Rut Roh Rorge - PSA wrong direction

@jeffmarc - Yes, I'm looking forward to finding out too. Had to shake the tree a little since my GUO's office told me next month is the earliest they could see me. My PSA doubling time is sitting at 2.8 weeks and has been since March. In my opinion, sitting around for months at a time waiting for treatment is not in my best interest, so I called radiation oncology directly. RO will check my scans and call back today with a treatment plan. And...I wanted him to know that he missed and needs to fix it.

OK then...got the call back from RO. Stat MRI of lower spine ordered to provide for SBRT targeting of L5.

He will not do any form of additional radiation to prostate at this time and tasks oncology with a pharmaceutical remedy. A radiological option may be available in the future, but it is too short a timeframe since concluding IMRT to be considered now since any damage from IMRT may not appear for some time. Seems to make a certain amount of sense.

@mjp0512

I am so glad that you got some input and explanation 😌 and the plan seems pretty straightforward which is good. You will zap that L5 (as did Jeff) 👍 - and perhaps it is better to take one step at the time. I am sure that your RO will now also "activate" the rest of a team and schedule your next app. ASAP ! It is really unconscionable that they pushed your app. so far down the road 😠. I do not understand doctors and clinics most of the time ....

@surftohealth88 - Yea, I'm glad he's being aggressive on the L5 met. Maybe I'll be able to sleep through the night without the lower back twinges! 👍

We also had a good news/bad news discussion regarding the accelerated PSA doubling time. Good news, PET scan indicates that it is not being caused by systemic cancer spread. Bad news, the activity in L5 and prostate are themselves generating this aggressiveness.

@mjp0512 At least you’ll get a handle on the L5 lesion. But your prostate gland is still that active after radiation? Unreal…
Perhaps some HDR brachytherapy in the future might do the trick?
Not sure of the allowable max Gy to the gland. Best,
Phil

@heavyphil Or Proton therapy, according to some sources.
Phil

@mjp0512
Hey mjp - I just watched this video

Thinking of you and sending healing vibes ✨✨

@surftohealth88 - Thanks Surf! It would be cool to not have to be concerned with prostate. Apparently, there's enough going on in my back to keep me occupied.

I guess my RO wasn't kidding when he said, "Stat". Lumbar MRI ordered this morning, completed this afternoon, results posted this evening.
_____________________________________________
Impression:

Osseous metastatic disease replaces the marrow of the L5 vertebral body. More diffuse marrow heterogeneity is noted which is likely related to diffuse marrow infiltration.

No significant spinal canal stenosis is noted in the lumbar region. Please see additional comments above.

Procedure: MR LUMBAR SPINE W WO CONTRAST

History: 70-year-old patient with L5 metastatic disease.

There are 5 lumbar type vertebral bodies noted.

Findings:

Diffuse marrow replacement is identified in the L5 vertebral body. This is consistent with osseous metastatic disease. No significant epidural component is demonstrated. Diffuse heterogeneous marrow signal suspicious for marrow infiltration is noted throughout the lumbar spine and sacral region.

No compression deformities are noted. The distal spinal cord and conus is of normal signal intensity.

Broad-based disc bulges are present at all levels in the lumbar region. A superimposed central disc protrusion is noted at L2-L3. A superimposed LEFT paracentral disc protrusion is noted at L4-L5.

Moderate bilateral foraminal narrowing is noted at L5-S1.
___________________________________________________________

I'll reserve any speculation until I hear from RO other than to say, this report is no bueno. Apparently, there's a reason my back hurts.

@mjp0512 If it is limited to L5, that can be spot radiated. My husband had metastases in L5 and that is what was done to destroy them.