After HDR Brachy and 25 days of IMRT (2019), RO does a brief DRE, looks me in the eye and states " you are not going to die from APC"!
GREAT!! No more Lupron and I can taper off Z and P!!
Well, MO reminds me that I still meet 2/3 of the Stampede Trial criteria (G9 and PSA>20. My high was 28) and he wants me to continue meds until the end of 1/21.
OK, since my SE's were relatively minor (even though I'm 72), I agreed.
Tapered off in January and everything went well until our little cat (Tiger Lily) died. Hold on, there is a point to be made here!
Lily had suffered from renal disease for a few years and our vet suggested that we weigh her weekly. Here was the procedure:
AJ steps on scale and barks to ( “ my darling wife of NOW 48 years”!) "AJ weighs in at 161.5 lbs" Then I pick up little cat and bark "AJ and cat 169 even, do the math Hon".
Lily died in March and I didn't step on the scale until about 3 weeks ago and my weight was 154!! WTF??
So. .. I met with my GP and he was clueless. On to my MO and he ordered a CAP CT and a bone scan. Results of the CT posting below (for those of you who like to get into the weeds. TA?) Bone scan next week...
Bottom line: I feel great!! Hmm...
Best to all
AJ
FINAL REPORT
Clinical Indication: prostate cancer, r/o mets
Comparison: October 31, 2018
TECHNIQUE: Sequential trans-axial images were obtained thru the chest and upper
abdomen . NO iv contrast used
CT imaging performed at this location utilizes radiation dose optimization techniques
which include one or more of the following:
-Automated exposure control
-Adjustment of the mA and/or kV according to patient size
-Use of iterative reconstruction technique
CT Radiation Dose DLP mGy-cm
FINDINGS:
LUNG PARENCHYMA AND PLEURA: There are several right-sided lung nodules. The
largest nodules are clustered in the right lower lobe measuring up to 5 mm. These are
stable. There is a right lower lobe nodule posteriorly adjacent to the pleural surface
unchanged measuring 3 mm. Minimal subpleural left lower lobe opacities likely scarring.
There is a left lower lobe nodule anteriorly measuring 2 mm unchanged. Right upper
lobe granuloma is seen laterally, 1 mm unchanged. Similar granuloma is also noted in
the right upper lobe anteriorly There is no interstitial lung disease. There are no pleural
effusions.There is no pneumothorax.
AIRWAY: The central airway is normal.
MEDIASTINUM: There is no mediastinal lymphadenopathy.
HEART: The cardiac chambers appear unremarkable. There is no pericardial effusion.
VASCULAR STRUCTURES: The pulmonary arteries and great vessels are
unremarkable. The thoracic aorta is unremarkable. The superior vena cava is
unremarkable.
OSSEOUS STRUCTURES: There are no definite significant osseous abnormalities
seen.
VISUALIZED UPPER ABDOMEN: The visualized upper abdomen is unremarkable.
IMPRESSION:
Bilateral lung nodules are stable
Clinical Indication: prostate cancer, r/o mets;
CT imaging performed at this location utilizes radiation dose optimization techniques
which include one or more of the following:
-Automated exposure control
-Adjustment of the mA and/or kV according to patient size
-Use of iterative reconstruction technique
CT Radiation Dose DLP
Comparison: CT scan from October 31, 2018
Technique:
Multi-detector CT imaging of the abdomen and pelvis is performed with contrast.
Coronal and sagittal reconstructions were obtained.
IV CONTRAST: 100 mL of Omnipaque
GI CONTRAST:
oral contrast was administered
FINDINGS:
CT ABDOMEN :
LUNG BASES: Unremarkable.
ABDOMINAL SOLID ORGANS:
The liver shows no focal mass lesions. Portal vein is patent. There is a normal
gallbladder identified.
Normal appearing pancreas with no inflammatory changes.
Normal adrenal glands. No mass lesions are seen
The pancreas shows no focal mass or inflammatory changes. No ductal dilitation.
The spleen is intact.
The kidneys show normal size contour and axis. No renal mass or hydronephrosis. No
definite kidney stones
STOMACH AND BOWEL:
The stomach is unremarkable.
Small bowel loops visualized are normal caliber.
The colon in the abdomen are unremarkable.
PERITONEUM AND RETROPERITONEUM:
There is no abdominal lymphadenopathy. There is no pneumoperitoneum or abdominal
ascites. There are no retroperitoneal abnormalities.
VASCULAR STRUCTURES:
The abdominal aorta is unremarkable without aneurysm.
The inferior vena cava is unremarkable.
The mesenteric vessels and portal veinous structures are grossly patent.
OSSEOUS STRUCTURES:
There are no significant osseous abnormalities seen. No suspicious lytic or blastic
lesion seen
-------
CT PELVIS :
BOWEL: Rectosigmoid colon is normal caliber. Extensive diverticulosis is noted.
PERITONEAL AND EXTRAPERITONEAL REGIONS:
There is no pelvic free fluid or lymphadenopathy. The inguinal regions are
unremarkable.
BLADDER / GU: The bladder is unremarkable. The prostate gland measures 3.2 x 4.3
cm. Radiation seeds are noted within the gland. No evidence for pelvic or perirectal
adenopathy OSSEOUS STRUCTURES: There are no significant osseous abnormalities
seen.
-----
IMPRESSION:
1. No acute abdominal or pelvic findings. No evidence for metastatic disease.
2. Placement of radiation seeds within the prostate gland.
3. Extensive sigmoid diverticulosis without diverticulitis.
PSMA Scan positive
Suggestions for next steps. Plan PSMA PET CT. If PSMA scan positive Would Bx be next step. If not would Bx still be indicated?
New scan results question metastatic staging
Is radiation still a good idea? Can APC be cured (until last week I always heard no)?
