Saturday, December 10, 2016

Bone Scan Scare Passes - And Cryo-Ablation Treatment Is Next

Two and a half weeks ago, as technetium 99m, a radioactive tracer. coursed through my veins, I had little inkling of what would be found some two hours later by the gamma camera, given the Tc-99m emitted 140 keV gamma rays..  After a longish wait, perhaps, ten days, the Urological Associates Nurse phoned me and said the bone scan results came back "mixed" with two suspicious areas identified.

She asked about a possible rib fracture that seemed to appear as a thin dense line in one right rib. I responded that I believed it occurred some 13 years ago when I tripped on a hump in the road while jogging and fell flat on my face. I managed to get up and walk back home but the pain was excruciating, and I had to get flexeril from our then primary care doc. But I never suspected a rib fracture and the doc herself diagnosed it just as a rib "bruise" - meaning the cartilage was bruised.

Anyway, having dismissed that, the Urological RN then pointed to an area in the pelvis which showed "unusual cellular activity". She said it was necessary to now get an x-ray of the pelvic area in order to rule out a bone "met" that escaped. Recall these "mets" are actual prostate cancer cells that have  escaped from the gland and taken up residence in other organs, regions. If indeed a met, as I pointed out in my earlier post (Nov. 21) it would have meant  there was no point doing the focal cryotherapy treatment- or the 3D staging biopsy, see e.g.

So now the stage is set to first get the 3D biopsy done next month, and then the month after do the actual focal cryotherapy.

The 3D biopsy will necessitate taking a total of some 62 cores of the prostate while I am under general anesthesia - because you can't be moving at all.  The number of cores taken, as Dr. E. David Crawford told me in our Nov. 16 meeting, is generally twice the mass of the prostate. Given mine,  at the last (MRI fusion) biopsy,  was 31.3 g that means at least 62 cores.

Since the entire gland then swells up in the wake of this "assault" (the usual biopsy is 10-15 sticks) it also means you have to have a catheter in for at least two days. Since I don't handle urinary catheters very well, Dr. Crawford suggest a supra-pubic catheter, which is effected by creating a hole below the navel so the catheter can be placed into the bladder. Unlike the urinary type, this one would have to be removed by medical personnel -so we plan to stay over at least two nights in the neighborhood close to the  university hospital.

It takes about a month for the perineum to heal (the biopsy is done by inserting the needles directly through the perineum, not the rectum) then I return to have the actual focal cryotherapy done.  That will require only one day having a catheter in, so again we will stay at least one night so the same type of catheter can be removed before we depart for home.

It was a relief to receive the follow-up phone call from the RN yesterday saying the x-rays also came out negative, but I am not exactly looking forward to the 3D biopsy and cryo -ablation with two general anesthesia administrations in a row. But as Janice said, the alternative of just letting the cancer be is not much of an option either, and invites metastases that can end up anywhere.

So, it's game on!  I will post after the 3D biopsy to let interested readers know how it went, since there are very few personal accounts of such medical procedures. (In contrast to regular prostate biopsies). In particular, it will be interesting to see the exact extent of any complications - of which I will certainly make others aware.

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