C/T Scan

Saturday 27/10/2007 - 8:30am.

Attended Dee Why X-Ray & CT facility to undergo a CT (computerised tomography) Scan to determine the possible 'spread' of cancer. The hope is that the cancer is contained to the Prostrate and not spread beyond to the lymph nodes and abdomen.

A 'dye' was injected into a vein to improve the clarity of the scans. The injection caused a feeling of being 'hot all over' for several minutes - which is normal for most people. The scan took about 30 minutes.

You lie flat on a table inside a large and circular device (CT scanner) which rotates around you, alternatively holding your breath while the scans are taken and exhaling while the machine relocates for a subsequent scan.

The Report from the scan was picked up later that same day and was as follows:-

The history of Prostate Cancer staging is noted.

Post contrast scans were performed with dual phase scanning through the liver.

There are multiple low density lesions in the liver, mainly in the left lobe. These are mainly too small to character, the largest measuring 10mm but the two largest lesions are of fluid density consistent with simple cysts.

The adrenals and pancreas appear normal. There are paraplevic cysts bilaterally in the kidneys.

There are two soft tissue nodes lying antetiorly to the spleen, the largest measuring 18mm in diameter. These have similar density to the adjacent spleen and I think most likely represent small splenuncili (as indicated on venous phase scans 21.5 & 25.5).

However, in addition there are multiple small nodular densities spread widely through the mesentery with mild mesenteric hazing. These nodules only measure up to 5mm in diameter but are more widely spread through the mesentery than is typical of normal mesenteric nodes and I think they are suspicious of early metastatic disease.

There are no para-aortic or pelvic lymphadenopathy.

The prostate margins appear rather ill-defined and the seminal vesicles are bilaterally bulky.

Review of thess images on bone windows demonstrates several tiny sclerotic lesions in the bony pelvis suspicious of early mestastases. These are seen bilaterally in the iliac bones, in the right side of the scarum and in the right femoral head as indicated on the hard copy films. The largest lesion measures 7mm in maximum diameter.

Scans through the lung bases show no evidence of pulmonary metastases.


CONCLUSION:

Multiple low density lesions in the liver which are mainly too small to characterise. The largest lesions are of fluid density consistent with small cysts. Follow up scans will provide clarification as to the nature of the other liver lesions.

Appearances suspicious of several tiny bony metastases in the pelvis as described. An isotope bone scan is suggested for further assessment.

Appearances suspicious of early mesenteric lymph node metastases but again follow up scans will provide clarification.

Biopsy Explained

Thursday 25/10/2007 - 4:30pm.

Attended the Urologist's Surgery to receive the results of the transrectal biopsy. As predicted, the cancer was not contained in the prostate. I was then given the shattering news that I had 'advanced and incurable prostate cancer' and was told that the only real treatment option was hormone therapy.

I was told that the cancer was very agressive with a 'Gleason Score' of 9. The Gleason score (the most commonly used biopsy grading system) indicates whether the cancer is slow or fast growing depending on a score out of 10. The higher the score, the faster (more agressive) the cancer.

After pressing for a prognosis that I could understand i.e. 'how long have I got'; I was told the following:-

Under a 'best case' scenario, I was informed that I could expect to live for a further 3 to 5 years. However, if the 'worst case' scenario were in play then I could look forward to just 12 to 18 months.

It was then determined that further tests be undertaken, including a CT scan and a Bone Scan, in order to determine the most appropriate treatment options.

Trans-rectal Biopsy

Monday 22/10/2007 - 8:45am.

Attended the Monavale Pathology Unit to undergo a 'transrectal ultrasound/biopsy'.

Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body.

Ultrasound exams do not use ionizing radiation (x-ray). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.

Ultrasound imaging is usually a painless medical test that helps physicians diagnose and treat medical conditions. The prostate or transrectal ultrasound provides pictures of a man's prostate gland. It is a minimally invasive ultrasound because it sends sound waves through the rectum.

Ultrasound Equipment

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body.

The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out a high frequency sound wave and then listens for a returning sound wave or "echo."

The ultrasound image is immediately visible on a nearby screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer. For ultrasound procedures requiring insertion of the transducer, such as transvaginal or transrectal exams, the device is covered and lubricated.

Transrectalultrasound

A painless procedure in which an instrument is inserted into the rectum and sound waves bounce off the prostate, producing a picture of the prostate which can be used to help identify abnormal areas requiring a biopsy. If the results of the transrectal ultrasound are normal, you may be able to wait and repeat the PSA test a few months later and then have a biopsy if needed.

Figure 2: Transrectal ultrasound

Biopsy

In this procedure a sample of cells, tissue or fluid is removed from the prostate and viewed under a microscope, to check for signs of the disease. There are two types of biopsy:

Transrectal biopsy: a needle is inserted through the rectum into the prostate and a sample of prostate tissue is removed.

Figure 3: Transrectal biopsy

Transperineal biopsy: a needle is inserted through the skin between the scrotum and rectum into the prostate and a sample of prostate tissue is removed.

Both biopsy procedures are short and you can usually go home the same day. A biopsy is the only way to confirm or diagnose the presence of prostate cancer.

If you have been diagnosed with prostate cancer, your specialist may want to carry out some further tests to find out if the cancer has spread to other parts of the body. The results of these tests help your doctor to decide which is the best type of treatment for you.

The Prostate - What is it?

The following is excerpt from the Prostate Cancer Foundation's website. I have reproduced the information here, but encourage all readers to visit the above website

The Prostate is a organ forming part of the male reproductive system. It is located immediately below the bladder and just in front of the bowel.

Its main function is to produce fluid which protects and enriches sperm. In younger men the prostate is about the size of a walnut.

It is doughnut shaped as it surrounds the beginning of the urethra, the tube that conveys urine from the bladder to the penis. The nerves that control erections surround the prostate.

There are four main disorders of the prostate. All can have similar symptoms, which may include one or more of the following:

* Waking frequently at night to urinate

* Sudden or urgent need to urinate

* Difficulty in starting to urinate

* Slow flow of urine and difficulty in stopping

* Discomfort when urinating

* Painful ejaculation

* Blood in the urine or semen

* Decrease in libido (sex urge)

* Reduced ability to get an erection

Most men tend to accept the onset of one or more of these symptoms as being a natural consequence of ageing. However, anyone experiencing any of the above symptoms is advised to consult a doctor without delay. Early expert diagnosis and treatment is important and may avert potentially serious health consequences.

Prostatitis

Prostatitis is a benign (non life threatening) condition. It is NOT prostate cancer. It is caused by inflammation (swelling) of the prostate. It can cause discomfort deep inside the pelvis – all the time or when passing urine or with ejaculation. It can be painful and can spread to other areas of the pelvis. If caused by an infection it may be treated with antibiotics. Treatment is specific to each case and some types of prostatitis can be harder to treat, especially if symptoms have been ignored for some time.


Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) or enlargement (BHE) is quite common in older men. It is a benign condition and is NOT prostate cancer. Some enlargement of the prostate is usual in most men from age 50 onwards. If the enlargement is sufficient to squeeze the urethra, which passes through the prostate, difficulties with urination may occur. BPH is quite common – though not life threatening, it may be treated.

Treatment of BPH may require antibiotics, or, in more developed cases, an operation to widen the urethral passage. This is known as a trans urethral resection of the prostate (TURP).

Under a general anaesthetic, an instrument is passed up the urethra through the penis and some of the prostate is removed to improve urine flow. This procedure usually involves a few days in hospital, with a catheter installed during recovery.


Prostatodynia

This is long standing or chronic prostate disease. There is usually no clear signs of infection or inflammation but there may be pain or discomfort in the pelvic region. Treatments are varied including antibiotics, non –steroid anti-inflammatory agents, muscle relaxants and sometimes medications for chronic pain.


Prostate Cancer

Prostate Cancer is the only one of the four disorders is potentially life-threatening. One of the most worrying aspects is that many prostate cancers develop without men experiencing ANY SYMPTOMS.

Every year, around 12,000 Australian men are diagnosed and more than 2,700 die of the disease, making prostate cancer the second largest cause of male cancer deaths, after lung cancer. Almost one man in eleven will develop prostate cancer during his lifetime.

Prostate cancer occurs when some of the cells of the prostate reproduce far more rapidly than in a normal prostate, causing a swelling or tumour. However, unlike BPH, prostate cancer cells eventually break out of the prostate and invade distant parts of the body, particularly the bones and lymph nodes, producing secondary tumours, a process known as metastasis. Once the cancer escapes from the prostate, treatment is possible but “cure” becomes impossible.

Prostate cancer is usually one of the slower growing cancers. In the past, it was most frequently encountered in men over 70, and many of those men died of other causes before their prostate cancer could kill them. This led to the old saying “most men die with, not of, prostate cancer”. However, that is certainly is not true today.

Three developments have changed things considerably:

* Men are living longer, giving the cancer more time to spread beyond the prostate, with potentially fatal consequences.

* More men in their early sixties, fifties and even forties are being detected with prostate cancer. Earlier on-set, combined with the greater male life expectancy, means those cancers have more time to spread and become life-threatening unless diagnosed and treated.

* Prostate cancer in younger men often tends to be more aggressive and hence more life-threatening within a shorter time.

Provided appropriate treatment commences while the cancer is still confined to the prostate gland, it is possible to "cure" it. The possibility of cure is the main reason why early diagnosis is critical.

All men should be aware of their risk of the disease and consider being tested for it regularly from age 50 onwards, or from 40 onwards if there is a family history of prostate cancer.

PSA results interpreted

Friday 19/10/2007 - 4:30pm.

Attended my first appointment with the Urologist/Surgeon in Monavale. After some intial discussion, I then underwent a 'digital rectal examination'. Not as painful as it sounds, but certainly a little embarrassing, as the process involved a gloved finger penetrating my anus! The result, confirmed a large firm (undoutedly cancerous) mass.

The Urologist explained that the normal PSA reading for someone my age would range between 0 and 3.5. Therefore my reading of 84.8 was cause for some concern and indicative of the cancer most likely NOT being contained to the Prostate.


The following provides a 'guide' in regards to PSA levels.

A PSA reading below 4, indicates that the chance of prostate cancer being confined to the prostate gland is 65%
Between 4 and 10, the chance is 50%
Between 10 and 20, 35% and
Beyond 20, 20% and less.

Once the PSA is above 30, it is very likely the cancer has spread beyond the prostate and therefore cannot be cured surgically.

However, confirmation of this and the best way to move forward would have to await the results of a 'trans-rectal ultrasound/biopsy'.

This procedure was then schedule for the earliest possible date: Monday 22/10/2007 at 8:30am.