Pain in prostate bed nodule (post RP) felt thru rectum

[jjpeabody]

When I met with RO in January to discuss SRT he did a quick digital check and didn't have any concerns. In early February had PSMA PET/CT with "intense uptake at left/posterior aspect of the bladder in the surgical bed", no other areas noted. In mid-february had physical with PCP who did digital exam and I told him I had period discomfort about "7 o'clock". He said he felt a bump/nodule and when pressed I felt sharp pain. I asked him if the nodule was in rectum and he said it was in perineum area, and said there's your cancer. Late February met with RO again and told him about PCP digital exam and he said I shouldn't be feeling any pain, and reminded me of his digital exam in January. I am having MRI on March 19 and assume that would show any concerns related to the nodule in this area. GS 4+3=7, extra-capsular ext and perineural invasion, last PSA after short term casodex 0.12. Anyone ever have a periodic painful nodule in "bed" (after RP) that could be felt thru rectum, or any thoughts or suggestions? Thank you for any replies, Jim

[Tall_Allen]

It might be an inflamed lymph node.

[jjpeabody in reply to Tall_Allen]

Thank you Allen, I generally never have hemroids and this seems about in from annus approx 3 inches and reltively chronic while intermittent, PCP believed it was on perineum, however hemroud is a very reasonable assumption. I will make sure they are aware of my concerns at MRI and ask to try and comment on that perineum/rectal interface if possible. Jim

[Tall_Allen in reply to jjpeabody]

There are perirectal lymph nodes too.

[jjpeabody in reply to Tall_Allen]

I have the MRI coming this month, and appts with medical oncologist and urologist. Is there another doctor and procedure I need to consider prior to SRT. Thanks again, Jim

[Tall_Allen in reply to jjpeabody]

Radiation oncologist, of course.

[jjpeabody in reply to Tall_Allen]

I did bring it up to RO and this didn't appear to ring an alarm with him or further investigation. In fact they ordered a CT Simulation for me while I was only expecting the MRI and a lupron shot. I will run this by the MO and urologist, and may work this in thru PCP side of things. I believe MO may prescribe Zytiga with lupron which would surely buy me time to persue this in short term. I definitely feel it needs to be resolved prior to SRT. Thank you, Jim

[Gemlin_]

Pain in that area could possibly be from inguinal hernia.

[jjpeabody in reply to Gemlin_]

Thanks Gemlin, I'll look into that. Jim

[dadzone43]

It is disappointing to see how readily physicians rely on high tech testing and ignore the low tech digital exam. " Shouldn't be there" is an unacceptable response IMHO.

[jjpeabody in reply to dadzone43]

Thanks dadzone43, yes as I head toward SRT this is a little unexpected and unexplained at this time but I will continue to seek an answer and hopefully a benign one. Jim

[Robert_san]

With a still fairly low PSA, it is possible that your pain is not from clinical recurrence PCa symptoms but rather from something mechanical. Another poster here and I have been dealing with a similar type pain and have been researching things like piriformis pain and PNE (pudendal nerve entrapment). Don't want to get between you and your docs, esp. with your moderate incontinence and other testing going on. But just as a long shot, want to offer following samples--you can find more splattered across the web. I do the lying figure 4 stretch and have incorporated it into my daily yoga before lifting weights. Have been doing it for a couple years. Helps me a lot. My discomfort, when I still do get it, is at my 7 o'clock.

tao-fit.com/low-back-and-sc...

runnersconnect.net/piriform...

doctorschierling.com/proble...

Need to mention that excessive kegels and PNE/piriformis do not play well together--I found out the hard way. So ease into anything in this regard.

Btw, saw in your other posts a possible liking for older Westerns. Would like to recommend "Hombre", with Paul Newman, based on an Elmore Leonard novel.

[jjpeabody in reply to Robert_san]

Thanks for your interesting reply Robert, never hesitate to offer your opinions especially in regard to other docs, they often don't have time to be up on all possibilities etc. While I have had mild discomfort there for a long time, thought from bike riding, it has never been a "sharp" periodic pain until last 3 months or so. I noticed mild discomfort did appear to increase with kegals (anal constriction) however this is area where cancer appears to be, and my PCP did feel a nodule there and when pressed felt that sharp pain. I will look into your suggestions. I have Hombre on CD and is no doubt one of my all time favorites, kind of a Blade Runner lover too. Thank you and best of luck, Jim

[j-o-h-n in reply to Robert_san]

"Hombre" One of the Best westerns. Also "Shane"..... Best war (anti war) and best movie ever made "Paths of Glory = Stanley Kubric - director (main actor - Kirk Douglas)..... Great war movie "Bridge on the River Kwai" (main actors - William Holden, Alec Guiness)...

I know my movies!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/06/2021 9:57 PM EST