Well today was the BIG day ... today I underwent a 'planning CT' (CT scan) as a precursor to further radiation treatment, this time on my chest!
It was quite a strange experience to be 'trussed up' on an 'incline board' hands and arms secured above my head - naked from the pelvis up!
But more 'strangeness' was to come!
Next I had a doctor drawing pictures of 'boobs' on my chest!
Stranger still these were then traced onto a sheet of clear plastic - no doubt to be preserved for posterity!!
I was told that I had 'breast buds' growing under my nipples and that this was the reason why my nipples were so sore.
A little weird, but it made sense, given that my testosterone production (assuming it was still happening) was 100% blocked and therefore the eostrogen that we all (male an female) have in our bodies was turning me, quite literally, into a female!!
I don't mind admitting, I was tempted to forego the treatment and be 'on hand' to 'breast feed' my grand daughter in Chile if needed ... imagine the possibilities!!
Well after all the planning was concluded; it was off for treatment number 35 ... leaving just 3 to go!!
No strangeness there, just more of the same that I had become so used to over the past couple of months or so!
Thursday, 22 May 2008
Radiation Therapy - Week NINE
Monday, 10 March 2008
More Scans
In a couple of days, I'm scheduled to undergo an MRI, followed by another CT Scan at one of Sydney's premier hospitals. These procedures will assist the Radiation Oncologist to map out the best plan of action for the upcoming 8 weeks of Radiation Treatment to commence on Tuesday 25 March. Since this is my first MRI, I thought I would do some research on the procedure and have included it below.
What is MRI?
MRI is a way of creating pictures of your body that does not use X-rays or radiation. The MRI machine makes pictures by organising and collecting the magnetic fields that naturally occur within the body. MRI pictures show the soft tissues of the body (muscles, nerves, brain, discs, ligaments etc). In many situations MRI offers unique information to help your doctor better plan your treatment and care.
During the scan you will be lying inside a large tubular machine. The Radiographers want you to be comfortable and will ask you to be very still during the scan because even slight movement can spoil the images and reduce their usefulness to you and your doctor.
The inside of the scanner is well lit, and has a fan to blow fresh air gently over you. Music is provided from an FM radio, or from tapes and CDs.
Most MR scans take between 25 and 60 minutes. The Radiographers will talk to you through an intercom system.
Preparation for MRI
In most cases there is no special preparation for an MRI scan. You can eat and drink normally on the day of the scan although it is best to avoid large amounts of coffee or other things that make you restless.
It is very important not to bring any metal into the scan room without letting the Radiographer know. Before the scan you will be asked to remove your watch, keys, coins, credit cards, bus tickets and phone cards. These can all be damaged by the strong magnet of the MRI scanner, or might cause distortions in the MRI pictures.
When you arrive at MRI, you will be asked a series of questions to find out if you have any metal or implants in your body.
Depending on what part of your body is being scanned, you may have to wear a cotton gown.
For some MRI scans we need to measure your heart beat by placing small dots and wires on your back or chest.
Pelvis MRI - Abdomen MRI Special Preparation
If you are having a scan of the abdomen or pelvis, do not eat or drink anything for 5 hours before the appointment. This is important to ensure high quality pictures.
Please Bring Old X-rays
You may have had other X-ray tests, Ultrasound, Thermography, or Nuclear medicine. These films can all be interpreted by the MRI Radiologist and greatly improve the relevance of the MRI report.
It is very important to bring old X-rays etc with you to the MRI scans so they can be reviewed. You may need to supply them before a full MRI report can be made.
Private films will be returned to your referring doctor with the new MRI images.
Getting Comfortable & Keeping Still
MRI images are very sensitive to movement. By keeping very still during the scan you can improve the quality of the images we obtain. We have found that the best way to keep still is to be relaxed, lying comfortably as if you were dropping off to sleep. The MRI Radiographer is very interested in making you comfortable in the scanner so that you feel settled, secure and relaxed, let them know what they can do for you and together you will ensure the best possible pictures.
Problems with MRI
It may not be possible, or safe, to have an MRI scan if you have any of these items:
- Cardiac pacemaker
- Surgical clips in your head (particularly aneurysm clips)
- Some artificial heart valves
- Electronic inner ear implants (bionic ears)
- Metal fragments in your eyes
- Electronic stimulators
- Implanted pumps
Let the MRI Unit know well before your appointment if you have any of these. Experienced MRI staff will have to discuss the exact implant or metal with you to decide if it is safe to perform the scan.
Deciding which implants cannot be scanned takes special knowledge and experience. Please do not try to guess, and don’t just rely on your doctor to determine if we can scan you.
Before the scan you will be asked a series of questions to check that it is safe for you to enter the scan room.
People with dental fillings and bridges, hip and knee replacements, and tubal ligation clips can all be scanned safely. The Radiographers will want to know about these things to minimise the effect they have on your images.
Claustrophobia
If you have experienced claustrophobia, or have trouble in enclosed spaces talk about it with the MRI staff before your appointment date.
For mild claustrophobia we find that the staff can help you to relax enough to get rid of the anxiety in a few minutes.
If your claustrophobia is severe you may need an anti-anxiety prescribed by your referring doctor or G.P. Staff at the MRI unit can be contacted about this and can offer your doctors some advise. You shouldn't drive after taking such drugs, so arrange a safe way to get home.
Because there are no side effects of MRI you can bring a friend into the scan room for support if that will help your anxiety. Children in particular should feel free to bring an adult in with them. Everyone coming into the scan room will be asked the questions about metal and implants.
Contrast Injections (Dye)
Most MRI tests do not need you to have an injection, but in some situations a contrast agent can greatly improve the accuracy of the scan. The contrast is injected into a vein, and the dose is quite small.
MRI contrast is not the same as X-ray contrast. Very few people notice when it is injected.
Pregnancy
If you are pregnant or could be pregnant at the time of your scan appointment, please call us early so we can discuss the situation with you and consult your doctor.
MRI causes a slight heating of your body, so most MRI sites avoid scanning during the first 3 months of pregnancy unless the diagnosis cannot wait and the only alternate test uses X-rays. Beyond that period, MRI is still avoided if the diagnosis can wait till your child is born as a matter of extreme caution. In many sites around the world MRI is used to examine pregnant women and their babies to avoid the need for X-ray tests.
MRI contrast is not used during pregnancy.
Results
MRI scans are usually not reported while you are at the MRI Unit. The images are filmed by the Radiographer who scans you, and then later interpreted by a specialist Radiologist. Their report is sent with the MRI films and any private films you brought along, to the doctor who referred you to us. This delivery usually takes several days. If you have an appointment very soon after your appointment, let us know and we will try to arrange faster reporting and delivery. The referring doctor can also ring MRI for results.
Tuesday, 6 November 2007
CT and Bone Scans Explained
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
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.
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!
Saturday, 27 October 2007
C/T Scan
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.