Speed Bump in Life's Mystery Tour

[Dougie]

Month and year of diagnosis. Example: June 2009.
February 2012
Age at diagnosis. Example 61 years
60

Current treatment status. Examples: Continuing ADT OR Monitoring PSA each 6 weeks.

Monitoring PSA - every 3 months

Last few PSA scores with dates. Example: PSA 0.07 Feb 2012, PSA 0.11 Jul 2012.

June 2014 PSA 0.068; September PSA 0.072 January 2015 PSA 0.094: April 2015 PSA 0.21

Gleason score at diagnosis. (from biopsy) Examples: 7 OR 3+4.

3+3 

Bone scan result at diagnosis. Examples: Clear OR Metastases in pelvis and lower spine.
No Scans performed

Highest PSA before treatment. Example: 10.4

5.6
Initial treatment - surgery. Examples: Robotic prostatectomy OR open prostatectomy:
Robotic Prostatectomy

Lowest PSA after initial treatment. Example: 0.2

0.02
Month and year of recurrence. Example: June 2012
February 2014
PSA at recurrence. Example: 2.7
0.06

Recurrence treatment - radiation. Example: External beam to prostate bed OR External beam to 2 bone metastases.

External Beam Radiation to Prostatic Bed 

Final paragraphs - anything else you wish to say
 

I had regular visits to the Doctor from age 22 for high blood pressure. Commenced PSA tests at about age 50 and they were normal until November 2011.

8 November 2011 -PSA 5.6 up from 4.2 on 30 December 2010. Considered high velocity change. 
21 November 2011 Total PSA 4.4 free PSA 0.68. % Free PSA 15.5%. Comments on collection "The median %Free PSA for men of all ages is 25%. Elevated total PSA less than 10ug/L and free/total PSA ratio is within the reference interval but at or below 25 % may be associated with an increased risk of prostatic neoplasia)."
I was referred to Urologist. Had biopsy in February 2012
2 of 18 samples positive for carcinoma -Right Apex Medial Gleason 3+3=6, spanning length of<1mm and Left AnteromedialGleason 3=3=6 spanning a length of1mm. Both amounted to between 5% and 10% of the prostatic tissue in section.
Diagnosed localised prostate cancer Gleason score 3+3= 6 -Stage T1c.
No perineural Invasion
No Extraprostatic Extension

Robotically Assisted Laparoscopic Radical Prostatectomy October 2012
Post Surgery Pathology 
Tumor location :
Dominant nodule; Direct posterior peripheral zone, toward the apex
Smaller nodules: Right anterolateral peripheral zone toward the apex; left anterior transition zone
Volume /Size Multifocal; dominant nodule 0.5cc
When the surgeon phoned and advised me of these results. He said "His gut churned" when he read the results.
Gleason Score 4+5=9 Stage pT2c pNX. 

Post operative PSA as follows
February 2013 -0.02
July 2013- 0.03
February 2014 Established PSA recurrence-0.06ug/L
"Discussed pros and cons of prostatic bed and pelvic radiation therapy. We don't have technology that will tell us exactly where the PSA is coming from but certainly is a body of literature that would support pelvic radiation in this setting rather than ADT."
7 March 2014
CT Abdomen and Pelvis 
Summary : "No convincing evidence of metastatic disease in abdomen and pelvis. There are small volume retroperitoneal lymph nodes which are not enlarged according to CT size criteria and are doubtful clinical significance. No osseous metastases."
Bone Scan 
Summary: "There is no confirmation on today's study of osteoblastic skeletal metastases from carcinoma of the prostate."

Radiation therapy to Prostatic bed 33 treatments at 2 Gy - 31 March to 19 May 2014
Post Radiation PSA
June 2014 - 0.068
September 2014 - 0.072
January 2015 - 0.094

PSMA Scan at Wesley Medical Imaging 13 February 2015
Opinion:
Small moderate PSMA focus in left pelvis laterally. this appears to correspond to a small or tiny 2mm short axis elongated distal iliac node. This is suspicious but not definite for malignant node due to the small size of the node and moderate PSMA uptake. In addition, the PSMA is 0.09. No other PSMA avid disease identified in the rest of the study. Depending on the clinical progress and PSA level, follow up PSMA PET CT in 3 months can be considered. 
February - March 2015. After discussion with Medical colleagues -Urologist-believes surgery is not a safe option.
April 2015 PSA -0.21. Results delivered by Radiation Oncologist who had viewed images of PSMA and read report. Additional radiation not recommended as it may result in perforation of small bowel. Does not think Stereotactic radiation is an option either as it is possible that cancer cells may have already escaped to other areas.
My case was to be considered by Multi Disciplinary Team on 12 May 2015.
I see Urologist later this month.
Date updated:
14 May 2015