Tuesday, August 31, 2010
The non-event
Well...today was supposed to be my date with the doctor. The mapping biopsy was supposed to start at 0730 this morning. However, after Tricare decided it was an "investigative" procedure versus "diagnostic", and after consulting with my doctor, we cancelled. Instead, I'm going to become somewhat of a test case for treatment through medication. I have been on Finasteride for 3 months. It's also known as Proscar and Propecia. There have been some studies that indicate this drug (used to reduce prostate enlargement) may be successful in killing off the tumor. My PSA has dropped from 4.33 to 2.03 so that's a good thing. At any rate, we are convinced the tumor is small and confined at this point. We will continue to monitor. Maybe it saves some guys from going under the knife in the future!
Saturday, August 28, 2010
MRI results
Fri 27 Aug: Got the MRI results back today. As follows:
PROSTATE MRI WITH AND WITHOUT CONTRAST 8/25/2010
INDICATION: Prostate cancer
TECHNIQUE: Multisequence, multiplanar MR images of the prostate are
performed with and without use of IV contrast. The patient received
20 cc of multihance intravenously without adverse reaction. Images
obtained with the endorectal coil.
COMPARISON: None
FINDINGS: The central zone of the prostate is hypertrophic. The
central zone demonstrates heterogeneous T2 signal. In the peripheral
zone at the level of the mid prostate at approximately 7:00 position,
there is vague area of low T2 signal which corresponds to enhancement
on postcontrast images and low signal on the ADC maps. The capsular
margin of the peripheral zone is smooth without nodule or bulge.
Groin and iliac lymph nodes are within normal limits for size. No
perirectal or internal iliac adenopathy. No abnormal signal or
enhancement from the neurovascular bundles. The seminal vesicles are
unremarkable. There is mild trabeculation of the bladder wall which
is likely due to prostate hypertrophy and outlet obstruction. An
irregular area of T2 high signal in the left femoral head insistent
with osteonecrosis . The bones are otherwise unremarkable.
IMPRESSION: MR findings suggestive of adenocarcinoma in the
peripheral zone of the mid prostate at 7:00 position. Correlate with
pathology results. No evidence of local spread or metastasis.
This last sentence is particularly important: It means the cancer is confined to the prostate. Good news!
PROSTATE MRI WITH AND WITHOUT CONTRAST 8/25/2010
INDICATION: Prostate cancer
TECHNIQUE: Multisequence, multiplanar MR images of the prostate are
performed with and without use of IV contrast. The patient received
20 cc of multihance intravenously without adverse reaction. Images
obtained with the endorectal coil.
COMPARISON: None
FINDINGS: The central zone of the prostate is hypertrophic. The
central zone demonstrates heterogeneous T2 signal. In the peripheral
zone at the level of the mid prostate at approximately 7:00 position,
there is vague area of low T2 signal which corresponds to enhancement
on postcontrast images and low signal on the ADC maps. The capsular
margin of the peripheral zone is smooth without nodule or bulge.
Groin and iliac lymph nodes are within normal limits for size. No
perirectal or internal iliac adenopathy. No abnormal signal or
enhancement from the neurovascular bundles. The seminal vesicles are
unremarkable. There is mild trabeculation of the bladder wall which
is likely due to prostate hypertrophy and outlet obstruction. An
irregular area of T2 high signal in the left femoral head insistent
with osteonecrosis . The bones are otherwise unremarkable.
IMPRESSION: MR findings suggestive of adenocarcinoma in the
peripheral zone of the mid prostate at 7:00 position. Correlate with
pathology results. No evidence of local spread or metastasis.
This last sentence is particularly important: It means the cancer is confined to the prostate. Good news!
Insurance
Thurs, Aug 26: Found out today my insurance will not pay for the mapping biopsy scheduled for next Tues. They consider it an "investigative" procedure rather than a diagnostic procedure. This mapping biopsy in fact usually results in long term savings to the patient and the insurance company, as localized treatment costs less than broader treatments such as chemo or removal of the prostate. The mapping biopsy costs around $20k. Lots to mull over the next few days!
The MRI
Wed, 25 Aug: Drove to Denver today for a Magnetic Resonance Imaging procedure. I won't go into all the details of the procedure here, but there is a good description at http://www.radiologyinfo.org/en/info.cfm?pg=mr_prostate
The procedure took a couple of hours and included a contract material injected the last few minutes of the procedure. I would imagine an MRI would be difficult for someone who is claustraphobic! I was also given earplugs and headphones, as the MRI machine is very noisy.
I should have the results back this weekend. One more test to go!
The procedure took a couple of hours and included a contract material injected the last few minutes of the procedure. I would imagine an MRI would be difficult for someone who is claustraphobic! I was also given earplugs and headphones, as the MRI machine is very noisy.
I should have the results back this weekend. One more test to go!
Wednesday, August 4, 2010
Test Results
Got my latest test results tonight. PSA is 2.03, down from 4.33. Testosterone is 270 - the PCA3 test is -21.7 (negative). From what I understand, the PSA and Testosterone is down due to the drug Finesteride, which I have been on for over 60 days. The PCA3 test, which is still experimental, is turning out to be a better predictor of cancer than the PSA. Since my initial biopsy has been diagnosed as positive, I'm doing this test as a data point, hoping that it may reduce the requirement for biopsies for other guys in the future. Golfing with my doctor tomorrow so I will discuss the results and post!
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