solitary lung nodule. Experience or literature about thorascopic lobectomy, no biopsy yet?

[Concerned-wife]

my husband received a call from his pulmonologist Friday who reported on the tumor board. Please see profile. We were expecting to hear biopsy but were surprised to hear they were sending him directly to a surgeon for a lobectomy. They are scheduling a FDG PET. (but the last one was fine with radiologist feeling the node was too small to indicated activity )

Has anyone read or experienced going directly to surgical resection without doing a navigation guided biopsy?

they seem to be thinking metastatic cancer, not lung cancer. We do happen to have his first consultation scheduled with Dr Armstrong at Duke in a few weeks so probably will delay , except PET scan until then.

[Seasid]

I am on doxycycline and my lung lesion gone. On FDG PET scan there was also something but it disappeared after the antibiotic. Obviously they picked up infection.

I would advise you to take antibiotics and redoing the CT scan.

How do they know that it is a cancer? Why is it so hard to do the CT guided biopsy? Maybe it is not possible?

Thanks God my nodule disappeared. It was first visible on the CT part of the PSMA PET CT scan and later on the FDG PET scan.

I started doxycicline and the finding (27mm) disappeared from the Canon CT scan.

[Concerned-wife in reply to Seasid]

thank you so much. The pulmonologist was talking to us about possible biopsy. Then the board apparently decided they think they should go directly to surgery. Your comments and experience are most helpful.

[Seasid in reply to Concerned-wife]

I don't really know much about your situation but for my situation to do a surgery just because some lung infection show up on the CT or FDG PET scan would be insane without first using doxycicline for at least 10 days.I started to use it myself because I was scared that they will do the biopsy without a need.

[GP24]

The lesion could be radiated with SBRT.

[Concerned-wife in reply to GP24]

we wondered about that. Thanks

[Carlosbach]

My first set of scans showed likely cancer nodules in one lung. I started ADT and the next set of scans did not detect any cancerous lung nodules. My MO and RO both said that this was likely due to the cancer being PC mets. Two years later, scans still clean.

[Concerned-wife in reply to Carlosbach]

he has been on ADT with undetectable PSA. Then this showed up and started growing.

[Carlosbach in reply to Concerned-wife]

I'm sorry to hear that this is new, and follows treatment with ADT. I'm not a medical whiz kid (like some of our compratriots), but the biopsy sounds like a good idea. Also, if you have any uncertanty about how the scans are being read and interpreted, you can ask for electronic copies to be sent to another RO for review. If you are interested, I recomend posting a question about where to obtain a second opinion on your husband's scans.

Best of luck and best wishes for you and your spouse

[Concerned-wife in reply to Carlosbach]

thanks! We were prepared to hear biopsy but not lobectomy. We do have second opinion arranged

[Tall_Allen]

Good idea to get a biopsy. Some lung lesions identified on a CT are peculiar enough that it may be worthwhile to investigate further. There may be a therapy for it.

[Shamrock46]

When my husband's PC showed up again in 2018 after surgery in 2014, a scan showed "spiculated lung nodules." The primary he was seeing then told us it should be treated aggressively and he should see a surgeon for a biopsy and removal. Not really liking/trusting this dr. we made an appt. with the head of pulmonology at a different hospital. He pulled up the scans on his computer and showed them to us as well giving a complete explanation. He didn't think they were anything to worry about...very small and could've been related to a earlier or childhood infection. He also noted that with my husband's cardiac problems he was in more danger of developing a collapsed lung from the biopsy. He said if he himself faced this situation he would wait and watch, have another scan in 3 months. We did what he said and there hasn't been any further development in his lungs since. I'd advise getting a second opinion like we did.

[Concerned-wife]

so very helpful! They have been watching this tiny, solitary node and what has surprised me is how the interpretations are so varied among those reading the scans. I can’t thank you enough for sharing!

[Hidden]

You say the doctors don't think it's lung cancer, but rather Mets from the prostate cancer? That's odd, I had widespread lung mets that have all but disappeared since starting Eligard, Zytiga, Prednisone 5mg twice a day and Xgeva, calcium, d3, magnesium, and multi vitamin for bone health. I've developed osteoporotic vertebral fractures but lung nodules are undetectable, as is original "huge" prostate tumor. I was 629 psa and 9 gleason, currently 0.23 psa (up from 0.16) 8 months ago. Good luck to you and your husband, this is NOT a fun journey, as we already know the destination. God Bless, and Happy New Year!

[Concerned-wife in reply to Hidden]

thank you! It has been abrupt. We think that’s what they think because they mention his history, which is prostate cancer. Not a smoker etc

We are preparing our questions. Unfortunately this little node showed up after being on Lupron and abi with all scans and PSA otherwise being wonderful

[pdold]

Hi Seasid.

I have experienced a similar set of issues. First. I'm in my 5th year being treated for advanced PC. I live in East central Florida. No gleason scaling. Diagnosed when a carful radiologist spotted unexpected MRI irregularities. and sent me for a screening. My PSA came in at 1700. It had previously been single digits. The local MO started me on Lupron. My discomfort with the local facility sent me to MSKCC in NY. who added Zytiga to the mix. The protocol sent my PSA rapidly plunging and it now hovers between 7 and 11 With various scans showing some small bone mets.

Two years ago a CT scan showed a small lung nodule (< 1cm) on upper left node. While watching it carefully it grew slightly to 1.1cm so we decided a FDG PET scan was appropriate. The node lit up noticeably leading us to agree on a biopsy. Biopsy showed it to be an original lung adenocarcinoma, not a PCa metastatic nodule. All this was done over a three week span. Size and location drove the decision to treat with SBRT. This was handled at MSK over two days of setup and three days of treatment after which I returned to Fla.

I had no appreciable SE and only occasional minor fatigue. In late January I'll have a followup scan. ( I go to Moffit for Florida support now, with MSK's Dr Deaglan McHugh as my primary MO) MSK expectations were very high that the SBRT would basically be the only treatment needed for this nodule. The MO at Moffitt agrees. I wish you luck Seasid.

[Seasid in reply to pdold]

I am using a sleep apnea machine and the nodule was an infection which disappeared after 10 days of antibiotics. Therefore I probably didn't have yet an original lung carcinoma.

My worry is that the path to cancer is infection, inflammation, DNA damage ending with cancer.

[Concerned-wife in reply to Seasid]

He uses a CPAP too and we have asked a couple times whether it could be an infection. They negated this idea, I think saying it’d be more than one node. It sure seems worth asking again rather than having a three day stay in the hospital with chest tubes.

Thanks!

Was yours a solitary node? Not multiple? Do you recall its size, location? Whether it grew?

[Seasid in reply to Concerned-wife]

CT chest

CT chest

[Seasid in reply to Concerned-wife]

I am on doxycicline for a long time now. The CT was made after 10 days of starting antibiotics.

Maybe you should ask your primary care physician? Doxycicline is reasonably safe and could be effective.

The specialist were not very happy that I am taking doxycycline even after my lung nodules resolved.

I don't understand their thinking. I just protecting myself as I really have often lung infections with the CPAP.

Sometimes the food comes up when I am chocking from apnoea. The machine is sometimes late to adjust the pressure after I changed sleeping position. I actually have an APAP which I sometimes using as a straight CPAP.

[Concerned-wife in reply to Seasid]

one thing after another! Agree we all need to take charge of your own health care decisions. Thanks again for sharing your insights and experience!

[Seasid in reply to Concerned-wife]

I am on 200 mg per day of doxycycline.

[pdold in reply to Concerned-wife]

Single node, 1.1cm x.8cm at largest to date. Very slow growing. Never had any other lung issue. Both MO's expect that the 3 days of Rad should be enough. They refered to this area as the Hilar area. I'm told the nerve and blood vessels are close by.

[Concerned-wife in reply to pdold]

Thanks so much! May I afk…Did they biopsy it? If so, how and what type of doctor?

[pdold in reply to Concerned-wife]

Biopsy was performed by Dr Stephen B Solomon, MD, an Interventional Radiologist at Memorial Sloan Kettering Cancer Center in NY. I cant speak highly enough of his and his teams efforts. His upfront explanations were spot on and the surgery was performed gently and fairly quickly, Entered the teams care at 8:15a.m. Went back to my hotel early afternoon and was comfortable enough to walk a NYC block to dinner about 6pm. Good Luck!

[Concerned-wife in reply to pdold]

thank you! They are proposing to skip a biopsy and go right to a thorasvopic lobectomy with biopsy We will get a second opinion. Seems extreme when you have metastatic cancer

[Concerned-wife]

thank you! Very helpful!