Saturday, February 4, 2017

The Good News: I'm A "Perfect Candidate" For Focal Cryo Treatment

The meeting with Dr. E. David Crawford earlier this week was concerned with the outcome of the 3D staging biopsy done some two plus weeks ago. To say it went well would be an understatement, especially after he displayed the 3D grid of the mapped prostate on his computer.

He pointed to one localized region, roughly 5-6 mm in diameter, where all the cancer was confined. There were no other lesions or regions, and that assurance is the primary benefit of having the much more invasive 3D biopsy. No such assurances exist for those who get regular prostate biopsies, including the highly touted MRI fusion form (which I also had).

Recall that biopsy mistakenly identified separate cores, e.g.
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And the pathology report showed a Gleason 7 score in one region (3 + 4) with 63 percent of the cells assigned malignant status and also with "perineural invasion". Thus, I beheld the summary of diagnostic information as shown:

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However, none of that was confirmed in the 3D staging biopsy. Indeed, there was no evidence of any perineural invasion, as the localized lesion was situated not only apart from the rectal wall but also from the urethra. In addition, the maximum Gleason score pair for the sole cancerous region was 3 + 3, not 3 + 4.  

When Janice asked what could account for the difference in Gleason score, as well as the reduction of multiple lesions to just one, Dr. Crawford said "the radiation treatment he had four years earlier". Basically, that high dose brachytherapy treatment - leaving loads of "scar tissue" - left the histology analysis a mess, and unreliable. That pathology report was basically useless, at least in terms of moving forward. Had I therefore not had the 3D biopsy I likely would have opted for a follow-up treatment that was inappropriate.

Dr. Crawford assured me there was no rush to get the treatment done, and in that case I've postponed it until later in the year, after we take a holiday in Barbados.  In any case, as I told him, I was still contending with residual urinary burning as well as urgency, which he agreed was because of the Foley catheter. Again, it had been in barely two days. 

When I asked him how long it would need to be inserted after the focal cryo, he said it "varied" but steered clear of his original claim of "one day" (which his RN vigorously disputed when I spoke with her after the biopsy)  He agreed the most likely interval was 2-4 days, which pretty well conforms with the 3-5 days cited on the UC site. But I am hoping given the localized tumor and placement, it can maybe come out in 2-3 days. 

We will see.   For now, I am simply enjoying the good vibes of being the "perfect candidate" for this focal cryotherapy treatment.  I have asked for the copy of the 3D grid map with the lesion identified, and when I receive it from UC Health I will post it as an update on this post.

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Darrin Rychlak said...

Thanks for the update. You have readers like me who are supporting you and your journey. I used to think psychic well-wishing, like prayer, was bullshit. I still do. But I can't argue with the benefits of a benevolent, appreciative perspective. Call it an impassioned resignation to life in its splendor and mystery. Ahhhh, What do I know.

Copernicus said...

Thanks, Darrin, and I truly appreciate that benevolent perspective!