19.2 PSA and 93 core saturation biopsy

93 core biopsy?!? ouch.

Just had my 6 month PSA along with another MRI. My PSA dropped from an all time high of 23.8 in February to 20.1 this week. The MRI shows the same PIRADS 4/5 area so we are doing another MRI guided biopsy sometime in October/November. Nothing else shows up on this new MRI but my prostate went from 57 grams to 47 grams. The PIRADS area has been sampled once by MRI guided by my original URO and then I had the saturation biopsy last summer and it was hit hard again. Both times there is nothing showing up and the Confirm MDX done on the first sample shows no signs of cancer. My current URO says he has had 3 other patients just like me. He eventually found Gleason 4+4 with one of them and the other two are still undergoing regular biopsies just like me.

maybe that saturation biopsy is the reason my prostate shrunk? lol

Hi GH, Sorry, of course, about the PCa, but at the same time glad it has been found. I assume you will discuss further imaging with your docs. I'm thinking your PSA is higher than what BPH can account for. Perhaps yours is a case where a 68GA-PET scan (and perhaps a genomics test for met risk) might be useful in your diagnostic workup to help choose and plan treatment. Were there any MRI findings other that the PIRADS 5 target that now seem relevant?

All the best,

Djin

CT Scan and Bone Scan scheduled for December 7th. URO said the PET Scan is about $10,000 and my insurance doesn't consider me a candidate to cover it.

my hat's off to you. you are brave and persistent. good luck man!

The situation is extremely rare, but people can have metastasis without cancer in the primary site. I have read of men after prostatectomy that had no cancer in the prostate and had positive nodespost surgery

I have a friend whose wife has stage 4 breast cancer and they can’t find cancer in her breasts.

mufjem said...
how can you call it stage 4 breast cancer when nothing is found in the breast-are breast cells easily identifieable in other locations
can understand where small unidentifiable tumor may develope in one location then end up elsware. unidentifieable cause of size location or maybe charactaristics that make it unidentifieable
we cant see everythin

Metastases can usually be identified correctly as to their origin. The histology of a PCa met seen under the microscope is basically the same as what's seen looking at a PCa lesion within the prostate. While there are the "usual suspects" based on statistics, such as PCa mets in bone, diagnosis does requires either a biopsy of the met or discovering the location of the primary tumor. In other words a PCa met still consists of prostate tissue, however abnormal its architecture.

Djin

The results of my CT scan and bone scan were just posted and I have a telemedicine appointment with my URO next Tuesday. Here are the results that I can see online.

========
CT Scan

IMPRESSION:
1. Multiple lesions throughout the liver, many of which are hepatic cysts.
Single nonspecific 2.5 cm soft tissue lesion of the right lobe is favored to
be a hemangioma, attention on follow-up.

2. No osseous metastatic disease.

3. Enlarged prostate.

4. Nonspecific nodular thickening of the left adrenal gland.

Electronically Signed By: Yaquob Tokhi, DO on 12/7/2020 2:48 PM

Narrative
EXAM: CT ABDOMEN/PELVIS WITH CONTRAST, 12/07/2020 13:07 PM

COMPARISON: No prior studies available for comparison.

CLINICAL INDICATIONS: History of prostate cancer;
C61:Prostate cancer

TECHNIQUE: CT images of the abdomen and pelvis were performed from the lung
bases through the ischial tuberosities following the administration of
intravenous contrast.

PROTOCOL: Standard.

CONTRAST:
iohexol (OMNIPAQUE) 350 MG/ML injection 1-171 mL; Route of Administration:
Intravenous; Dose: 110 mL.
iohexol (OMNIPAQUE) 300 MG/ML vial 50 mL; Route of Administration: Oral; Dose:
50 mL.


FINDINGS:

Lung Bases:
The visualized lung bases and lower mediastinal structures are unremarkable.

ABDOMEN

Liver:
Liver is normal in size and CT density. Multiple fluid density lesions are
scattered throughout the liver. A 2.5 x 1.0 soft tissue lesions present in the
right lobe posterior segment (series 2 image 44).

Biliary/Gallbladder:
The gallbladder is normal without evidence of radiopaque stones. The biliary
tree is nondilated.

Spleen:
Spleen is normal in size and CT density.

Pancreas:
Pancreas is normal. There is no evidence of pancreatic mass or peripancreatic
fluid.

Adrenals:
Right adrenal gland is unremarkable. Nonspecific nodular thickening of the
left adrenal gland.

Kidneys:
Kidneys are normal in size. There are no stones or hydronephrosis.

Retroperitoneal/Vasculature:
No retroperitoneal adenopathy is identified.

Gastrointestinal/Mesentery:
The bowel loops are non-dilated without wall thickening or mass.


PELVIS

Bladder:
The bladder is normal.

Genital:
The enlarged partially calcified prostate indents the inferior aspect of the
bladder.

Other:
No free air or fluid within the abdomen or pelvis.

Bony Structures:
Multilevel degenerative changes of the spine demonstrated. No lytic or blastic
lesions identified.

===========

Bone Scan Results

IMPRESSION: No prior bone scintigraphy study is available for comparison. No
definite scintigraphic evidence of osteoblastic metastatic disease at this
time. Indeterminate focal radiotracer activity overlying the distal right
humeral diaphysis as described above. Although this may possibly relate to
residual radiotracer activity in the patient's intravenous access hardware,
posttraumatic change or metastatic lesion is not entirely excluded. Continued
close attention on follow-up imaging is recommended.

I personally viewed and interpreted these images and I have reviewed and
approved this report.

Electronically Signed By: Chadwick Wright, MD, PhD on 12/7/2020 5:48 PM

Narrative
EXAM: NUC BONE SCAN WHOLE BODY, 12/07/2020 15:20 PM

CLINICAL INDICATIONS: 57-year-old man with prostate cancer. The study is
requested to evaluate for osteoblastic metastatic disease.

COMPARISON: No prior bone scintigraphy study is available for comparison.
Correlation is made with the CT of the abdomen and pelvis study dated
12/07/2020.

TECHNIQUE: 31.7 mCi of Tc-99m MDP was administered IV per protocol. Whole
body scintigrams were obtained in the anterior and posterior projection
approximately 3 hours post injection of radiopharmaceutical.

FINDINGS: Focal radiotracer activity is noted overlying the distal right
humeral diaphysis which is indeterminate. The patient's radiotracer
administration occurred in this region in the right antecubital fossa and this
focal radiotracer activity may possibly relate to residual radiotracer
activity in the intravenous access hardware. Osteoblastic metastatic lesion or
post traumatic change cannot be entirely excluded. Degenerative changes of the
wrists, shoulders, spine and feet are noted. No other suspicious focus of
abnormally increased or decreased bone radiotracer uptake is identified. Soft
tissue tracer distribution is unremarkable. Physiologic tracer excretion is
seen in the kidneys and urinary bladder.

I can't remember ever having an injury in that area of my arm. I did get my arm caught in a piece of machinery about 20 years ago and maybe that is what is showing up? I didn't break my arm, but I thought it was going to cut it off when it happened. My brother-in-law is a doctor and he's reviewed the scans and doesn't think I have anything to be concerned with.

Surgery is a valid choice (it was mine), but shouldn't you meet with a RO -- there should be hypofractionated, shorter RT modalities like SBRT possible. Wouldn't it pay to know all your RT options?

Also, please update your signature with a one-line-or-so summary of your last biopsy.

Djin