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Newly diagnosed, not clear about followup tests

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Posted 1/24/2017 6:12 AM (GMT 0)
Hopefully my signature shows the data it is supposed to. Anyway, I've read the relevant first-timer posts, and although I think I'm clear on what "clinically localized" means (basically, no evidence from DRE or symptoms that the cancer is outside the prostate), I'm not clear on whether a followup bone scan/CT scan is a good idea or not.

My urologist does recommend a bone scan and CT scan, and specifically recommends against any active watching type followup. He does so because a large percentage of the gland contains cancer cells. As you can see (I hope) from my signature, of the 8/10 cores that were positive, 4 are 3+3 and 4 are 3+4. My understanding is that those 3+4 scores plus the large involvement justify the followup tests.

Based on this, I think my urologist is right, and the tests are justified. Do you guys think I'm understanding all of this correctly?

Thanks!
Posted 1/24/2017 12:02 PM (GMT 0)
Welcome to the club no one wants to have to join.

A second read of the biopsy slides by either Epstein or Bostwick would be a good second step.

The CT and Bone Scan are pretty much standard operating procedures -

Bobby Mac
Posted 1/24/2017 12:23 PM (GMT 0)
Hi, pleased to meet you.

You appear to have what we refer to as a Gleason Score of 7 (3+4) or, G7(3+4). While many folks consider that 'intermediate risk', I personally consider even a single G4 cancer cell to be potentially fatal given that it can move around your body and colonize distant places (metastasize). The bone and cat scans are indeed standard operating procedure in our type of case.

The PSA of 17.3 is worrisome. I wouldn't sit on my hands too long as the stats aren't with you on that. (There are dotted lines at a PSA of 10 and another at PSA of 20. You and I are in the in-between on that. Not really wonderful.)

Mine was supposed to be 'clinically localized' too....but it turned out to be a little bit worse once they got in there. sad

As for 'active surveillance' or 'watchful waiting'...that would give you the opportunity to 'actively watch' your cancer go from a "stage 3" to a "stage 4" with all of the associated accoutrements.
Posted 1/24/2017 12:32 PM (GMT 0)
Sorry that you are here. Please know that there is hope. Also know that having cancer sucks, there is a lot of hope with your numbers.

I would strongly recommend getting a CT/bone scan. It will help rule out if the cancer has spread past the prostate. Hopefully the scans will be negative. Then they can be used as control for future scans.

Active survalence is generally recommended for a G of 6 or less. With a G of 7, I would recommend some sort of active treatment. The good news is that with treatment your cancer can be totally cured (as opposed to managed with a G of 8). Also, you have a large number of possible treatment options available, surgery, radiation (internal and external), cryotherapy, ultrasound, etc.
Posted 1/24/2017 1:11 PM (GMT 0)

IdeaSave said...
My understanding is that those 3+4 scores plus the large involvement justify the followup tests.


That is absolutely correct. This is the standard of care in this situation.

George
Posted 1/24/2017 1:35 PM (GMT 0)
Let me try to interpret trailguy's post (and, tg, correct me if I am wrong). He is NOT telling you that you are at risk of dying from PCa within the next few months. He IS telling you that although the nomograms (computer models) may say that your case is "intermediate risk" the nomograms are constructed from averages, and with your tumor load and pathology, you may be an outlier to that average because of the amount of G4 cancer cells in your prostate.

What I think we all are saying is that some form of treatment should be in your thinking, and it should be relatively soon. Yes, you can take some weeks to learn, discern and decide which treatment is right for you, but with the amount of PCa you have, and with the G7 cores, you need to think about how you want to actively treat it.

The tests your doctor is suggesting should give you a lot more information about how serious your situation may be, and may also be helpful in narrowing down the range of treatment options to consider. The bone scan and CT scan are typical for cases like yours. It sounds like your doc is following a standard path. Just don't let the first treatment option presented cloud your thinking so badly that you miss learning about others.
Posted 1/24/2017 2:03 PM (GMT 0)
With your biopsy results, you are going to need some kind of intervention, surgery or radiation. I had an endorectal coil MRI before surgery for the surgeon to use as a road map of sorts while excising my prostrate. Even with my Gleason (G7), I had no pre-treatment CT or bone scans. My urologist is an associate professor of urology at MD Anderson and said it wasn't necessary at that point in time.
Posted 1/24/2017 3:07 PM (GMT 0)
As others have said above, your cancer's extent is beyond the guidelines for any type of watching and will need treatment. The scans are commonly required, and are usually negative, but the doctors often want that additional check before deciding on a treatment plan.

Please keep in mind that the choice of a type of treatment is yours alone. Surgery, radiation (several types), and some other options are available to you. Keep reading and asking. Try to attend some local prostate cancer support groups. Many men have been down this path and gone on to live long and enjoyable lives.
Posted 1/24/2017 9:19 PM (GMT 0)
You have what they might call "intermediate risk" prostate cancer, but because your Gleason score is 7 and your PSA is in the 10-20 range, and you have a heavy tumor burden, your urologist is justified in considering you as having borderline "high risk" prostate cancer. With "high risk," a bone scan/CT is standard. It is "clinically localized" unless the bone scan/CT shows that it is not. You have to rule out distant metastases before you can consider curative therapy.

You may wish to enter your data into a nomogram to see the probability that it is indeed localized:

/www.mskcc.org/nomograms/prostate/pre-op

I agree that it is a good idea to get a second opinion on the biopsy slides from Epstein. He shows the percent pattern 4 and he'll mention any pattern 5 he sees - all useful in making a therapy decision.
Posted 1/25/2017 12:59 AM (GMT 0)
A cat/bone scan will tell you if the cancer is out of the prostate...it in no way will tell you that it is not...period...
The high psa is troubling....get it treated...the volume means the needles were guided and hit the bulls eye... it is not as prognostic as many believe... post op pathology could easily show the extent of whole tumor involvement as 10 percent or less. Your uro knows this...now you do...get it treated...get second opinion on slides... be ware of all internet advice.:: including mine...self advocate...imo...your u have little to worry about...a season of trial will pass and you will be a better man for it based on action vs reaction. Keep us in the loop...if can...can...if no can...no can( std Hawaiian kine advice....)
Posted 1/25/2017 3:06 AM (GMT 0)
T1C

I've never felt the importance of the DRE is stressed enough. Your's being Negative is a good thing.

that said.....
Posted 1/26/2017 5:47 AM (GMT 0)
Thanks everybody, your advice and comments are much appreciated!

I think I was unsure about the followup tests due to not having enough knowledge to judge the applicability of an article here on their overuse. You guys helped me correct that, and so I scheduled those tests today.

I scheduled both tests for the same day. The diagnostic center tells me that is not a problem. Am I taking on too much for one day despite what they say?
Posted 1/26/2017 6:57 PM (GMT 0)
You can both on the same day. Just means more laying around on machines.

Personally, I prefer to get it all done at once and avoid having to go on two different days.

Andrew
Posted 1/27/2017 4:52 AM (GMT 0)
My thoughts exactly, Andrew, thanks.

Mark
Posted 1/27/2017 8:18 PM (GMT 0)
Mark,
I suggest asking both your scan departments whether two in one day is okay. In my case at UCLA, I had to drink up different preparation potions in advance of each scan. Both departments advised not to try to do them on the same day.
Best wishes,
Jim
Posted 2/4/2017 7:41 PM (GMT 0)
Thanks, Jim - I did that, and they said it wasn't a problem. The CT scan requires drinking some solution, the bone scan requires an injection that takes four hours to distribute effectively. I'm doing the CT in the AM, after which they give me the injection, and I come back four hours later.
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