CT and Bone Scans Explained

Attended the Urologist's Surgery in St Leonards to receive an indication of the best way forward in light of the recent CT and Bone Scans. The earlier CT Scan, raised the possibility that the cancer had spread to the bones (pelvis); however, the subsequent Bone scan ruled that out.

This is of course is good news; but there remains a likelihood that the cancer is not contained in the prostate - largely because of the very high PSA reading of 84.8 and the '9' (out of 10) recorded on the Gleason index - '9' being a very agressive cancer.


Gleason Score

Utilising the 'Gleason Grade', the Urologist rated the two most common types of cancer cells present in the samples, numbering each type from 1 for the least affected up to 5 for the most affected.


Gleason Score Agressiveness of prostate cancer

2-4 Low
5-6 Moderate
7 Intermediate
8-10 High

A score of 2 to 5 indicates the cancer is relatively slow growing and probably not very agressive. A score from 5 to 7 indicates the cancer is faster growing and moderately aggressive. A score of 8 or higher indicates an aggressive cancer.


Hormone Therapy

This being the case, the recommended treatment is Hormone therapy - surgery is ruled out. Hormone therapy will involve four weeks of taking a medication which slows the production of testosterone. Since Prostate cancer relies upon testosterone to grow, the cancer often shrinks and goes into temporary remission sometimes for years.

Half way (two weeks) into this treatment, an injection of a luteinising hormone-releasing hormone (LHRH) is given to control the production of testosterone. LHRH is then given 3 monthly by injection to continue this treatment.

LHRH Agonists

LHRH, or luteinizing-hormone releasing hormone, is one of the key hormones released by the body before testosterone is produced. (Note that LHRH is sometimes called GnRH, or gonadotropin-releasing hormone.) Blocking the release of LHRH through the use of LHRH agonists or LHRH analogues is one of the most common hormone therapies used in men with prostate cancer.

Drugs in this class, including leuprolide (Eligard, Lupron, and Viadur), goserelin (Zoladex), and triptorelin (Trelstar), are given in the form of regular shots: once a month, once every three months, once every four months, or once per year.

The success of this treatment (in my case Goserelin 10.8mg every 3 months) will be monitored by regular blood tests which look specifically at the Prostate Specific Antigen (PSA) readings. A lower PSA indicates that the treatment is working.

Subsequent to this treatment and dependent upon how my body reacts to the LHRH, radiotherapy will then be considered.

As with most things, there is a down side to this treatment. Men receiving Hormone therapy may have side effects from the withdrawal of testosterone. This could include: increased tiredness, erection problems, reduced sex drive, weight gain, hot flushes, breast tenderness, depression, and loss of bone strength (osteoporosis).

These side effects can significantly affect the way a man functions, however there are treatments that can minimise the impact of the side effects.

In order to monitor the progress of the Hormone Treatment, I have been scheduled to have two further blood tests (December and February) with the expectation that my PSA readings will go down. At present my PSA is 84.8. Normal readings for someone my age would be between 0 and 3.5 - still a way to go!