PSA 170 waiting to see Urologist

Emmy, this sounds like a 'standard of practice' plan for the next few weeks. I would suggest you read up on Gleason scores, risk levels, grading, etc. As well as standard treatment protocols for the different risk levels.

It's entirely likely that your visit on the 17th will include not only a discussion of his scores-the pathology report-but the beginnings of a treatment plan. I would strongly suggest that you take a notebook and a pen, and take detailed notes. You're dealing with a Urologist--who almost by definition is a surgeon--and, it's possible that regardless of gleason score or staging that he will want to do a surgical treatment. As a first question, be ready to ask for referrals to local Radiation Oncologists who specialize in prostate, and delay any decision until they have been consulted as well.

The good news, really, is that with PC--even if he turns out to be very high risk--you do have time to do these visits, make the consultations, and develop a good treatment plan. It's not like other cancers that need immediate surgery the day after diagnosis. It just isn't.

At this point, perhaps you should make appointments to see a Medical Oncologist and a Radiation Oncologist. Your Urologist may say this is unnecessary but I would do it anyway.. The Oncologists have the training and skills that Urologists simply don't have...

At the appointment today they essentially just said the bone scan shows cancer in his bones but becuase we haven't gotten the biopsy back (it was just taken today at the same appointment) they can't say its prostate cancer. The bone scan results from online:

Impression
1. Findings highly suspicious for osseous metastatic disease involving the
axial and appendicular skeleton.
2. Given sizable focus of activity in the proximal left femur would recommend
dedicated left femoral radiographs as patient may be at risk for pathologic
fracture. Other radiographs can be obtained as clinically indicated.
3. Activity within the left AC joint may be degenerative/posttraumatic given
history of recent fall and pain though neoplastic process is also possible.

A Yellow - Send to Agent message has been sent via the Power Scribe 360 |
Critical Result system on 9/5/2018 2:05 PM, Message ID 100996.

Dictated by: Eric Payne, MD on 9/5/2018 1:58 PM.
Electronically signed by: Eric Payne, MD on 9/5/2018 2:09 PM.

Narrative
EXAMINATION: Total Body Bone Scan

HISTORY: elevated PSA, abnormal prostate exam. Fall 2 weeks prior. Left
lower rib pain and left shoulder/collarbone pain.

COMPARISON EXAMINATION: No pertinent comparisons available.

TECHNIQUE: After injection of 22.2 mCi of Tc-99m MDP, total body imaging was
performed at 2-4 hours.

FINDINGS:
Normal soft tissue uptake and excretion of radiotracer. The bladder appears
distended.

There are numerous foci of increased activity within the axial and
appendicular skeleton. This appears to involve bilateral ribs, sternum, right
scapula, mid and distal right humerus, thoracic and lumbar vertebral bodies,
pelvis, proximal and distal left femur and proximal/mid right femur. Findings
are highly suspicious for metastatic disease. Moderate focus of activity
within the left AC joint. Uncertain if this is degenerative/posttraumatic
given history versus neoplastic.



So now we wait a week to hear back on the biopsy. It's so hard that we know it's throughout several bones but they can't even explain treatment options or time estimates or anything seems how technically we can't say it's prostate cancer due to not having the biopsy back. He doesn't think he will be open to chemo or surgery (though from what I've read at this stage they aren't likely to be advised anyway? Usually just hormone treatment?) but I still wish they could tell us more. I didn't go to this bone-scan results appointment because two of my sister went (one is a RN) so i'm off to go to his house now so he's got company.

Due to the bone mets, he should get a Chemo with Docetaxel combined with ADT.

He might need more than norco. Tell the doc it's not working.

Andrew