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RE: Follow-up Imaging post treatments; HD-Brachytherapy, HD-EBRT
Diagnosed July 2024; Locally advanced PC, Gleason 3+4/4+3 in 16/19 cores, No distant metastasis.
HD-Brachytherapy and HD-EBRT done Fall 2024.
HT (Orgovyx and Zytiga/Nubeqa) started September 2024, ongoing.
PSA was at 6.3 ng/mL pre-treatment and steady at < 0.1 ng/mL since treatments.
Oncologist recommending CT scan with contrast; for no apparent reason other than standard of care.
Wondering what imaging should be done at this time (and how frequently) and why another PSMA-PET scan wouldn't be a far better option to establish post-treatment baseline.
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@rdmiller
Today's visit with oncologist at Stanford Med was most concerning. Doc was dismissive of my concerns in 3 areas; Re radiation exposure of possibly unwarranted/untimely CT Scan; he indicated that radiation was no more than flight from SFO to NYC (which is patently false)! Re lymphopenia and my concerns about natural immunity etc; he indicated that I have plenty of lymphocytes to fight infection and said nothing re increased risk of metastases. Re Anktiva and Dr. Patrick Soon-Shiong; he indicated that he's undertaken "non-transitional" trials and he wouldn't advise paying for any related treatments, stopping one click short of saying that Dr. Patrick is a quack. Very disappointing feedback and consultation today.
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You asked about ALC earlier and I wasn’t sure what you were talking about. That is one thing I’ve never heard anybody having an issue with, with prostate cancer treatments. It might be that yours is low, but the standard treatments don’t normally cause any issues like that. I suspect that is why The doctor didn’t feel it was something to really be concerned with.
There’s a lot of other blood issues that are a problem. RBC, WBC, HGB, Hemocrit, ALT, Blood sugar, glomerular filtration and Platelets are more common issues for many.
The CT scan can be equal to hundreds of flights across the country. He was way off there. It is more than an x-ray, but the results are generally considered a small theoretical cancer risk, far outweighed by the diagnostic benefits.
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2 Reactions@rdmiller Yeah, way off on the CT scan numbers - more like 1500 flight hours - but I’ll cut him some slack because even experts get confused sometimes…
I had a similar concern after IMRT, as my lymphocytes were well below normal. My regular physician (I happened to be in for a regular checkup and showed him my results) shrugged and said the low number was really not concerning to him at all; and all the cells have recovered nicely since.
I think you have to really weigh the risk/benefit: get the scan and impact your lymphocytes - which will bounce back hopefully - vs. not getting the scan and missing a metastatic cluster.
It’s ALWAYS a trade off with cancer treatment; the diagnostic tools and treatments can sometimes be almost as dangerous as the disease itself.
Personally, I used to try to micromanage all of this until it got to the point where I just said enough🤯. I still ask questions and still appreciate a non BS reply, but I’ve accepted the dangers of treatment as being part of the disease itself and now just say screw it…Best,
Phil
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