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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2005A Call from my doctor
I got a call from Dr. Catalona last night. He's gonna be my surgeon here at Northwestern in Chicago in a few weeks and I had never spoken to him or met him before. dx: age 56 PSA 7.2 T1c Gleason 3+4=7 I'm to see him Thursday but he called to tell me that there were hot spots on the bone scan (which I knew) and that in the follow up x-rays the radiologist said that it showed a place in a rib that could be a metastases (sp?), but he had doubts. He said that an MRI could show more and a biopsy of the rib could show even more. But...the acid phosphotase test was normal and from my PSA (7.2) he didn't think that it was anything. He said that in his opinion, I should ignore it and do nothing. He said it was a serious prostate cancer that needed treatment as opposed to a minor cancer that didn't need treatment. (I knew this also) but his experience said that I should ignore the rib thing. I just said thanks. But I'm in a daze. I didn't pepper him with questions (I said nothing) but I wondered why he would call if I shouldn't be worried. I DO trust his expertise so I'd likely do whatever he feels is best but he is not an emotive guy (from watching his video) and he never said..."don't worry about it." or anything like that. He just said that he would ignore it. No change of tone...no reassuring comment. Maybe that was supposed to be reassuring enough. Any ideas are appreciated as I see him on Thursday. Thanks to all. Ron B. Chicago > I got a call from Dr. Catalona last night. > [quoted text clipped - 7 lines] > the radiologist said that it showed a place in a rib that could be a > metastases (sp?), but he had doubts. I think this is not unusual. I have read that all sorts of things show up in bone scans and Xrays, and it is highly unusual for them to represent metastases in an early prostate cancer like yours. My surgeon didn't order a bone scan and my case was very similar to yours. I hate to think of what they would have found, had he ordered one. I would probably have been grinding my teeth down even more than I did before the surgery and my quite good pathology report afterwards. Also, remember that radiologists are trained to look for abnormalities and clearly they would rather err on the side of caution. I had an experience like that when a radiologist found something in my esophagus that might be a tumor. My gastroenterologist was sure it wasn't anything, but he had to do an endoscopy to be sure, and of course he was right; it was an innocuous bulging vein. > He said that an MRI could show more and a biopsy of the rib could show > even more. [quoted text clipped - 14 lines] > I didn't pepper him with questions (I said nothing) but I wondered why > he would call if I shouldn't be worried. He is just being thorough. Also, it would be unetihical for him to go ahead with surgery without first discussing it with you, since there is a remote chance it is a metastasis. > I DO trust his expertise so I'd likely do whatever he feels is best but > he is not an emotive guy (from watching his video) and he never [quoted text clipped - 3 lines] > > No change of tone...no reassuring comment. You have to remember that he has to deal with this sort of thing every day, so it is basically a non-event for him. Like many doctors, he gives you the facts as he sees them, and leaves it at that. It is perfectly normal for you to read into what the doctor says or doesn't say, or even his tone of voice, hidden meanings. But they just aren't there. He told you exactly what he thinks, and you should accept it for what it is. It would be pointless for him to tell you not to worry about it, because he knows that you probably will. But he did say he thinks it highly unlikely it means anything, which from what I've read does seem to be the case. Of course, it is possible that you are the one case in a hundred or a thousand (or whatever it is---I don't actually know) where there is a visible metastasis at this stage, but obsessing about that possibility won't help. The odds are way in your favor. > Maybe that was supposed to be reassuring enough. > > Any ideas are appreciated as I see him on Thursday. Try to concentrate on getting straight the big things that will happen such as the details of the surgery, anesthesia, recovery in the hospital and afterwards. Don't dwell on unlikely things. This is going to be a difficult period for you psychologically, but you will get through it. You can take consolation from the fact that given the available information you've made the best possible choice under the circumstances. You can't do anything more than that. Good luck. > Thanks to all. > > Ron B. > > Chicago Ron, I had a couple hot spots on my ribs pior to my RP but they concluded arthritis or old fractures. I had another one 2 years later after my PSA began to rise and again had some rib hot spots - but in totally different locations! Had the first ones been PCa they would not have gone away. Don't fret over it. This reminds me of something I have never posted about - the "informed consent" speech. On the Friday before my Tues. RP I had an appointment w/ my uro and he started bringing up all these stats that said RP might not cure me, that there could be complications, that they could not be sure the hot spots weren't mets, side effects. etc. etc. It was very disconcerting because he had been rather optimistic until that point. I was so shaken I started re-evaluating whether I should proceed. My perception was that the guy had changed his mind about surgery or had major reservations about and was trying to scare me out of it. I finally called him at home on Sun. night and asked him point blank and he seemed much more normal and optimistic. All the negative talk was just the legally-required disclosures necessary for them to obtain your informed consent - i.e. CYA. So, guys facing RP or any treatment: be prepared for some negative talk from your doc and don't let it shake you. Bill Denton RP 2/12/02 PSA .45 Memphis > This reminds me of something I have never posted about - the "informed > consent" speech. On the Friday before my Tues. RP I had an appointment [quoted text clipped - 14 lines] > > Bill Denton My urologist presented the negatives to my wife and me, but he focused on the side effects and outcomes of treatment. I asked him about the risks of surgery and anesthesia in general. His answer was that there were risks, but the probability was extremely low and these problems were so unlikely that "it wasn't worth talking about them." A few months after my RRP, I learned that a man I was friendly with at work for 20 years had PCa. He was seeing an experienced Urologist in the same hospital that I used. We had many discussions of my prostatectomy experience and I gave him advice and materials for study. He ultimately decided to also undergo an RRP. There were complications following my friend's surgery. He was in the ICU for about 10 days before passing away. I have no information on the details. I'm not mentioning the name of the hospital because I choose to believe this is just one of those rare situations that can occur anywhere. The hospital is very highly regarded. Its urology department is ranked in the top half of the U S News "best hospital" list. The lesson that this shows is that if the possibility of a problem exists, it could happen to you, no matter how low the probability. Al You haven't even got a palpable tumor in the prostate gland. According to the Partin Tables, the chances the cancer hasn't even gotten as far as your lymph nodes are 98%. http://urology.jhu.edu/prostate/partintables.php Forget about your bones or any more tests. Just choose your treatment and get cured. jimhoney stage T2c, standard RRP age 52, cured, no significant aftereffects > I got a call from Dr. Catalona last night. > [quoted text clipped - 44 lines] > > Chicago I'm where you are. A PSA 7 and Gleason 7 are each probably borderline for even having a bone scan. Mets are not likely under the circumstance. I had hot spots that were arthritic. But, then he throws in that rib, then says he wouldn't worry about it? I guess, in your case, you might want to consider whether you would choose a different treatment if you knew your rib spot was cancer. If so, do what you can to find out if it is. If not, get your surgery and keep an eye on the rib.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > I got a call from Dr. Catalona last night. > [quoted text clipped - 44 lines] > > Chicago Hey Ron, hang in there..... I had highlights on my bone scan and that was in 1999. I was 49 at the time.....The scanner person said it was carpentry.... Yes, I am a builder, and some of my joints may or should look worn. Anyway, Leonard is right on...He is very smart.... You are headed in a good direction. John Loomis RP Nov. 1999 7.0 on the richter scale. PSA Gleason 7 T-1 if not 2...... so far now at 55.....0.01 or less PSA Erection best with 30mgs of Viagra... No peeing myself..... >I got a call from Dr. Catalona last night. > [quoted text clipped - 44 lines] > > Chicago I've had a hot spot on my left femur, found in a bone scan for Non-hodgkins lymphoma in 1976. It was determined at that time that it was a result of an old injury, a hard blow for instance. When I was DX'd with PCa I told the docs this, they looked at the old scan and agreed. At the time I wasn't aware that an injury could show up as a hor spot. Tom >I got a call from Dr. Catalona last night. > [quoted text clipped - 9 lines] > > Chicago > I got a call from Dr. Catalona last night. > [quoted text clipped - 44 lines] > > Chicago It's all a stupid game at our expense. They call for tests that really do nothing but call for more tests to clear up the first ones! We've all been through it. My Uro told me that he doesn't even want to ask for all these scans when the PCa is diagnosed early, but he's kind of forced to, to protect him form being sued. You'll be fine! SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories |
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