The Wait Is Over

Yesterday I secured an appointment with my medical oncologist for the morning of December 24. According to him the bone lesion on the femur is almost certainly prostate cancer. The most appropriate treatment for the PC at this time will be androgen deprivation therapy (ADT). The actual drug or combination of drugs remains to be seen, but I'll know next week.

A different doc who is an expert in mesothelioma ordered a bone biopsy for a lesion on the iliac crest, a specific part of the pelvic bone. All four doctors want to know what it is. They say it's unlikely to be mesothelioma, but you never know. That's not scheduled yet but it will probably happen within a few weeks.

Nobody wants to touch the lesion on the spleen. It's hard to biopsy and may bleed. At present the idea is to monitor it. It's all a little frightening, but it's good to have a plan.

Still Waiting...

I had the PSMA PET/CT on December 5, as planned. Three days later I was able to see the results. The prostate cancer (PC) has spread but not extensively. It has reappeared in the prostate gland. The small lesion on the femur is PC. The lesion on the pelvic bone is not PC and so remains a mystery. The spleen is also a mystery. There is no guidance yet as to how to proceed.

Why no guidance? So far no doctor has contacted me about the scan. Yesterday I made a call to see what's happening. I had a chat with an admin and then received a call from the radiation oncologist. It sounded like he hadn't seen the results until just before he called me and went through it. 

The back story is that there are four doctors in the communications loop, each of them a specialist in different but overlapping fields. They are looking at two different cancers and two unknown lesions. They have been in touch with each other but I think someone may have dropped the ball on following up with me, the patient. I politely triggered one doc to step into this yesterday. He's now requesting that the cancer oncologist meet with me ASAP. Everyone else will be copied on that message. 

Oddly, I'm not upset about this. I kind of wish the whole thing would just go away, so this period of inaction is welcome. But I know that things are going to get busy in 2025.

Hurry Up And Wait

Last week, the day before Thanksgiving, I met with my radiation oncologist. The rise in PSA since the last treatment did not cause undue alarm. However, it’s likely that the disease has spread to other locations. Tomorrow I’ll have a PSMA PET/CT to look for those other locations. Small lesions on the femur and pelvis are suspects. The lesion on the spleen is probably something else. Future PC treatments will have to be hormones or drugs. Now that the cat is out of the bag the pinpoint radiation treatment will no longer be effective to contain the disease.

The doctor who treated my peritoneal mesothelioma in 2014 recently retired, so I met with his replacement yesterday to talk about the lesion on the spleen and what it’s cause might be. He said that there are many possibilities (some of them benign) and the return of mesothelioma is not a favored diagnosis, nor is PC. Tomorrow’s imaging study should show definitively whether the lesion is caused by PC. If not, his approach will be a very specific imaging test to better define the spleen problem. Unless something specific is discovered, the plan will be regular images to monitor the size of the lesion and the spleen. If it continues to grow then a biopsy is likely. Biopsy results would determine future actions. Interestingly, the doc described the spleen as a loose sack of hamburger. It’s highly vascular and a biopsy may cause bleeding that would require a surgical repair. If the lesion continues to expand, the risk is that it may rupture unexpectedly, which would require immediate attention due to the risk of bleeding out and dying.  

Summary: This is a step-by-step situation. I’m pleased that these doctors are in touch with each other and that all of them see all of the test results and images. I’ll post again when the PSMA PET/CT results are in.