As many of you know, I have recently posted about my dad's Bone Mets PCa. Here's the strange part about my dad's case, I was hoping if someone experience this or know what's going on. My dad has been visiting urologist for the past two years, and did regular checks and taking Tamsulosin pills for urinating. According to his first path report, there are no prostate cancer cells found. Second report which was in Jan 2018, it also shows no cancer cells found. However, it only happen when they extracted from the bone and did CT, PET scan that shows he has Stage IV Bone Mets PCa. I've spoken to some people on forum, they mentioned this is really strange and extremely rare because it appears that he has 25 cores and hardly this will be a miss site. Has anyone experience this before? The doctors are clueless too on why its not there but its on the 10th rib and lymph node. Anyway, here is the report I would hope someone can share the same experience. Dad is currently on Lucrin Depot 11.25mg, 3 months basis, first injection started on 6 March 2018.
PS: I found this link, i wonder if this is the explanation to it: prostatecanceruk.org/prosta...
25 Aug 2014 first Path Report:
DIAGNOSIS
A to H. Prostate, TRUS core biopsies: Foci of chronic inflammation & atrophy.
GROSS DESCRIPTION
Multiple pieces of prostatic tissue are recieved fixed in formalin labelled as follows:
A. Right apex x 2 (1.0 and 0.4 cm)
B. Right mid x 2 (1.5 and 1.0 cm)
C. Right periurethraf x 2 (0.9 and 0.6 cm)
D. Right base x 3 (1.0, 0.7 and 0.2 cm)
E. Left apex x 4 (1.5, 1.2,1.0 and 1.3 cm)
F. Left mid x 3 (7.1 , 0.9 and 0.2 cm)
G. left periurethral x 2 (1.4 and i.0 cm)
H. Left base x 2 (1.3 and 0.5 cm)
B blocks no reserve. ce1
MICROSCOPIC DESCRIPTION
A to H. PRostate, TRUS core biopsies:
The cores of prostatic tissue show foci of atrophy, basal cell hyperplasia and chronic inflammation. No high-grade prostatic intraepithelial neoplasia (PIN) or invasive maglinancy is evident.
29 JAN 2018
DIAGNOSIS
TRUS PROSTATE BIOPSIES:
A TO H.
No high grade PIN or invasive prostatic adenocarcinoma seen
Request form stated as
- Raised PSA = 17.8
- 2nd TRUS biopsy
- PET Scan suggest Ca prostate with possible metastasis in lymph node and bone
GROSS DESCRIPTION
Received multiple pieces of prostatic tissue fixed in formalin labelled as follows:
A. Right apex x3 (2.0, 1.5, 1.0 cm)
B. Right mid x3 (1.3, 1.0, 0.5 cm)
C. Right periurethral x3 (7-2, 1.2, 0.5 cm)
Q: Right base x3 (7.2,7.0, 1.0 cm) E. Left apex x4 (1.3, 1.0, 1.0, 0.5 cm)
F. Left mid x4 (1.5, 1.0, 1.0, 0.3 cm)
G. Left periurethral x4 (7.2,1.3, 0.5, 0.3 cm)
H. Left base x3 91.5, 1.3, 1.0 cm)
The tissue is completely passed for histological examination (8blocks).cel
MICROSCOPIC DESCRIPTION
A. Right apex
Two cores of benign prostatic tissue
B. Right mid
Three cores of benign prostatic tissues
C. Right periurethral
Three cores of benign prostatic tissue
D. Right base
Three cores of benign prostatic tissue
E. left apex
Three cores of benign prostatic tissue
F. Left apex
Four cores of bengin prostatic tissue
G. Left periurethral
Four cores of benign prostatic tissue
H. Left base
Three cores of benign prostatic tissue
Here's the PET and CT SCAN:
MAIN FINDINGS:
1. The left 10th rib destructive bone lesion with soft tissue component shows intense FDG
uptake (SUVmax 7.6), suspicj-ous for metastasis.
2. Intense FDG uptake seen in bil-ateral external il-iac lymph nodes, the right with SUVmax 4.9
(Im 241) and the left with SUVmax 6.1 (Im 240) suspi-cious for disease. A further right
internaf iliac lynph node shows only mild FDG uptake (SUVmax 2,0, Im 243) but j-s al-so
suspicious for disease,
3. Enlarged prostate gland with mild heterogenous EDG uptake. There is slight focaf increased
uptake in the left posterior aspect of the prostate gland (SUVmax 4.0, Im 256) which is
indeterminate however, in view of rising PSA 1evels and bifateral- i-l-iac nodes, prostate
carcinoma is not excluded.
4, Status post distal pancreatectomy and splenectomy for IPMN. Stable sna11 tubular fluid
collection in the surgi-ca} bed extending from the distal pancreas to the stomach with
calcifications. Stabfe mil-d soft tj-ssue thickening wi-th minj-mal- FDG uptake (SUVmax 2.4, Im
170) at the distal pancreatectomy surgical bed is stabl-e since CT of L9/03/1-4 and is 1i-ke1y
post-operative. No evi-dence of local- recurrence.
Other findings:
No gross i-ntracranial mass fesion or significant metabolic abnormality.
No FDG avid cervical or supraclavicuLar adenopathy. The nasopharynx, oro- and hypopharynx are
unremarkable. Physiologj-ca1 FDG uptake is present in the tonsifs.
No FDG avid hilar or medlastinal- adenopathy. No FDG avi-d pulmonary nodule. No pleural or pericardial effusion. Prior midline sternotomy, tricuspid and mi-tral- annuloplasty. Minor
atel-ectati-c changes in the lung bases,
Stabfe hepatic hypodensities with no discernible FDG uptake are too sma11 to characterise.
Uncomplicated chol-elithiasis. There are stable small non-specific abdomi-nal- nodules in the
Ieft anterior abdomen (Im 177 vs 4-44) , left posterior abdomen (Im 167 vs 4-43) and anterior
to the urinary bladder (Im 241 vs 4-136) with no discernibfe fDG uptake. Mil-d FDG uptake
within the bowel and stomach is likely physiological.
He was then asked to do further PET SCAN and here is a portion of the report:
MAIN FINDINGS:
1. The left 1Oth rib destructive bone lesion with soft tissue component shows intense FDG uptake
(SUVmax 7.6), suspicious for metastasis.
2. lntense FDG uptake seen in bilateral external iliac lymph nodes, the right with SUVmax 4.9 (lm
241) and the left with SUVmax 6.1 (lm 240) suspicious for disease. A further right internal iliac lymph
node shows only mild FDG uptake (SUVmax 2.0, lm 243) but is also suspicious for disease.
3. Enlarged prostate gland with mild heterogenous FDG uptake. Th-ere is slight focal increased uptake
in the left posterior aspect of the prostate gland (SUVmax 4.0, lm 256) which is indeterminate
however, in view of rising PSA levels and bilateral iliac nodes, prostate carcinoma is not excluded.
4. Status post distal pancreatectomy and splenectomy for IPMN. Stable small tubular fluid collection
in the surgical bed extending from the distal pancreas to the stomach with calcifications. Stable mild
soft tissue thickening with minimal FDG uptake (SUVmax 2.4, lm 170) at the distal pancreatectomy
surgical bed is stable since CT of 19103114 and is likely post-operative. No evidence of local
recurrence.
IMPRESSION
Overall findings may suggest underlying prostate carcinoma (possibly in the left postero-lateral
aspect)with FDG-avid bilateral pelvic nodal and bone (solitary left 1Oth rib) metastases. Further
imaging and histological correlation is however suggested.
On February 2018 this year, he went for tests and reports shown that his Prostate is CLEAR, however since PET SCAN shows high level of PSA, he was advised to do biopsy and they found out that it has spread to the bone, and its metastasis. I do not have information such as Gleason score, etc like what many of you have, but here is the report that was given to us:
DIAGNOSIS
LEFT TENTH RIB LESION: Metastatic Adenocarcinoma,' Favour Prostatic Primary
GROSS DESCRIPTION
SPECIMEN LABELLED AS 'LEFT TENTH RIB LESION':
2 tissue cores are received fixed in formalin, 0.1 to 0.4 cm. The tissue is completely passed for histological examination. (1 block) tyn
MICROSCOPIC DESCRIPTION
LEFT TENTH RIB LESION:
Section shows lytic bone lesion with metastatic adenocarcinoma surrounded by desmoplastic stroma. There is nuclear hyperchrmasia, inconspicuous large nucleoli, Immunohistochemical stains with appropriate controls show the following:
Positive: CK19, PSA (Focal), PSAP
Negative: CK7, CK20, P63, Hepar-1 TTF-1
Interpretation: The immunohistochemical stain results support a prostate primary.
Private doctors consultation alone can be ranging from 2k USD above, just consultation alone. I personally visited a private doctor for my nose, a small epistaxis issue that requires me to laser off my vessels, that costs me a whopping of 3.5k USD! Lesson learnt! That is also one of the reasons why we go for Government hospitals like Cancer Center, they provide subsidies, the first lucrin depot ADT costs us 350USD after subsidized from Govt. Hope that helps.
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