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Prostate Cancer Treatment Timeframe

Mksnow
Posts: 2
Joined: Oct 2020

Hi, My Dad was diagnosed with prostate cancer in early Sept.  Gleason 7 4+3  Just got results from follow up CT Scan findings were possible Lytic lesions in pelvis. Whole body bone scan showed nothing.  His urologist is highly recommended and has years of experience treating prostate cancer.  Now urologist wants a bone biopsy scheduled in three weeks and said no treatment can begin until bone biopsy results.  Treatment process seems to be moving slowly taking weeks to get approval for tests and referrals to radiology oncologist etc.  By the time the bone biopsy results total time from being first diagnosed will be almost three months.  Should some kind of treatment have already started?  What if these lesions are bone metastasis and time is ticking?  Thank you for any insight.  

Clevelandguy
Posts: 600
Joined: Jun 2015

Hi,

From what I have read the Lytic lesions could be caused by bone cancer and a biopsy is a good way to tell if there is cancer present.  Prostate cancer is a slower growing cancer but a 4+3 is on the slightly agressive side.  I know it seems a lifetime to you but if you trust your doctor wait for the scan to see what is going on.  Sometimes with the word cancer people want to move at lightning speed to eradicate it, I know I did but take a deep breath and follow your doctors lead.  Hopefully once you get the result from your biopsy your father can move on with the next phase of treatment. Did the Urologist perform an MRI or Pet scan to determine where the cancer in the Prostate is located, by this I mean near the edge or deep inside of the Prostate.  If the cancer has left the Prostate gland then it could spred to other areas.  If its deep inside of the Prostate then maybe it has not had enough time to spred.

Dave 3+4

Mksnow
Posts: 2
Joined: Oct 2020

Thank you for you insight and kind replies!  Grateful to have found this message board.  When you hear possible pelvis bone tumors it adds a new worry.  No MRI or PET-CT scans have been suggested. Just the original prostate biopsy, abdominal CT scan and whole body bone scan have been done.  Interesting part is the CT scan radiologist reported the tumor is fully contained within the prostate along with these lytic lesions and refered further investigation to the bone scan later in the day.  The bone scan was read by different radiologist who found no definite bone metastasis.  Reported some various skeletal uptake, including the pelvis are, was due to degenerate age.  My Dad played softball until last year and has had many injuries.  Urologist felt these lesions were probably nothing but still wants to investigate, which is good.  After researching lytic lesions are somewhat uncommon in prostate bone spread.  My Dad will be meeting with the radiology oncologist next week and I will remind to ask about MRI or PET-CT.  I don't live close so I have not met his urologist and the last time I visited, because of COVID I wasn't allowed to accompany him to the appt. The urologist came highly recommended by many resources from friends and within the medical community, although it sounds like he is not the "warm fuzzy" type.  Curious why the bone scan didn't pick up the lesions.  My Dad is 83, very active, feels great, still teaches but lives alone as my mom and brother passed a couple years ago. Concerened he will be able to physically handle treatments.  Three months ago my Dad had to push for urology referral as he has no urinary symptoms or pain but was concerned his PSA went from 6 to 8 in over a year.  So many research studies talk about PSA <20 being unlikey for spread, even stating bone scans should not be offered for PSA < 20.  And now with my Dad we are talking possible bone spread.  Also Urologist said because of his PSA of 8 he suggested no surgery. I was thinking surgery wasn't an option due to age.  So many questions on this new journey!  Thanks for any additional suggestions, insight and for listening!  

VascodaGama's picture
VascodaGama
Posts: 3240
Joined: Nov 2010

MK,

Welcome to the board.

The success of a therapy goes hand in hand with the success of the diagnosis. Quite often patients spend two to four months pos diagnosis, investigating the pros and cons before deciding on a treatment. Apart from that prostate cancer does not spread overnight allowing that time needed for us to educate on the matter.

Typically contained cases are treated with surgery or radiation but if spread is identified then radiation ou a combined therapy of hormonal plus radiation gets prime recommendation. If still bone lesions are found then the options are narrowed to sort of systemic therapy such as chemotherapy, hormonal treatment or immune therapy.
One should get from the doctor his best "clinical stage" to choose and decide on the best treatment.

 

Do things coordinately and timely.

Best,

VG 

hopeful and opt...
Posts: 2273
Joined: Apr 2009

A CT scan does not provide much definition in finding suspicious lesions. A mri is preferred as a scan. The mri looks at the prostate and close surrounding areas and may indicate extracapsular extension. The mri uses a Tesla magnet. The 3.0 tesla is the best in clinical use. There is also a 1.5 magnet that is not as powerful. 
Also there are PET scans that are avaliable that survey the body for cancer spread. There is one called an Axiom which is approved by medicare and is good. There are also investigation PET scans that provide better results. One of these are at ucla and UCSF gallium 68 PSMA. There is a $2700 charge for the test at ucla. There are also other investigational pet scans using different contrasts at selected major medical centers at various locations in the US. 
Bone scans are recommended for men with Gleason 8 and above, or for men with a lot of 4+3. There are various bone scans, the f18 better than the t99 however there is a charge. 
.............

Also family members are more likely to be diagnosed with prostate cancer and also breast cancer, so if you are a male start being monitored for PCa at age 40 or before, and if you are a female get those mammograms. Also heart healthy is prostate and breast cancer healthy. 

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