the pain.

I appreciate your nice words and advices.

hopeful and opt...
Posts: 2266
Joined: Apr 2009

The American Urinary Association does not recommend a bone scan for men who have a Gleason score less than 8. This is one tool among others to determine where a patient stands.

Things have to be done in a coordinated way with excellence, not out of fear. 

With reference to a possible bone scan; there are different types. In the usa the t99 tech scan is generally covered by medical insudance, however there is a F18 bone scan, not covered by insurance which is better

I wonder, have you seen an internist. What does he/she say about the possible reason for your symtoms

I attend local support group and there are men here at this site who have stage 4 cancers, who go on and on for years and years. Improvements in medical technology since scans and therapies are better nowadays with less side effects. 

 

VascodaGama's picture
VascodaGama
Posts: 3238
Joined: Nov 2010

Frank

I agree with above survivors. You need additional tests and should wait for the pathologist’s report. For the moment you have nothing identifying cancer. The pain and hot-flashes could be a cause from a moment of anxiety. Your mind is playing tricks on you.

In my opinion, the prostate volume of 52cc and the negative DRE justifies well the high PSA of May (5.1 ng/ml), which could be a case of hyperplasia. In fact none of the other PSA tests are valid because of inflammation caused by the biopsy on August 17 (3 days only of interval). You should repeat the PSA in two to three weeks if you want a real value. The Transrectal Ultrasound of the Prostate has limitations in identifying cancer. It is good to verify the presence of calculi. Your doctor surely is only using this image to compare with the MRI.

I wonder if your “PSAD = 0.09” shared above signifies the calculated value of the free PSA represented in percentage. Please check because a free PSA of 0.09 % (Total divided by Free) would elevate the probability for existing cancer.

The other shared data has nothing to do with prostate cancer. Let’s hope that the results are negative to cancer and you get peace of mind.

Best wishes.

VG

Frank-1964
Posts: 20
Joined: Aug 2020

Tusen Takk.. (many thanks)

 

You are all such a great guys. I appreciate your advices and will do more to learn and study myself. Already I have learned so much from VG and hopeful and opt...

I will go in 2-3 weeks to take a new PSA test as VG is telling.

With respect to PSA density: I have no idea about the length, width and height but the volume is given and I am not sure what is the correct PSA that must be used. Is PSA value calculated authomatically by TRUSP?

I see from following link that the value of PSA is important in order to calculate correct value for PSAD.

https://www.omnicalculator.com/health/psa-density#how-to-calculate-psa-density-and-its-meaning

 

Best wishes Frank

Clevelandguy
Posts: 593
Joined: Jun 2015

Hi Frank,

Only a biopsy will confirm if you have Pca and also the agressiveness with a Gleason score. Did you have a TRUSP?  The PSA is usually calculated by a blood test and could be influenced by your biopsy, recently having sex, or other physical things that can irritate the Prostate.

Dave 3+4

Frank-1964
Posts: 20
Joined: Aug 2020

Thanks Dave

Yes I had a TRUSP on 17. august and waiting for histology results, expected on 3. sept.

Yes, as VG is telling a more correct PSA value will be after 2-3 weeks of biopsy process, so I need to wait at least 2 more weeks to take a new PSA.

Best wishes

Frank

VascodaGama's picture
VascodaGama
Posts: 3238
Joined: Nov 2010

Frank,

Let's wait for the report but I think we could be hopeful for a negative result if we take into consideration the PSA density of 0.09 (5.1/52=0.09), which is below the threshold PSAd of 0.15 considered by many urologists as the cutoff value to predict positive from negative.

Thanks for confirming the meaning of "PSAD=0.09".

Let's cross our fingers.

VG

Frank-1964
Posts: 20
Joined: Aug 2020

I need to mention that I have constant pain in my both legs, knees and feet 24/7. I have also some pain in my arms, hands, shoulders, joints, ribs, back and neck which comes and goes. Has  anyone experinced such pain?

Clevelandguy
Posts: 593
Joined: Jun 2015

Hi Frank,

To me a lay person the pain you are describing does not sound like early Pca.  Pca usually does not spread through the whole body that quickly((August+).  Dont know what causing your pain but if it was me I would go see an Internal medicine doctor for some blood tests. The pain your describing could be from many different conditions or diseases other than Pca or it just could be stress.  Just my 2c worth...

Dave 3+4

Frank-1964
Posts: 20
Joined: Aug 2020

Dave  agree if it was from august 2020 but my symtoms started early in january of 2019. And constant pain started from last thursday 12. August 2020. I spoke with doctor on monday 17. August and he took many blood tests but he says blood tests are ok. The pain is worst at nights and is accompanied with heavy night sweet. 

MK1965
Posts: 201
Joined: Jun 2016

Frank,

pain you describe sounds like osteoarthritis.

You are 1 year older then me, and I am alredy diagnosed with osteoarthritis in both knees and my right shoulder.

Also, had prostate cancer and RP in November 2016.

MK

Frank-1964
Posts: 20
Joined: Aug 2020

MK many thanks for your massage. However, there is no stiffness involved. So it is hard to believe that these pain are due to osteoarthritis.

Is there any blood test that can reveal osteoarthritis?

MK1965
Posts: 201
Joined: Jun 2016

Frank,

No specific labs that can diagnose osteoarthritis. For rheumatoid arthritis there are special labs.

i was diagnosed by xrays ( right shoulder) and by MRI's for both knees. Pain is more General with or without stiffness.

Usualy, once you start moving every morning, it gets better. I still run 2 miles in the mornings and walk 2 miles in the evening.

Osteoarthitis is progressive disease and I am trying to adjust to minimize the discomfort. 
NSAID over the counter works for me. In June I was prescribed MELOXICAM which is also NSAID but you get it on prescription.

I can tell from my experience, it works way better compared to Ibuprofen.

MK

Clevelandguy
Posts: 593
Joined: Jun 2015

Hi Frank,

To answer your question on a blood test for RA check out this link from the Mayo clinic:

 

https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653

 

Dave 3+4

 
hopeful and opt...
Posts: 2266
Joined: Apr 2009

Frank,

Have you seen a internist to evaluate your condition?

Frankly you are not a doctor, and are not qualified to make a determination of your condition.

Frank-1964
Posts: 20
Joined: Aug 2020

Thanks for yout advice and yes you are right Hopeful.

I got a referral to perform a CT scan on pelvis area from dr. yesterday. so I will take a CT as soon as possible in next week, hopefully.

 

Frank-1964
Posts: 20
Joined: Aug 2020

Update of my status: I've got results from pathology yesterday (5 days earlier than planned date of 3. sept). No cancer is detcted and dr. said there are some inflammations. The MRI showed a small region in the middle with PI-RADS 4. so I have cofused. It is strange that inflammations can result in PI-RADS4 region. I've got new appointment, late september, for further examination, so I am preparing to asking a lot of questions.

I appreciate all support and advice you have provided me in the last couple of weeks.

VascodaGama's picture
VascodaGama
Posts: 3238
Joined: Nov 2010

Frank,

Yes it is confusing that the two tests are and provide due results but got different conclusions. You need to consider that the MRI serves only as a predictive tool. The analyzes of biopsy cores under the microscope provide the real finding. For the moment you can only conclude that you have no cancer. However you need to continue vigilant with periodical testing (PSA) and investigate what is causing that nasty pain.

Surely the biopsy could miss areas with cancerous cells but the urologist may have directed some needles to the critical area found by the MRI.

Your initial comment of "I know that I have PCa" has no basis to be considered valid.

I recommend you to request a Bone-scan in your next meeting with the doctor.

Best

VG

Frank-1964
Posts: 20
Joined: Aug 2020

Thank VG. Yes I will do that.

Best wishes Frank

Georges Calvez
Posts: 464
Joined: Sep 2018

Hi Frank,

I think you might get an x ray or a CT scan, which is a posh x ray, I doubt that you will get a technetium bone scintigraphy.
That is reserved for cases of suspected prostate cancer metastases, etc. You do not have a primary tumour at the moment so that is not justified on those grounds.
Doctors do have some latitude in prescribing tests but they do have to justify them to management at the end of the month.
But you might get another biopsy concentrating on the area of interest to see if they can find something.
I would be grateful to have dodged the bullet of prostate cancer if I was in your shoes, maybe you have arthritis or something similar?
Not nice but a breeze compared with metastatic prostate cancer!

Best wishes,

Georges

Trew
Posts: 920
Joined: Jan 2010

I think I am now 11 yrs out from stage iv prostate cancer.  My cancer moved into the bladder neck area instead of heading for bone.

 

I just want to share this thought, for what it is worth.  I was given a 50/50 chance of survival and I am still here.

Most of the terms you are using- I have forgotten what most of them mean.  

 

I do have a AUS800 that reminds me that I did have PC every time I pee, but I am still here.  I have been out backpacking in Colorado 2x this year for a total of 17 days in the backcountry.  Not bad for being 71.  

Just don't give into panic, yet.  It's true some die from PC, but many don't.  

 

Saying all that, you have my sympathy.  Life is just very stressful when all this begins to break on a person.

 

And if you really start feeling anxious at times, xanix is a nice pill when life gets to be too much.  I didn't use them very often but there were times, especially in the followup treatments I did use xanix once in a while.  

 

Frank-1964
Posts: 20
Joined: Aug 2020

Hi again. just to update

Histology results showed no PCA. However, MRI showed a suspecious region in Ramus inferior. So dr. ordered a new MRI and in addition a CT scan of pelvis on 10 sept. I know most probably that the suspecious area will be a type of bone cancer that is giving me this constant and severe pain in legs, knees, feet, arms and back. I am hoping for the best but I know that this pain that I am experincing is something very serious. unfortunately very soon, I am going to find out about it. 

Best wishes

Frank

hopeful and opt...
Posts: 2266
Joined: Apr 2009

anesthesiologist 

It seems that the mri will also  be directed toward the pelvis. The results hopefully will be available this week so the next step can be determined It may be that you will see any pain management doc (anesthesiologist) to manage your case. Just a wild guess from a non medical person - perhaps referred pain coming from the hip

Best

hopeful and opt...
Posts: 2266
Joined: Apr 2009

 

It seems that the mri will also  be directed toward the pelvis. The results hopefully will be available this week so the next step can be determined It may be that you will see a pain management doc (anesthesiologist) to manage your case. Just a wild guess from a non medical person - perhaps referred pain coming from the hip

Best

Frank-1964
Posts: 20
Joined: Aug 2020

I am now pasient in urology and orthopedy dep.

urology due to problem with prostate enlargement and orthopedy due to new finding, Chondrosarcoma (bone cancer).

I am just hoping that the cancer is in early stage and hopefully not spread to lungs.

Best wishes to all who is living and striving with this disease.

Frank

Frank-1964
Posts: 20
Joined: Aug 2020

The findings seems to be a fatty mass, intraosseeost hemangioma and not cancerous for the time being. But now the dr. is suspecting a great deal towards lung cancer. As the pain in my back, shoulders, shoulder blades, neck, arms and chest are symptoms of lung cancer as well. Lung cancer spreads first into bones. In addition lung cancer cause nervological pain (so pain in my legs due to tumor pressing the nerves). I have smoked for almost thirthy years and I quit smoking in 2013 just before my heart by-pass surgery (5-bypasses).

So I will do a CT scan of lungs during next week. I know that this is probably the cause and root of all my pain. I will write in Lung cancer forum soon.

 

Best wishes to all, struggling with this disease

Frank

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