New dx for my fiancee.... still in shock **Updated**

I'm 3 hrs south of Atlanta. Emory didn't offer robotic when I had my surgery in 2006. My Surgery was done by Fray Marshall who has since passed about 4 years ago due to throat cancer. He and Walsh at Brady worked together, you can google his name and can see he was one of the pioneers and I was very fortunate that he performed my surgery, he invented the Min-lap surgery of RP where you only open a 3 inch opening instead of the normal 5-6 inch. I thank God he was so positive that he could help me with the surgery when others didn't want to perform it.

There are several places you can go within driving distance, Duke, Mayo Jacksonville, Vanderbilt if you are not comfortable with Emory. I would ask your doc to give you referrals to more than one to get different opinions, but if it really has spread, your options will narrow as to initial treatment.

I wish you success, I know this will be a trying time with many decisions. Your finance should be thankful he has such a caring lady in his corner

Okay maybe we jumped the gun a little. CT scan just resulted and not looking good. Extends past prostate bulging into bladder and several suspect lymph nodes. Also noted innumerable small lesions in both lungs. That would explain his bad cough lately. He's been on antibiotics for more than 10 days for his UTI/Prostate infection and lung xray was clear at ER visit on May 14th.... Here are the two reports:

Nuclear Medicine Bone Scan
Date: 5/27/2014 2:52 PM

Clinical Indication: Recently diagnosed prostate cancer. PSA of
84.61 on 4/4/2014

Comparison: CT of the abdomen and pelvis with contrast dated
5/27/2014.

Procedure: Approximately 2-4 hours following intravenous
administration of 25.9 mCi Tc99m MDP, delayed planar images of the
whole body were obtained in anterior and posterior projections.
Spot anterior and posterior images of the pelvis and feet were also
obtained.

Findings: Symmetrically increased metabolic uptake within the
shoulders is likely degenerative in etiology. Uptake within the
right ankle joint and the left first metatarsophalangeal joint may
also be degenerative in etiology. There is otherwise physiologic
biodistribution of radiotracer within the axial and appendicular
skeleton. No areas of focal abnormally increased or decreased
accumulation of radiopharmaceutical to suggest metastatic disease.
There is normal biodistribution of the radiotracer within the
genitourinary system and soft tissues.

Impression

1. No scintigraphic evidence of osteoblastic metastatic disease.
2. Metabolic activity within the bilateral shoulders, right ankle,
and left first metatarsophalangeal joint is likely degenerative in
etiology.

Lab and Collection
NM BONE SCAN WHOLE BODY on 5/21/2014


Result Summary for CT ABDOMEN AND PELVIS, W CONTRAST

Result Information
Status


Final result (5/27/2014 8:16 PM)

Entry Date
5/27/2014

Result Narrative
ABDOMEN AND PELVIS CT WITH IV CONTRAST

INDICATION: Prostate cancer staging.

COMPARISON: None

TECHNIQUE: Helical CT scan of the abdomen and pelvis following the
uneventful IV administration of 100 mL Omnipaque-300. Oral contrast
also given. Multiplanar reconstructions. Informed written consent
obtained before contrast administration.

FINDINGS:
Lower thorax: There are innumerable small pulmonary nodules
throughout the imaged lower lungs bilaterally, reaching a maximal
diameter of 6 mm. Because nodules are so numerous, it is unclear
whether the predominant distribution is centrilobular (favoring
infectious/inflammatory etiology), random (favoring metastatic
etiology), or a combination.

Liver: Unremarkable.
Gallbladder and biliary system: Unremarkable.
Pancreas: Unremarkable
Spleen: Unremarkable.
Adrenal glands: Unremarkable.
Kidneys and upper urinary tract: Few bilateral renal cysts,
largest measuring 2.1 x 2.7 cm on the left.
Urinary bladder: Base is indented by nodular prostatic tissue.
Mild circumferential wall thickening is noted.
Gastrointestinal tract: Unremarkable.
Reproductive organs: Prostate enhances heterogeneously and
measures approximately 4.8 cm transverse by 5.0 cm AP and there is
nodular prostatic tissue indenting the base of the urinary bladder.
Peritoneum/Retroperitoneum: There is an increased number of
normal-sized to top normal size lymph nodes in the pelvis and
retroperitoneum, which include (short axis diameter): 8 mm left
external iliac lymph node (series 3 image 480), 10 mm right
external iliac lymph node (series 3 image 419), 9 mm left external
iliac lymph node (series 3 image 421), 7 mm right common iliac
lymph node (series 3 image 354), 8 mm aortocaval lymph node (series
3 image 21), 9 mm aortocaval lymph node (series 3 image 259).
Vascular: Unremarkable.
Bones: No aggressive lesions.

Incidentally noted is a 3.8 x 3.9 cm periumbilical hernia
containing only fat.

IMPRESSION:
1. Mildly prominent pelvic and retroperitoneal lymph nodes,
maximally 10 mm in short axis, borderline by imaging criteria.
2. Innumerable small pulmonary nodules, maximally 6 mm in diameter.
Pattern is nonspecific and the differential includes infection and
metastatic disease. Dedicated CT scan of the chest is recommended
to assess the upper lungs, which may help narrow this differential.

IDK what is going to happen now... Its a mess.... All I know is he had a gram of rocephin at the ER on May 17th and has been on Keflex and Cipro since then.... Chances of infection are small. Also the Xray was negative of his chest that day.... I wonder if too small to pick up... IDK...

Oh, kukukajoo, , so sorry to read this thread. Knowledge IS power, i have learned over the past 10 months. And, at least for me, knowledge made me calm and determined. Determined to read, research and ask questions. To take notes. To give Nick space just to be.
I will be following your storie with concern. And wishing the best for you.

Had appointment today after playing phone tag hell with MD's office.

Told today its terminal. Mets to lungs and lymph nodes. They are going to do Ct of full chest tomorrow just to view the rest of lungs. Had decided to biopsy of lymph nodes to know for sure but may cancel that after talking on way home. If they can get one with needle (which they think they can) then maybe will do that. Otherwise no reason when its so darn clear.

Other docs looked at CT including PCP and said that isn't an infection for sure and said to me "we both know what it is" so he agreed don't put him through bx if no need to.

So after this we regroup and hormone therapy. Will be researching this. Paul was shocked when he said it eventually stops working so may be better to wait until after these. Remission may be possible (we are hoping it responds). Very strange spread of cancer for sure and the way its literally all through the lungs. No wonder he's had such a cough.

Jim- why the cardiologist? I haven't researched this at all yet.....

Taking some time to absorb this, then figure our options. Boss promised me a day off so I can make some calls during business hours to get some answers and talk to legal and financial team.

Its still sinking in. I can't believe I actually went back to work after that appointment and not sure how I made it through the day- autopilot....

Thanks for that compiler. There are definitely micro mets to bone for sure with Paul.

I hope it is years. Now we need to see what type of hormone therapy they are recommending and maybe a visit to oncology, who knows where else.

Thank you John, going to look on Amazon for them now.

Kukukajoo,

I don't know Lisa but I am going to assume that she meant they met some great friends because of cancer.

I never give cancer for anything! But, we have made some incredible friends along our journey with this beast.

Who knows, you and I emailing back and forth may lead to one of those friendships. Perhaps one day our friendship will be a blessing. :)

Maybe that was the "blessing" she was referring to. Friends they met along the way.

Huge hugs sent your way!

PS..don't hesitate to use my phone number.

Kukukajoo
My name is Todd. At dx my Psa was over 3200. I had multiple lesions in both lungs. I had bone metastasis. I had lymph node involvement. I had a mass growing out of my prostate into my bladder. My Gleason score was a 7. I had just met the love of my life and we were planning on a June wedding the following year. They gave me a year to live. Stupid doctor. I fired him. Mandy and I will celebrate our 7th wedding anniversary in 12 more days. It has been 7 years 358 days since my diagnosis. I say all this to tell you that there is much hope. I understand your fear. I was 42 years old and not tall lol. Read my blog. I have cancer. I am sick but I am not dead and I will go kicking and screaming to the grave 30 years or so from now. Regards..... Todd

I would also like to say something from the heart to you. Cancer has given me good and bad. Mostly it has given me good. At the time of my dx " live like you were dying " by Tim McGraw was new on the radio. I took the song to heart. Before cancer I walked through life but I never truly lived life to the fullest until after my dx. I know we are all different but there are gifts in everything if you choose to see them. To my surprise my bride married despite my diagnosis. I would not blame her if she left. Our relationship was new and she didn't sign on to watch me die. The title of my blog is living with prostate cancer. The focus is not on the cancer but on the living. Men and women do one of two things when they are told they have a terminal illness. They put on the gloves and step into the ring or the pick up a shovel and start digging a hole. I believe your fiancé will be here for many years to come. Life will change. It always does. Hang in there. Todd

Oops you said ringing. My bad.

Well the honeymoon was seven years ago. Mandy and I are taking our daughters on a Caribbean cruise two weeks after our anniversary. It has been a wonderful seven years.

Todd- thank you for the inspiration! I will definitely read your blog and sure Paul will too. I bet he may want to talk to you at some time if you are up for that...

Your story is so similar to yours but his latest PSA was only like 114!! Holy crap is all I can say!! I would love to know some of you treatments and where you go for that, etc. I hope and pray that Paul has same reaction!

MsWorry- that is too funny that you were able to conjure him up like that! Got your email but not time to respond yet- another sleepless night but did get a little bit. Taking weekend to regroup and I hope we can touch base. Your help has been awesome. I think we should start a women of PC group or something!