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This question was answered on Sun 23, Mar 2008 04:53pm by Dr Heinrik M, MD

prostate cancer - Biopsy revealed T1C, PSA and Gleason score reveal less than 1% chance of metastasis


    
Asked by royross (Male ) on Fri 21, Mar 2008 03:06pm

i am a black 44 year old and was diagnosed on 02/29/2008. i went to my primary physician on 02/02/2008 for a routine physical. my dre was normal, but doctor decided to do a psa on me because i would turn 45 in may. the psa results after dre was 6.18 two days later it was 5.77. i was refered to a urologist and he did a 12 core biopsy test. the test came back with 4 positive cores all on the right side 1 core 5 percent, 1 core 10 percent, 1 core 15 percent and 1 core 90 percent with a gleason score of 6. the urologist said i was a stage t1c. i have seen another urologist and both agree on the stage t1c. both said treatment options are surgery or radiation. neither of the two doctors feels no need to due any imaging test due to my staging. i explained to both doctors approx 6 months ago i went to see my primary physican because my left side neck, arm and shoulder was stiff after trying to take bowling lesson and he stated i had a pinched nerve and sent me to therapy which it got better but not totally gone. approx 4 months ago i went back to my primary physcian because i was having pain on my right side of my back. my doctor did a urine test which showed i had blood in my urine. he sent me for a ct scan it showed i had a kidney stone, but because where it was located he thought it woudn't be as painful as other ones. i never notice if i had passed the kidney stone but was feeling better not perfect. then i help some friends move some heavy furniture and my back started to hurt really bad at that time. if i try to move something heavy it makes the pain worse. now that i have been diagnosed with prostate cancer i'm not sure what the cause of the pain is. i also recently notice numbness sometimes from funny bone down to my pinky and some discomfort around my chins, pelvis, hip and thigh all recently. i am not sure if this is from anxiety, pinched nerve, kidney stone, prostate cancer or something totally different. my lab report from my primary physician when i got my physical also showed my alkaline phosphatase at 130.0 and normal range shows 30-100. both urologist have examined me and there is no blood in urine now. both tell me my examine is normal. they tell me that i have a less than 1 percent chance of metastasis due to my psa and gleason score. that's why they don't think it's necessary for any more test and go straight to treatment. scared to ask for some imaging test, but what's the right thing to do and could thier be other unrelated problems. thanks in advace

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Answer by Dr Heinrik M, MD  on Sun 23, Mar 2008 04:53pm:

Hi, The urologists are correct that based on the findings on your biopsy and the PSA, the odds of having bone metastasis is very small that the bone scan would be unnecessary. The alkaline phosphatase though, can also signify that there may be bone disease. If your kidney function is normal (this is usually measured by blood tests like serum creatinine and blood urea nitrogen), then this may raise the issue of doing the bone scan. If your kidney function shows impairment, this may account for the raised alkaline phosphatase. Pain from kidney stones is not really associated with physical activity (you mentioned the back pain being triggered by moving furniture). Looking at this scenario I would be concerned with having a traumatic spine injury like a slipped disk. This would also produce pain, but when an examination is done – everything would be normal except the pain. If the pain is severe especially when it is triggered by certain postures only, an injury does become suspect. Different tests would be sought with this is in mind, such as an MRI. The next step would thus depend on a thorough assessment of the pain. If it seems to be triggered at certain positions only or with certain activities – imaging for an injury may be required. If nothing can explain the elevated alkaline phosphatase – the bone scan would be helpful to rule out bone metastasis.

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