Radiology Report

Hi Guys,
I posted this elsewhere, but maybe under a new topic someone will be able to help.
I am 53, Gleason 6, 9 of 12 positive cores. PSA was 4.5 two months and 4.0 a month ago.
I had a CT scan a month or so ago. It showed 2 areas of concern, but the radiologist was not 100% sure. I went for my bone scan last week, and it still could not pinpoint a yes or noas to if the spots are prostate cancer or not. My urologist gives it about a 15% chance that it is. I will post both reports below. Any comments are appreciated. This is my main concern. Everything I read says that is prostate cancer spreads to a bone, you have maybe 2 years tops to live. But my urologist who is a surgeon says otherwise. He said first I need to have the prostate removed. Even if there were no cancer, he said my prostate is huge and at my age it will only get worse and cause major problems. So either way he said within the next 5 years or so, it ill have to come out. But now knowing I have cancer, it should be done much sooner. So he feels the plan should be remove the main problem for both reasons, cancer and enlargement. If my PSA goes to zero, I am home free. If not, then the spots are cancerous, and will need extra treatment. He said it would be a couple shots and pills. And it could be cured.
So do you guys agree if it did spread it can be cured still?
He has done over 1800 robotic surgeries, and is highly recommended, so I do trust him. But he is the only one I have ever heard say mets can be cured. Here it the reports....
Thanks,
Tom
Hi guys,
I just scanned the reports so I don't screw them up in my own translation. So this is exactly what they say. If there are spelling errors its because the scanner did not read it right when it scanned to a text file, but I think its OK. I think the first is the CT scan and the second for sure is the bone scan.....


Radiology Report

1.Small but slightly elongated uptake focus in posterior right eighth rib with correlating blastic architectural abnormality on previous CT. While this could reflect old trauma, obvious
posttraumatic deformity not evident and appearance similar concerning for solitary skeletal
metastasis,
2. Subtle increased, asymetric activity correlating with previously identified mixed lytic/blastic
architectural abnormality of the medial left ilium. CT appearance atypical for metastatic prostate
carcinoma and therefore this more likely reflects incidental benign osseous pathology i.e. fibrous
dysplasia.

NUCLEAR MEDICINE BONE SCAN

HISTORY: Prostate cancer
COMPARISON: CT 517/2015
TECHNIQUE: Whole-body MOP skeletal scintigraphy

FINDINGS:
Mildly increased, slightly elongated uptake focus in posterior right eighth rib, only evident on
posterior projection. On prior CT, blastic change visualized in retrospect at this location (image
1, series 6). No obvious posttraumatic deformity evident, finding therefore somewhat suspicious
for skeletal metastasis.
Bony architectural abnormality visualized in the left medial iliac bone on previous CT, with
mixed lytic/blastic features, demonstrating mildly increased, asymmetric radiopharmaceutical
uptake. While exact etiology unclear, CT appearance atypical for metastatic prostate carcinoma,
and this may reflect incidental benign osseous lesion i.e. fibrous dysplasia.
No other definite evidence of bony metastatic disease. Degenerative uptake in the spine, with
underlying thoracal lumbar levoscoliosis, and joints of the extremities, particularly the
patellofemoral compartment of the right knee and the first carpometacarpal joint of the right
wrist,
Physiologic activity: in kidneys and bladder

with your gleason score and PSA i would certainly get treated and take the 85% odds that the spots are not cancer. good luck.

ed

I just posted this on another thread but I will say it here too. I may not have explained it correctly. What he meant was that the size of it now, which he says is huge, and my age, 53, that eventually it is going to grow to a size where it will be giving me major problems and it will have to be removed. Maybe 1 year, maybe 10 years. But when you factor in the cancer, it should be done now, because if I get the radiation, and it cures it, then 10 years from now I have serious problems from an enlarged prostate, I will be in trouble because they will no longer be able to remove it after radiation. So he did not mean either way I am taking it out soon.
My main fear is still the bone part. He made it sound so easy that if the PSA is not zero after removal, then the spot on the rib is prostate cancer, but it can be treated and cured. I don't see anything on the Internet saying it can be cured. I just see all the 2 year life expectancy stuff. Hopefully he knows something better!
Tom

The point that we are trying to make on the other thread is that they don't do radical prostatectomy for enlarged prostates that are non-cancerous--the typical procedure is a TURP. So what your uro is saying about your prostate needing to (eventually) come out regardless of whether you have cancer strikes many of us as odd--and a borderline scare tactic. Yes, you are a G6 and if you have treatment, surgery might be the better choice due to the size of your prostate--I'm not arguing against that--but saying that he would be removing it in 10 years anyway if you didn't have cancer is...weird.

OK, you're scared of the bone mets. I get that. Again, your uro ain't doing you any favors here with his: "I think there's a 15% chance of these being bone mets." Where does that come from? With a Gleason 6 and a PSA of 4?

So here's the question: what are you doing about this? Who are you going to go to for a second opinion? Who are you going to ask to read your bone scan and give you their opinion? Are you going to talk to a radiation oncologist? And what about your biopsy slides? You need a plan.

We're just a bunch of guys (and gals) on the internet, but if there's a consensus opinion between the two slides I'd say that we're not comfortable with how your uro has handled this and that you need to start getting others involved. Tall Allen put it a lot more succinctly than I have upthread.

It's very unusual for CT or bone scans be ordered for a G6 and a psa under 20. Did the doctor suspect something to take such an unusual step.
I would say it would be extremely rare to have bone mets with your current stats.
If it did spread, and I doubt that it did, it can be managed for years, but a cure is very improbable.
Talk to your radiologist, but I am fairly certain that radiation will shrink the prostate and cause it to stop growing. My prostate was 60cc and 6 years after radiation it is about 25cc.
Your doctor is correct in that if your psa goes to 0 after surgery then you don't have mets. If it doesn't go to 0 than it could mean mets or just that the surgeon didn't get all the cancer and it is still local in the prostate bed.
With your case and the uncertainty of the scans I would see a top notch oncologist like Snuffy Myers in VA or Mark Scholz in LA to get their opinion.

Tom,
Sometimes, but not always, blood in the urine is a sign of advanced disease, and, perhaps that was the reason for the scans. as for the focal uptake, it could be anything. It is not confirmation of metastatic disease, only an indication that there is activity. Only a biopsy can confirm the existence of metastatic disease.

Your Doctor could very well be playing the insurance game and insisting that the focal uptake is not metastatic disease but something else. By doing so, you keep surgery on the table which means you have an additional option. And, if I read his comments correctly, he is saying that he believes that you are not metastatic and that surgery would most likely offer you a cure. However, in the off chance that the Pca has advanced, there are still treatment options. But like the others have said, your PSA and gleason score are typically not suggestive of advanced disease.

As for the two year survival time, you will see from my signature that I am coming up on my two year anniversary since my diagnosis and I am still kicking. So don't believe everything you read. You have a lot in your favor and will likely live a very long life.