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  • Awaiting Biopsy and possible PC diagnosis

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    Old 03-15-2019, 01:36 PM   #1
    Whimpurr
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    Question Awaiting Biopsy and possible PC diagnosis

    Hello! My loving husband of 27 years is likely facing a cancer diagnosis. During his yearly physical, his doctor felt a hard area on the right side of his prostate during the routine DRE. Because my husband's PSA has continually been rising over the past several years and now this nodule is present, he sent him to an urologist for follow-up.

    The urologist also felt the nodule and stated that Jerry's PSA is "high for his age". Jerry is currently 55 years of age and his PSA was right at the top of "normal" ... just under 4. The urologist didn't really say much else except that he needed a biopsy and that if it was cancer he thought it was "early" and that "sometimes" it is something other than cancer. That was about it for the visit. Neither of us even asked the first question. Unfortunately the first available appointment for the biopsy wasn't until April 8th and we've already been waiting 3 to 4 weeks. *sigh*

    Now ... here lies my "extra" concerns. Jerry has been having shoulder pain in his right shoulder for a few months now. (2 to 3 maybe slightly longer) He saw an orthopedist and was given a steroid injection and sent to PT for several weeks. He returned to the orthopedist this week and told him that the pain is WORSE than it was in the beginning. The orthopedist had previously diagnosed him with a "frozen shoulder" but then said that it should NOT be getting worse. His range of motion is very compromised as well. It hurts primarily early in the day but some days it hurts all day long. In addition to this shoulder pain, he is also experiencing recent onset of sciatica sometimes in both legs. He states that it sometimes nearly kills him to get out of the truck when he gets to work in the morning! He says the pain is "screaming" pain. He HIMSELF doesn't scream but that is how he describes what he feels!

    I am scared to death that this is bone metastisis!
    I pray that I am jumping to conclusions but I'm not so sure!

    Oh ... the orthopedist did order an MRI on his shoulder (thank GOD) and that will be this coming Monday and results on Tuesday. I'm not sure that anything will be directly on the shoulder as an original xray showed nothing.

    Do you think a MRI will cover enough area that if there is cancer anywhere near the shoulder, it would show?

    Last edited by Administrator; 03-15-2019 at 04:30 PM.

     
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    Old 03-16-2019, 07:14 AM   #2
    yayagirl
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    Re: Awaiting Biopsy and possible PC diagnosis

    Dear Whimpurr,

    I'm so sorry you have this to deal with! He needs a trusted doctor to manage the cancer possibility, so stay on track with that. First of all, hon, take each thing one at a time. Yes, there is a prostate cancer possibility as you know. There is some really good feedback available here about that, which I am sure will be added soon.

    For sciatica and shoulder pain, there are effective overthecounter pain relievers. Ask a pharmacist what works. I ask at two or three different pharmacies, then I make my own decisions based on what has the least side effects. I am well experienced with body function scares, having had quite a few of my own. An overthecounter solution that stops muscle cramps and spasms like a miracle is Theraworx relief. A pharmacist told me about it. Read and follow the directions.

    Another thing that works for me is to soak in a bath of very warm (as warm as he tolerates) water that has two cups of Epsom salts dissolved in it to relax the muscles. He can soak till the water cools. Sometimes that is all it takes. The bath can be repeated as desired. It is harmless. Also, you can give him a massage or get him a massage with a sports therapist. Also, a good chiropractor can help if something got out of place. But more likely he is having normal cramping from lack of adequate muscle stretching and movement.

    We must keep the joints moving. Not just to sit and steer a wheel. To deal with the common results of being in a sitting position for hours at a time requires really regular and intentional exercise and stretching.

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    Old 03-16-2019, 08:45 AM   #3
    IADT3since2000
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    Re: Awaiting Biopsy and possible PC diagnosis

    Hello Whimpurr and welcome to the Board!


    I too am thinking the pain your husband is feeling is likely not cancer related – more likely arthritis or a nerve issue, but, though the odds are probably long, it might be caused by one or more metastases. Was your husband an athlete back in the day with some old injuries? My wife had a diagnosed frozen shoulder, but PT helped. She has a lot of arthritis and it is painful, but we are in our seventies, so some wear and tear is not uncommon.


    MRIs come in quite a variety, and they can be aimed and tuned to pick up various conditions in various locations. As a layman, I’m not sure whether a regular MRI aimed at the shoulder would pick up a possible metastasis nearby when previous x rays have been negative.


    Prostate cancer pain is usually sourced from the bone and tends to be continuous and progressive, from what I have read. Bone scans can detect possible/likely metastases. The old but still widely used technetium (Tc99) bone scan is not that sensitive, as it requires about 10% of cancer involvement at a site before it will show a dark spot, and it is not overly specific, as arthritis and bone rebuilding around old injuries will also show up; radiologists are pretty good at filtering out likely cancer. In contrast, the sodium fluoride (NaF18) PET/CT scan is highly sensitive and discriminates quite well, though it is more expensive. Bone scans for most patients with suspected early and mild prostate cancer are a waste of money, but having worrisome pain could tip the scale in favor of a scan. Fear and anxiety, like that you and your husband are no doubt experiencing, can magnify what would otherwise be felt as a lesser or even no pain.


    An increasingly popular imaging tool, typically used prior to a biopsy, is a multiparametric (mp) MRI (mpMRI). Most mpMRIs depict anatomical detail, including suspicious detail, as well as water flow and blood vessel activity, all three of which are good clues for cancer. If you get a trifecta of positive clues for cancer, the area in the prostate showing that combination is a strong candidate for cancer and an outstanding target for a “targeted biopsy” sample. However, this valuable technology is not much good if you don’t have talented and experienced radiologists and doctors to make use of it. I see you are in Tennessee. I’m sure there are some good resources available, and your husband’s doctor might be up to speed in these resources; I believe he has done a good job in screening your husband for prostate cancer. How are things in Nashville these days?


    On the very good side, your husband has been well monitored over the past several years, at least. It is very unusual for such patients to be diagnosed with metastatic prostate cancer, even more so wide-spread metastatic prostate cancer, especially with a relatively low PSA, for prostate cancer, of around 4. If he does have prostate cancer, but it is a mild kind (especially with a PSA less than 10, which he has, a Gleason Score of 6 or lower, and a stage of 2, which he has per the DRE but not 2b or higher), he is likely an excellent candidate for what is called “active surveillance” (AS). AS has emerged over the past decade and a half as the go-to approach for best management of mild prostate cancer. Basically AS is a very smart way of monitoring to detect aggressive prostate cancer but deferring treatment until it is detected, if ever. Voluminous research has shown that it is highly effective and safe.


    If it turns out that your husband has a prostate cancer that is more aggressive, you need to know there has been enormous and continuous, continuing progress against prostate cancer over the past three decades. Indeed, survival averaged over all kinds of cases of prostate cancer is now over 95% at 15 years since diagnosis, compared to age-matched peers. The men who pull the number down from 100% are overwhelmingly men diagnosed with wide-spread metastases at diagnosis; the picture is improving for them too, but it is not yet a good picture for most of them. Still, that may be already changing.


    Good luck!

     
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    Old 03-16-2019, 07:49 PM   #4
    Whimpurr
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    Re: Awaiting Biopsy and possible PC diagnosis

    Thank you BOTH for your kind regards and helpful information! Waiting for the biopsy is aggravating! It's already been 3 weeks and we have 3 more to go ... April 8th.

     
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    Old 03-17-2019, 10:49 PM   #5
    MrSunshine
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    Re: Awaiting Biopsy and possible PC diagnosis

    Whimpurr,

    In my case, bone metastisis were evident in a cervical spine (i.e., neck) MRI that my neurologist ordered because I mentioned my left index finger felt a little numb. As an aside, this bothered me not much at all and I was surprised that it justified a MRI. I have lots of friends with severe back pain (not associated with prostate cancer, BTW) who are told that their insurance won't reimburse a MRI based on back pain complaints. Also as an aside, I have no pain, but after the MRI, I got my first PSA test (111) in about a decade, a biopsy that confirmed prostate cancer, and additional imaging that confirmed a cervical spine met but didn't find ant other mets.

    While I'm no expert, I think it's highly unlikely that, as miserable as it is, your husband's back pain is due to prostate cancer metastisis.

     
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    Old 03-18-2019, 08:08 AM   #6
    yayagirl
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    Re: Awaiting Biopsy and possible PC diagnosis

    Dear Whimpurr, I know it's so hard to wait.

    While waiting, why not get him a good massage? It really can help him get through this.
    Or at least get some Epsom salts and have him soak in very warm water with two cups of Epsom salts dissolved in it. It is really so very relaxing.
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