CT scan

Go west, young man

Abiraterone, Advanced Prostate Cancer, CT scan, David Emerson, Provenge -

Dr V called Friday night with the results of my CT scan. That’s right, my doctor calls patients at home on a Friday night! His news was for the most part good.
1) No, the cancer has not spread to any organs.
2) The radiologist noted a new tumor in the T5/6 vertebrae. This was new compared to the CT scan from 12 months ago, but we were made aware of this new tumor when he communicated to me the results of my last bone scan, which was last month.
3) There are three areas with enlarged lymph nodes, two nodes above my prostate, two below and two in my neck. The largest being approximately 3cm or a little more than an inch, this was near my prostate. The other areas were smaller.  He recommended for now we keep an eye on these and they should go down as we treat the disease in total. In other words, get my PSA down and these could go away as well.

This news is good in the sense it just eliminated one option and made my next treatment decision a choice of two Provenge (immunotherapy – vaccine) or Abiraterone (oral – pill). Both are going to require travel, the former to the east coast, the other to the west. I’ll wait and see how things evolve but there’s a little voice saying, ‘Go west, young man’.

Unwanted, but hardly unexpected

Advanced Prostate Cancer, alkaline phosphate, CT scan, David Emerson, PSA, t -

If the past 55 months have been nothing else, they have been tumultuous. Today was just another example of the uncertainty that is my life.

My PSA number was back up, this time to 99.43

I was pretty bummed out, for about an hour. Seriously, by the time Mary and I got home I was pretty much over it. It’s a good time, if there ever was one, because I’m busy…between the preparation for the upcoming golf tournament, the reorganization going on in the office, and a few other irons I have in the fire, I have little time to slow down or dwell on my PSA number.

We did leave the doctor with this plan; on October 6th I will have follow up bone and CT scans. Aside from taking up most of a day, these don’t bother me too much. I am slightly concerned however about the total number of these I have had over the years. I should probably know this off the top of my head but I would estimate that this makes a dozen. That much radioactive dye can’t be that good for me. On the 6th I will also have a PSA, CTC and alkaline phosphate test. The combined results of these tests are what we are hoping will lead us to a new plan.

The choices for my next treatment are limited; DES (estrogen), another round of chemo (3 weeks on, 1 week off versus last time when I did 1 on 3 off) or a yet to be determined clinical trial.

So that’s the update, pretty crummy overall but we’ll get through this like we have before. Many, many thanks for all the kind thoughts and prayers!

“Stable”, adjective, from Latin stabilis

Advanced Prostate Cancer, bone scan, CT scan, David Emerson, metastatic -

Main Entry: stable
Function: adjective
Inflected Form(s): sta·bler l “”
Etymology: Middle English, from Anglo-French estable, stable, from Latin stabilis, from stare to stand Date: 13th century

1 a: firmly established : fixed, steadfast b: not changing or fluctuating : unvarying c: permanent, enduring 2 a: steady in purpose : firm in resolution b: not subject to insecurity or emotional illness : sane, rational 3 a (1): placed so as to resist forces tending to cause motion or change of motion (2): designed so as to develop forces that restore the original condition when disturbed from a condition of equilibrium or steady motion b (1): not readily altering in chemical makeup or physical state (2): not spontaneously radioactive

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Are you scratching your head yet wondering what the heck I am getting at?

Well I picked up my copy of the scans and the Radiologist’s report and within the seven page report lies the bottom line, the conclusion the good news!

CT Scan: Impression
Abdomen:
1) Stable sclerotic foci within L2 vertebral body consistent with blastic metastatic disease from the patient’s known prostate cancer. No new sclerotic metastses are identified.

2) No evidence of hepatic metastatic disease or abdominal lymphadenopathy.

Pelvis:
1) Stable sclerotic lesions within the hips and bones of the pelvis consistent with metastatic disease from the patient’s known prostate cancer. No new osseous lesions are indentified.

Full Body Bone Scan
Stable bone scan with uptake in multiple pelvic osseous metastases. There is no scintigraphic evidence of new osseous metastatic disease since February 23, 2009

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All this means is that the overall disease appears to be stable. On Monday we will find out what the blood and other markers (PSA, CTC, BAP etc) are indicating and we’ll go from there.

Not sure what the options are, but we’ll be sure to let you know once we discuss with Dr. V, and perhaps Dr. L in Houston

How did you react?

Blue Koi, bone scan, CT scan, David Emerson, iodine allergy -

In this case I broke out in hives!

Today I had a follow up bone scan and C/T Scan. Like everything else with this disease, it all takes time.

At 1:00pm I was injected with a radioactive isotope in preparation for the 4:00pm bone scan. Not much to the prep other than accessing my port and injecting me with a syringe they take out of a lead container that contains a warning symbol for radioactive material. It’s kind of ominous.

Immediately after the injection I spent the next hour drinking a “creamy vanilla” mixture in preparation for the C/T scan. This scan was approximately my 4th or 5th in the last four and a half years. It’s a relatively easy process that seems to have gotten easier over the years. My memory isn’t the greatest but I do remember that the first few times the liquid was dreadful and it seemed to take a lot longer to consume, or perhaps it’s just that the wait used to be longer after consuming the liquid. Anyway, after I finished drinking the required dose I was immediately escorted to the scan room. The C/T device is not like the scanner you see on TV or in the movies. It’s like a gigantic donut. I lie on a table that slides me in and out of the donut hole. Before the scan starts however they injected me with some type of iodine that reacts
with the “Creamy vanilla” liquid in order to make ‘areas of concern” light up on the scan. I can tell when they begin the injection, as I feel a weird warming sensation in my lower abdomen and bowels…lovely!

Today, shortly after the injection I started feeling a little itchy but thought it was the chigger bites from recent rounds of disc golf. As it turns out, I was was having an allergic reaction to the iodine and started breaking out in hives. I didn’t put two and two together until they were done and I was back in the waiting room with Mary. I told her I was itchy, she pulled up my shirt and discovered a few hives on my stomach. I returned back to the procedure area and the doc, the nurses and techs knew right away what it was and 50mg of Bendryl took care of everything. The only problem was the Benadryl wiped me out and I needed a 45 minute nap when I got home. Also, now anytime I need a C/T I’ll have to take Prednisone (steroids) the day before. Hopefully, it’s low dose and at least my knees will feel good for a day! We were surprised that I had an allergic reaction, as I’ve had numerous scans previously, and I never had a problem. The doctor explained that one’s immune system can be altered after going through chemotherapy, so we will assume that’s the case.

Mary and I had 90 minutes to kill before the bone scan so we ran out to one of our favorite places to eat, the Blue Koi. Ever since chemo my favorite dish at the Blue Koi has never tasted quite the same. I am glad to report that today it was great once again! We both enjoyed the meal and our time together mid-afternoon.

The bone scan was routine: lie on the table and 45 minutes later, you’re on your way. After receiving the Benadryl, I think I might have dosed off for most of the procedure and my ride home as well!

I’ll pick up the CD’s tomorrow and we’ll review with Dr. V on Monday.
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I’m not sure where this thought came from today, it may have been the murder/mystery I was reading or the article on Elizabeth Edwards from an old dog eared People Magazine, but I was thinking two things; I think Mary and I are doing a pretty good job of living a “normal” life. I’m not sure what normal looks like anymore, but my guess is there is some semblance of it in our day to day lives. That makes we happy.

The other thing I was thinking is I am grateful. Grateful for what you may ask? I am grateful for all the time God has blessed me with since this happened. So many people in this world die quickly, unexpectedly and without any warning. I was just reflecting on how lucky I actually am!

Doc, are you serious?

Advanced Prostate Cancer, bone scan, CT scan, David Emerson, Ketokonizol, PCa, PSA -

Today was my monthly doctor appointment. I am not sure where the time went…June is nearly over.

For the past weeks I have felt the same, no new aches and pains, no need for Advil or the like. As reported, my knees hurt but Glucosamine is helping a little. I think chemo pretty much trashed my cartilage. As for cancer related pain, I really have none.

So, on to the test results. A little history; after leaving MD Anderson we agreed to pay more attention to everything going on instead of focusing primarily on PSA.

My PSA today was: 66.14
This is up from 55.13 last month. I was not at all surprised considering I am only taking Lupron at this time.

The three new tests came back looking like this:

Alkaline Phosphate (bone portion) – 6 [very low!]
Circulating Tumor Cells – 0 [excellent!!]

This was all followed by the fact they once again screwed up the forth test (the urine test). I could only ask, “Seriously?”. Doc tried to lessen the blow by saying the other markers are indicating good things. I had to just bite my tongue and move on. He promised to write out very, very specific instructions for my appointment on the 14th. I’m not holding my breath.

So then we were off to the treatment center for a shot of Lupron and Zometa [a 25 minute infusion to strengthen my bones]. Turns out someone wrote the orders for next week, so it took 45 minutes to get that straightened out and then another hour to wait for the pharmacy. I’m really finding it hard to be patient in regards to the the service at the cancer center, but I will.

In the end, the plan is this; on the 14th I will have a bone and CT scan. The following week will be my usual four week appointment on the 20th. If at that time, my PSA has continued to climb we might start High Dose Ketoconazole once again. By then it will have been 17 months since I last took Keto and it MAY work again? Like a broken record, I guess we’ll just wait and see.

Looking West

Advanced Prostate Cancer, bone scan, chemotherapy, Colorado, CT scan, David Emerson, Lake of the Ozarks -

A few medical updates after Monday.

I / we were not real comfortable waiting an additional week to start chemo (until June 16th).
Tuesday, Mary did the leg work, called the doctor’s office and inquired if if there was anything we could do in the next four weeks, or if there were any alternatives/options.

Yesterday they called back with some encouraging news. I will start treatments on the 9th as originally planned! This means on the 3rd I will have to spend most of the day at the hospital getting; a chest x-ray, a C/T scan and full body bone scan. This will mark the 6th set of the latter two tests. I imagine I might begin to glow at night, as they have to inject me with low-dose radiation each time they do a bone scan.

These last three weeks have been draining. Not only are the days longer, but the weeks seem to drag on and on. I never thought I would look forward to starting chemo. It’s just this; we made a decision, let’s get on with it.

Another somewhat stressful aspect is that we can’t really plan our summer. We wanted to take Brad to Colorado, I was going to take him camping, a trip to the lake, a weekend at my brother’s property, a trip to see my dad in St. Louis, and the annual get together with my sister from Ohio. Well all of that is currently in limbo. The whole chemo process could go according to plan; very few side effects, little fatigue, white and red cell counts stay high or near normal etc. but because we don’t know, we have to be careful not to plan too far ahead.

I pray for results like I had with Ketoconizal and other medications. I consistently responded well to previous treatments. Our hope is that the chemotherapy will get the cancer under control, my PSA will decrease, we can follow it up with other meds to keep it under control and resume a somewhat normal lifestyle for years to come. We’ll see.

I thank God daily for such a loving wife and wonderful, understanding son. I know he’ll love Colorado, when we finally get there……

Spoken like a politician, weatherman or economist…

Advanced Prostate Cancer, bone scan, CT scan, Nilandron, PCa, radiologist -

I finally got the radiology report from last week. The CT report needs to be re-done because it states “no previous exams are available for comparison”. Kind of funny (but not ‘ha-ha’ funny), being that my previous scans were done at the same hospital!

As for the bone scan, they apparently were able to locate the previous exams. Here is the Radiologist’s report:
Impression:
1. Stable foci of activity involving the left ilium, right acetabulum and pubic ramus as well as left 7th rib posteriorly. Initial patient’s known history of prostate cancer and elevated PSA levels these lesions are suspicious for stable metastatic lesions.

You get it, right? This is the report, word for word. Reminds you of a politician, economist or weatherman doesn’t it? For those of you who don’t speak the language of radiology, the last sentence is the key take away: “…are suspicious for stable metastatic lesions.” Interpretation – So PSA aside, things are stable!

I asked the doctor to have the radiologist re-write the CT report based on a comparison of the previous report. After this screw up, we might be in the market for a new diagnostic imaging center in the future!

Nilandron, which I started the day before the scans, might be working; back pains are all but gone. We’re definitely keeping the positive attitude going!

More updates later….work beckons.