I'm now nearly 8 years since diagnosis. RRP and EBRT failed to reduce my PSA below 2. At the beginning of treatment a bone scan showed a problem with vertebra T10 but it was decided it was not cancer related. Since then intermittent ADT (Triptorelin) has been successful at keeping my PSA below 1, until last year when it failed to go below 2 and I moved onto continuous ADT. Since then my PSA has crept up and is now between 5 and 6, with a doubling time of about 6 months. Apart from tiredness and a pretty constant ache in the lumbar region I am more or less symptom free. Last week I had a full body MRI scan which showed nothing except that lesion at T10. The guy who reported on the scan thinks it is definitely a metastasis. My oncologist want to irradiate it urgently. Does anyone have any thoughts? It seems really strange to me that the lesion has been there for 7 years (at least) and only now does it seem it's been a met all along.
Bob
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rhbishop2
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I have had a single lesion irradiated (rib cage, left side), but it was not until it was truly painful. In retrospect, I think I would have asked to have it irradiated earlier. I don't think it contributed to progression, but the pain was unnecessary.
I have a couple of recent personal experiences with scans & the problem of interpretation.
Latest was with my wife. She was told that she had "several" plasmacytomas. Was treated as if for multiple myeloma. Was referred to Wake Forest for stem cell replacement. The doctors there in essence told her she was crazy. There was only a solitary plasmacytoma (which could have been radiated & saved $140,000 of Velcade). & there was a 2.5% probability of dying during the stem cell procedure. Her oncologist had chosen to take no chances - even if it killed her. She has a new guy now.
In my case, I had a bone scan in 2016, due to pain not caused by PCa, as it turned out.) A lesion showed up at L5. Other areas that showed up were ribs & collar bone. I saw a radio-oncologist who agreed to treat L5 with radiation, & dismissed the other areas as "not cancer". Normally, he would only have treated if there was pain, but was sympathetic to my case for treating oligometastatic (few) lesions.
In your case, you had a scan 8 years ago, where T10 was deemed not be cancer. You seem not to have follow-up scans over the years, which implies no doubt in the interpretation. Would be interesting to compare bone scans 8 years apart. If the image hasn't changed ...
I would be skeptical of the interpretation of your MRI. If it's PCa, what has it been doing over the past 8 years? A second opinion? & even a third. You don't want to be overtreated IMO.
I had something of a lesson in reading bone scans. My wife's spinal plasmacytoma (they are osteolytic) appeared as a scary black hole. My L5 stood out as being entirely white. PCa is almost always osteoblastic - i.e. osteoblasts, which build up bone are not balanced by osteoclasts, which break it down. So it is unnaturally dense. Dr Myers says that they contain mostly normal cells. Did you get a look at the original scan?
Thanks for this - very interesting. I do have the original scan but have not seen the latest one. I hope to get to see it tomorrow. I'll let you know how I get on.
I was diagnosed with low grade prostate cancer in August 2012, my PSA was 2.2, but I was taking medications to reduce my Testosterone (these drugs interfere with your PSA results) so you can double your PSA result to 4.4. So, for my age then the maximum was 3.0. Therefore, I was 1.3 over! My cancer was graded at 3+3 = 6 Gleeson score. In 2015 I had problems urinating, so I was given a TRUP which helped a bit. In 2016 I was then put through a urodynamics test which I failed miserably!!!
So, since 2016 I have been self-catheterising to empty my bladder. I was told the same time by my consultant to scream when my PSA went over 8!!! So, 2019 came in and I had a PSA test which came back as 6.1 – OMG!!! So I got a bit fed up with my care and I demanded I have the new “PNMRI” scan which has shown my little low grade cancer in 2012 have grown to over 2CM, but luckily, I WAS TOLD it had not broke out of my prostate.
By coincidence I have trouble with my right shoulder and my T&O consultant arranged an MRI scan. I went back for the results and I was informed I had a torn rotacuff tendon, oh and by the way you have a lesion in T10 they said. So, this was pointed out to my Urology Consultant and he categorically stated that there was no way a prostate cancer would a find its way up the spine to T10.
I am going to print your blog off and shove it right up my Urology Consultant’s Nose!!!!
My first metastasis to bone showed up on a scan in 2006 on my left 10 rib. It wasn't until 2013 that it spread to adjacent thoracic vertebrae and caused serous pain and I needed external beam radiation. Summary of treatments since diagnosis in 1999 are in my profile, if you're interested.
That sucks Bob. You got to have somebody take another look at it. It doesn't make sense imo. Especially, if it's not painful.
Actually I saw the oncologist today and the news is not all bad. After a full-body MRI the only cancer site they found was T10 where the bone lesion has quadrupled in size since the MRI I had in 2011. The plan now is to hit this with the Cyberknife, thereby strengthening the bone and killing off at least some of the PCa cells. This may mean I can delay additional medication and maintain a good quality of life for some time.
Many thanks to those who replied for your helpful input.
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