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Thread: Can Prostate Cancer Escape Radiologists CT Scan Readings

  1. #1
    Senior User
    Join Date
    Mar 2009
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    189

    Can Prostate Cancer Escape Radiologists CT Scan Readings

    Hi, I am coming over from the Lymphoma forums and am probably looking more for reassurance than anything. I will be 62 in April.

    In December '07 I was dx'ed with Indolent NHL and was checked regularly via CT scans. A January '09 scan showed progression so treatment, via chemo, was started in May '09.

    My PSA always hung just below 2.0 and had a check up by my GP prior to starting treatments. I am taking 10mg of Hytrin per day for BPH.

    In March '10 the disease was stable (partial remission with no progression), so treatments were stopped; so I went back to the GP for an annual check up. My PSA was 4.8 and my GP wants to recheck it in the middle of May.

    During all this time, the lymphoma was checked via CT scans. In many of the scans, the radiologist made comments about my prostate gland being enlarged but only in a passing manner. True, they were looking for the status of NHL, but still they looked at it.

    Here are the comments that were made on the Radiology Reports:

    October 22, 2007: Prostate is enlarged with coarse calcifications.

    April 7, 2008: Prostate is enlarged with coarse calcifications.

    January 16, 2009: Moderate enlargement and heterogeneity of prostate which measures 2.3 cm in diameter.

    April 20, 2009: No mention of prostate.

    July 16, 2009: No mention of prostate.

    September 25, 2009: The prostate is enlarged and contains calcifications. The prostate measures 5.4 X 4.1 cm. Impression: Prostatic Hypertrophy

    October 29, 2009: The prostate gland measures 5.3 X 4.5 X 4.0 cm for an estimated weight of 40 grams. No inflammatory changes or fluid collections are seen. Impression: Enlarged Prostate Gland.

    December 16, 2009: Calcification is again noted within the enlarged prostate gland.

    March 1, 2010 (Last Scan): Prostate is enlarged with coarse calcifications.

    The rapid rise in PSA is alarming to me. I know I should just do things to forget about it; but I just got through a year of treatments for NHL, it is in remission, I am enjoying life again...and now this.

    I know you are not doctors, but what is your take on the radiologist's reports? Can Prostate Cancer escape their readings of the CT scans?
    Don B
    Dec 07 Dx Follicular NHL, Grade I (Indolent)
    Stage IIIA - No Symptoms
    Watch and Wait - 6 Month Checks
    Jan 09 Scan shows Progression - no symptoms
    May 18, 09 - Started R-CVP
    After Third Round, CT scan showed some tumor shrinkage
    July 31,09 - Completed 6 Rounds R-CVP

  2. #2

    Hi Don

    It would be rare for prostate cancer to show up on CT scans (or nuclear bone scans either) with a PSA as low as yours. Scans are not an effective method for screening for prostate cancer.

    It's good that you have a baseline PSA in place. Have you also been getting a rectal exam (the DRE)?

    What matters more than a PSA score of 4.8 is what it does over time. If I read your notes right, your PSA went up from somewhere below 2.0 to 4.8 in a year. That is a matter for concern, but not alarm. BPH itself can cause elevated PSA, and prostatitis is well-known for causing PSA to spike upwards.

    I would go to a urologist for evaluation, and I would not wait until May. A urologist will do a DRE, probably repeat the PSA test, and see what is going on. He may order a biopsy - the only definitive way to diagnose prostate cancer. He may order a "free PSA" test first, which is a way of discerning whether the elevated PSA is likely coming from a benign source or a cancerous one. He may try a course of antibiotics.

    There's no reason to rush or panic, but I see no reason to put this off until May, either.

    Those are just my layperson's thoughts on the matter.

    I wish you well, and welcome to the prostate cancer forum.
    Replicant

    Dx Feb 2006, PSA 9 @age 43
    RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
    PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
    Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar [email protected] age 44
    PSA 6/07 0.1, 9/07 (and thereafter) <0.1
    http://pcabefore50.blogspot.com

  3. #3
    Senior User
    Join Date
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    Chemotherapy Drugs and PSA

    Thanks.

    I just read where drugs used in Chemotherapy can cause a rise in PSA; and I just finished up the end of February. That may have something to do with it.

    Also, it appears that my prostate enlarged within the past year.

    God Bless...Do
    Don B
    Dec 07 Dx Follicular NHL, Grade I (Indolent)
    Stage IIIA - No Symptoms
    Watch and Wait - 6 Month Checks
    Jan 09 Scan shows Progression - no symptoms
    May 18, 09 - Started R-CVP
    After Third Round, CT scan showed some tumor shrinkage
    July 31,09 - Completed 6 Rounds R-CVP

  4. #4

    Don can you post the link or source on the chemo thing ?

    Would like to read that source about chemo and psa rise and see the info, just for crictical thinking, not making a judgement, I already do not trust the system enough as it is and have witnessed such things.

  5. #5
    Experienced User
    Join Date
    Oct 2009
    Posts
    63

    Re: Don can you post the link or source on the chemo thing ?

    Quote Originally Posted by neutrondbob
    Would like to read that source about chemo and psa rise and see the info, just for crictical thinking, not making a judgement, I already do not trust the system enough as it is and have witnessed such things.
    I don't know what source Don might have for his information but hopefully the following will be helpful.

    I have a good friend who recovered completely from terminal prostate cancer (PSA 4460) in early 2007. He is committed to staying healthy so continues his researching. The following are from some of his files.

    Quote:
    "A rise in PSA levels following treatment with Taxotere does not necessarily indicate treatment failure
    Treatment of prostate cancer, whether hormonal treatment or chemotherapy, can cause an early, temporary rise in PSA levels. This temporary rise in PSA, sometimes called a "PSA flare," is a distinct response from a sustained rise in PSA, and is not a reliable measure of treatment failure. The exact cause of the PSA flare is unknown."

    SOURCE: http://www.medscape.com/infosite/taxotere/article-3#a5

    http://www.ehow.com/facts_5020425_ca...sa-levels.html

  6. #6

    Thanks for a reply

    I did know some about flare issues(later), and my uro-doc did not offer (ever) or give casodex prior to starting on Zoladex and I was a high end-high stats, high risk patient to start with (his error and lousy judgement), when combined with other errors and agenda I witnessed, I later fired him, best thing I ever did. I don't know if flare happened in my case, but like I needed flare added to his ignorance???

    I thought the psa rise after chemo, mentioned prior herein was a definite thing and so I wanted to read who says so...I do question alot more about all things concerning PCa and for alot of reasons, usually shown valid to me also.

  7. #7

    Re: Can Prostate Cancer Escape Radiologists CT Scan Readings

    Hi Don
    My husband has NHL. I have been reading your progress ... My husband has been told he needs to start R-CVP or R-CHOP.

    Can you give us an update from when you started the 2 treatments of R-CHOP please.

    Thank you
    Frank and June, from Sydney Australia
    01Feb07: Diagnosed NHL Stage III
    26Feb07: Biopsy - Low Grade Follicular NHL, WHO Grade II (FLIPI-2)
    02Mar07: 3 cycles Chlorambucil 10mg (no response)
    06June07: 4 x weekly cycles Rituximab
    28Sept07: PET Scan, further response to treatment
    10Oct07: 8 x 3 monthly cycles Rituximab. Last treatment 04Aug09
    13Jan10: PET Scan, recurrent hi grade disease
    05Feb10: 3 x weekly cycles Rituximab
    14Apr10: 1 treatment of Rituximab
    04May10: PET Scan, Differential response to Rituximab.

  8. #8
    Senior User
    Join Date
    Mar 2009
    Posts
    189

    Should Be on NHL Forum - But, What The Heck

    Hi FPJ,

    Sorry I didn't answer as fast as I should have, but I have not been on the forums lately.

    My Indolent NHL has been stabilized after 6-R-CVP's, which did not do as much as they were supposed to do, and 6-R-CHOPs, which did (almost). I am starting Rituxan maintenance. My hair is coming back and I am doing a lot of physical work in my yard.

    Here is a link to help you in your decision:

    http://www.molecularonc.com/mor/mor010233.html

    I went to the GP today; found out the PSA reading was 4.1 vice 4.8, still too high. The GP sent me for a "Free PSA" test so I will know in a few days.

    The DRE proved "negative".

    God Bless...Don
    Don B
    Dec 07 Dx Follicular NHL, Grade I (Indolent)
    Stage IIIA - No Symptoms
    Watch and Wait - 6 Month Checks
    Jan 09 Scan shows Progression - no symptoms
    May 18, 09 - Started R-CVP
    After Third Round, CT scan showed some tumor shrinkage
    July 31,09 - Completed 6 Rounds R-CVP

  9. #9
    Senior User
    Join Date
    Mar 2009
    Posts
    189

    What Do You Think?

    GP just called with the repeat PSA results.

    PSA went down to 3.2; but the % free PSA is fairly low. He said 0.7.

    He thinks it is great news that the PSA went down, but wants to repeat the test in three months.

    What is your impression?

    Thanks...Don
    Don B
    Dec 07 Dx Follicular NHL, Grade I (Indolent)
    Stage IIIA - No Symptoms
    Watch and Wait - 6 Month Checks
    Jan 09 Scan shows Progression - no symptoms
    May 18, 09 - Started R-CVP
    After Third Round, CT scan showed some tumor shrinkage
    July 31,09 - Completed 6 Rounds R-CVP

  10. #10
    Senior User
    Join Date
    Mar 2009
    Posts
    189

    August 28th PSA

    Follow up PSA in August: Back down to 2.2. GP says to go back to yearly PSA tests.

    Don't know what caused the spike; it could be the Chemo effects from the Lymphoma treatments.

    My GP says he has never heard of that; but I guess I don't expect him to.

    Anyway: God Bless you all and my prayers are always with you and everyone else suffering with conditions such as these.
    Don B
    Dec 07 Dx Follicular NHL, Grade I (Indolent)
    Stage IIIA - No Symptoms
    Watch and Wait - 6 Month Checks
    Jan 09 Scan shows Progression - no symptoms
    May 18, 09 - Started R-CVP
    After Third Round, CT scan showed some tumor shrinkage
    July 31,09 - Completed 6 Rounds R-CVP

 

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