River: State of the Bear

[mdlbear]

I'm starting this at a quarter after ten pm on Friday the 13th of October. It will either wait for a week before completing it, or push it out sooner and add a Part II next week. Medical TMI: prostate cancer. New tag pc.

OK, you were warned.

TL;DR: I have prostate cancer. You may have read or heard that prostate cancer is usually not particularly aggressive, and can sit there for decades without growing much. Mine, however, is in the "aggressive" range, with a "Gleason score" of 8 (4+4). So Something Must Be Done. The prognosis is still pretty good as long as it's confined to the prostate and its immediate vicinity. Which, as I write this waiting for another test, remains to be seen.

10-18We

I'll pick up the story here in the lobby of Harborview Medical Center, where I'll be sitting until a little before 2pm, at which point my bones will be sufficiently radioactive for me to go back upstairs to Nuclear Medicine for my bone scan.

What's a bone scan? The idea is to identify any fast-growing spots in my bones, which would indicate that the cancer has spread to them (which would be very bad). This morning I was injected with a solution containing technetium-99m, complexed with methylene diphosphonate, which is taken up by growing bone tissue. Bones love phosphorus -- they're made mostly of a phosphate mineral called apatite. Tc-99m has a half-life of about six hours, and emits gamma rays with a wavelength of 8.8 picometers, which is in the same range as a dental X-ray machine. Only instead of passing radiation through my bones, it's coming from inside them. Clever.

The stuff came in a metal-shielded syringe, which sat wrapped in a sheet of lead on the table until it was needed. One dose isn't harmful, but someone who handles the stuff all day needs protection.

11-09Th...

So I appear to have let this sit in my queue for almost a month; things have been happening. The bone scan was promising, but ambiguous, so they scheduled me for a PET/CT scan, which was last Friday. Results came back on Tuesday.

PET/CT is a combination of positron emission tomography and X-ray computed tomography scan; done in one session. The PET scan identifies places where prostate-like cells are located, while the CT scan pinpoints where they sit relative to all the other body parts, in particular the places that they couldn't be sure of on the bone scan.

The PET scan used gallium (68Ga) gozetotide, which consists of an atom of gallium attached to something that binds to prostate-specific membrane antigen (PSMA), which identifies cells that look like they came from a prostate. 68Ga emits positrons (anti-electrons), which immediately combine with normal, negative, electrons and annihilate one another, producing a pair of gamma rays.

Unlike the radioactive tracer used in the bone scan, it only took an hour for the stuff to attach itself to cancer cells. The results came back this Tuesday:

1. Multiple foci of increased uptake indicating PSMA expression in known prostate primary with extension into right seminal vesicle.
2. No findings to suggest nodal or distant metastases.

... so the cancer is indeed confined to the prostate and its immediate neighborhood. This should be treatable. Modified rapture.

Meanwhile,...

The combination of enlarged prostate and severe constipation has been blocking my urethra, to the point where in the last week of September I made the first of a series of ER visits, where they put in a Foley catheter and drained nearly two litres of retained piss. The catheter has not been comfortable. Between irritation at the urethral opening and the occasional bladder spasm, I'm quite ready for them to do whatever it takes to rid me of it. Presumably that will also get rid of the prostate as well. I'm looking forward to it.

I'm not sure why I'm not more upset than I appear to be over this. I suspect dysthymia and antidepressants have something to do with it.

Comments

[radiantfracture]

Really sorry about this terrible news. It sounds like you're under good care, for which I am glad. And glad that it sounds contained and relatively straightforward to treat.

[mdlbear]

Thanks!

[acelightning73]

I'm really happy to hear that your prostate cancer is extremely operable.

I have had a few technetium injections. One of them had me lie on a special detector platform, an as the technetium was filtered by my kidneys, they got a good image of how good the flow is. And I also got some when I had some kind of heart scan, but I don't remember what it did.
And after they removed my cancer-filled uterus, after I had radiation treatments from a LINAC, I also had to have a raidoactive isotope of iridium placed near the surgical site, by means of a device I nicknamed the Iridium Dildo (which made the technicians giggle).

Mazel Tov and Qa'pla!

[azurelunatic]

Congratulations on your PET/CT results, and I hope you can get it out completely and promptly.

[ellenmillion]

I'm glad the news isn't worse and wishing you lots of health!

[mdlbear]

Thanks!

[madfilkentist]

Glad to hear that if it must be cancer, it's a treatable one with a fairly good prognosis. It may not be fun, but you'll get through this.

[mdlbear]

Thanks!

[dreamshark]

Not feeling upset doesn't necessarily mean your emotional response is defective. Knowing that something is wrong but nobody can figure out what - that's the worst. In your case, the not knowing included a highly intrusive and uncomfortable treatment with no projected end date. *ugh* Now you have a diagnosis of something that is treatable. That's actually a good thing. Best of luck with all of this.

[mdlbear]

Thanks!

... although the treatment is still likely to be both intrusive and uncomfortable.

ETA: ... and there's no telling how long I'm going to be stuck with a catheter. It's not even clear whether the urine retention is due to the cancer, the pre-existing enlargement, or the chronic constipation.

[figmo]

I just saw this (I'm catching up on blogs between jobs) and am glad that if it's cancer, it's one with a good prognosis.

[mdlbear]

Thanks! I'm already having less urine retention, so that's a big improvement.