Doubts with PCa

Amazing how no matter how we are doing, or feel we are doing, it is extremely easy for us to sink in self doubt when it comes to PCa.

I'll preface this by saying that I had a herniated back years ago, that pre surgery test showed significant degenerative spine disease, and that I started working out again with weights two weeks ago and have gone quite heavy right away.

When my accountant came by yesterday and discussed his open surgery form more than 15 years ago he mentioned that he still does yearly nuclear bone scans. When I told him I just do a blood test to check my PSA he said his surgeon, an oncologist named Weiss from Long Island NY said that a psa test alone is not enough. My accountant said what I already know, that it can come back anytime, and suggested I speak to my surgeon to do more. I don't want to go down that road right now.

However, my lower back has been killing me, my shoulders hurt, and I feel sore bones everywhere. I somehow made the connection between PCa and these symptoms and have started to stress about it. My wife moaned, rolled her eyes and said that she knew I would go down this road as soon as she heard him saying that to me.

my plan is to continue working out and I presume the aches and pains will go away the fitter I get. But the point of this for me is how fragile my psyche' is now and how no matter what, I always go back to thoughts of PCa returning. That's one of the most wicked things about this disease for me. W elearn to live with it and adapt to it, but no matter what, we can never leave it. At least I can't.

Hello: I think that most of us simply and CORRECTLY relay on our PSA tests done at 6 month or yearly intervals. This would be for us guys who have had organ confined PCa and were treated by surgery or radiation. I personally would be afraid of yearly nuclear bone scans if I were a gleason 6 or 7 since amount of radiation would be significant over 5 to 10 years. My surgeon simply said to regularly have PSA tests and even recommended a yearly DRE (to be sure that nothing was growing in the prostate bed area). As long as the numbers remain below 0.1 and nothing is felt by DRE, we should be just fine. It is my understanding that Prostate cancer is one few cancers that can be effectively monitored (after treatment) by such a simple blood test such as the regular PSA.

Bill K. from NJ

David, first of all, anything can come at anytime and kill us. All our lives we have lived under this "axe." A diagnosis of cancer just brings this "thing that only happens to other people" into reality that it is going to happen to all of us sooner or later.

"When my accountant came by yesterday and discussed his open surgery form more than 15 years ago he mentioned that he still does yearly nuclear bone scans. When I told him I just do a blood test to check my PSA he said his surgeon, an oncologist named Weiss from Long Island NY said that a psa test alone is not enough. My accountant said what I already know, that it can come back anytime, and suggested I speak to my surgeon to do more. I don't want to go down that road right now."

 

I read the above paragraph with amazement.  First, of all there is absolutely "no" study anywhere that states, the sooner you detect metastatic recurrence, not a local one,  the longer you will live.  The statement of "a blood test is not enough" is based on what, I would ask your accountant?  Even if your accountants doctor sees something on a bone scan before his PSA rises that knowlege will do absolutely nothing for him.  Other than maybe get him started on HT therapy and ruin his quality of life sooner rather then later.  Purgatory's doctor would agree, that there is no benefit to starting HT sooner rather then later. 

Besides a PSA test, what "more" could you possibly do?  If there was something more, every doctor in the country would have their patients doing it, not just one guy in Long Island, NY.  What does he know that the rest of the country doesn't? 

Why don't you ask your surgeon what more you could be doing?  I am sure he would like the recurrent revenue stream from an uneeded bone scan from you every year, but if he is a good surgeon he will tell you there is nothing else you need to do right now.

You want to know what more you can do?  Try diet and exercise....You know take care of yourself....I bet your accountant isn't doing that........ 

Casper, I never said taking care of yourself would guarantee a long healthily life. But it will do more for David then needless annual bone scans. Bones scans do nothing more then help stage or determine progression. There is absolutely NO evidence that the earlier you detect metastatic PCa the more "manageable'" it will be. To suggest otherwise is absolutely baseless. The advice given to David by his accountant to "do more" is a bunch of garbage by someone who obviously knows nothing about PCa recurrence and is blindly following bad advice by his doctor. Especially after 15 years of being "in remission" bone scans are doing nothing more then draining this guys bank account. Read up on it.

ChrisR Said:
"First, of all there is absolutely "no" study anywhere that states, the sooner you detect metastatic recurrence, not a local one, the longer you will live."

I don't totally agree. There is a lot of controversy with this but early PET scan studies have shown that the ability to detect early metastatic disease can indeed be useful in delaying mortality. In addition, because they know it's possible it's the key driving factor in todays study's in imaging using varying contrasts to detect distant metastatic disease.

While these studies cannot prove that early detection of distant mets can extend lives, there is also no study that proves the contrary. In other words, it is plausible that we have seen cases where an early detection was beneficial. But I won't debate this as it's a very controversial debate and there are many variables.

Clearly, the search for an imaging scan that can detect the tiniest mets is based on the theory that it WILL and DOES matter. Even in some cases, such as the CTC scan, imaging has proven to be a breakthrough in telling us whether a certain treatment is working. And that one is a Level 1 Study that makes it possible to shift treatment protocols to more effective alternatives. Some of the doctors that are using CTC are Myers, Leibowitz, Scholz, Vogelzang, Crawford, Carroll....etc.

I think these guys know what they are doing.

Tony

PCa doesn't give me as much self doubt as getting OLD does.

Every week seems to bring on a new ache or pain.

This week, my right ankle ...where the leg meets the foot on top... hurts like heck. Ibuprofen makes it better for a while.

Can't wait to see what next week brings

Tony - I'm glad you think that now, you deserve it.

David - I know, you're right. But I'm wired that way.

Answers here have helped, i have less doubts vis-a-vis the actual process to follow to monitor. Indeed my surgeon would probably shrug the suggestion of more tests than a simple PSA off.

Probably am just getting old. Played soccer last night, feeling very stiff now. Will go to gym tonight to work on core and shoulders and hopefully the aches will go away as I get back in the gym routine.

Logoslidat,

That doesn't sound like Chesterton to me. He likes paradoxes and tensions between ideas. I've seen that quote attributed to Bette Davis. It sounds more like her.

Chesterton said: Youth is the period in which a man can be hopeless. The end of every episode is the end of the world. But the power of hoping through everything, the knowledge that the soul survives its adventures, that great inspiration comes to the middle-aged

Apparently getting old aint for quote quoters, either. Betty Davis??? I believe, but everyone knows goils can't be sissies