No Bone Scan, MRI, or CT Scan offered...?

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FairRider
Regular Member


Date Joined Jan 2008
Total Posts : 32
   Posted 2/23/2008 8:35 AM (GMT -7)   
My curiosity:

From all my reading, it seems most men have some type of further Imaging Studies after a 'positive' biopsy. Neither our Urologist or Surgeon have suggested this. When we asked, they didn't seem to think it necessary. I=From what I am reading there is much information that can be obtained about the tumor, location, size, lymph nodes........should we be concerned that these studies are not being requested before surgery?

We SO much appreciate all the posting that gives so many information, support, and hope. This is a wonderful network - thank you everyone who contributes!

FairRider
Age 54; (Father, paternal uncle and 1 brother so far with Pca) 1999 PSA 2.8; 2004 PSA 2.88; 1/2008 PSA 5.6 & repeat 4.37
DRE - "Unremarkable, L side slightly larger"
Free PSA 0.46 and ratio 0.11
Biopsy 1/25/2008 - 10 Cores - 4 with adenocarcinoma
3 cores Gleason 3+3=6 and 1 core 3+4=7
No Stage given on report, maybe T1c or T2c ?
Robotic Surgery Scheduled for March 17 - eekk!!


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4461
   Posted 2/23/2008 1:02 PM (GMT -7)   
I think it is rare that any of the scans are done just from the usual biopsy results.  With the occasional exception of a biposy that shows cancer in lots and lots of the cores, at a high percentage rate, it isn't normally done.  My scores are close to yours and it wasn't considered in my 'fairly normal' test results for cancer. 
James C. 
 
Help support the forums so they can support you:  http://www.healingwell.com/donate 
 
Age 60 
4/19/07   PSA 7.6, referred to Urologist, recheck 6.7 06/05/07
7/11/07   Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07   Path report:  3 of 16 PCa, 5% involved, left lobe , GS 3/3:6. 
9/24/07   (Open) Retropubic Radical Prostatectomy performed 
9/26/07   Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07  ED- begin 25mg Viagra nightly, Fully continent
11/15/07  1st Post-surgery PSA-0.01
01/14/08  Caverject started/stopped, aching and pain , Bimix started
02/04/08  Bimix X 6 tries, .1mL, .15mL, .2mL, .3mL, .4mL, .5mL, success at .5mL
3/24/08   ED- 6 mts.-continue 50mg Viagra and pump-no change-no response


Jayadub
Regular Member


Date Joined May 2007
Total Posts : 89
   Posted 2/23/2008 2:07 PM (GMT -7)   
I had no additional scanning or tests after my positive biopsy. It is not unusual considering your PSA and Gleason score.

54 years old

PSA 5.6 on 3/20/07

DRE: Negative

Biopsy on 4/20/07 

Results 4/25/07:

3 out of 12 cores positive, 2 on the right lobe with 5% adenocarcinoma Gleason 3+3, 1 on the left lobe 10% adenocarcinoma Gleason 3+4, overall Gleason graded 7 Cancer T1C.  After web research discovered Proton Beam Therapy and called Loma Linda. Completed consultation with Dr. Luu on 7/5/2007 and started treatment at Loma Linda on 7/26/07. Completed treatment 44 on 9/28/07. 0 treatments remain. Side Effects remain minimal. 1st PSA result on January 28th is 1.1.


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 2/23/2008 7:06 PM (GMT -7)   
I'm post surgery and didn't have any scans either. You should be fine.
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.
Walked a lot
90% control the day the catherter removed.
pad only for a sneeze before the week was out
No pads most of the second week.


GreenAcres
Regular Member


Date Joined Jul 2006
Total Posts : 474
   Posted 2/24/2008 5:50 AM (GMT -7)   
It's possible that it's more the doctor than the patient. We had one core out of 12 come back at 5% positive and our urologist ordered scans - CAT and pelvic X-rays.

I know others on here have had those questions (always a good thing) and the general response goes both ways, regardless of expected extent of the cancer.
Husband: Age 67
PSA had doubled in 14 mos to 4.3/Gleason 6
da Vinci 8/06 in Austin with Dr. Randy Fagin
Post surgical path shows encapsular penetration; possible bladder neck involvement.
PSAs remain undetectable; no further treatment at this time.
Next PSA: April 08


Argylegolf
Regular Member


Date Joined Mar 2006
Total Posts : 42
   Posted 2/24/2008 10:14 AM (GMT -7)   

My urologist did not do any scan prior to my surgery. My PSA was 6.58. I ask him about a CT Scan. He said that it use to be routine to do a scan on all patients, but the new literature shows that it is not necessay if the PSA is under 10. He said studies show no metastasis until at least 10. As a precaution, he removed the adjascent lymph node. They were tested & were neg.

Hope that helps. I had the same question.


jrponalameda
Regular Member


Date Joined Dec 2007
Total Posts : 56
   Posted 2/24/2008 6:24 PM (GMT -7)   

Yes, I'd say this is quite typical. My doctor didn't mention any scans either after my biopsy, which was similar to yours, and you and I are the same age. My Dad, who had the open surgery in 2001, asked about additional scans since he had gotten a bone scan. My surgeon said that additional scans were no longer common without strong indications of spreading.

John


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 2/25/2008 8:06 AM (GMT -7)   
Good Morning Fairrider,
 
My situation is very similar to your husband.  My original Doc who is an old timer, did do a Bone Scan for I was having a lot of pelvic area pain but my second and third opinion Docs did not feel based on my biopsy, that a bone scan or a CT scan was indicated and a waste of money.  My CT Scan was again done in an Emergency room because of my pelic pain which they all agree is not from the prostate cancer.   

Post Edited (Frank1205) : 2/25/2008 8:09:08 AM (GMT-7)


Mike A
Regular Member


Date Joined Feb 2007
Total Posts : 213
   Posted 2/25/2008 8:27 AM (GMT -7)   
Hi FairRider!
I hate to be the oddball on here, but my urlogist ordered both a bone scan, and a CT scan after my positive biopsy. Maybe it's because my PSA was a little higher, I'm not sure. But I can tell you, when they both came back negative, indicating that my cancer had not spread, it was a big relief!
Best,
Mike
June 2005 - Age 53 PSA 4.8 at regular physical October 2005 - After several rounds of anti-biotics, PSA 5.2 at Urlogist November 2005 - Biopsy negative July 2006 - PSA 5.9 at regular Physical October 2006 - After several more rounds of anti-biotics PSA 8.1 November 2006 - Second biopsy - Positive December 2006 - Gleason (3+4=7), Tumor T1c, CT Scan and Bone Scan Negative
January 2, 2007 Robotic Prostatectomy, University of Rochester Medical Center - Tumor confined but larger than thought, only one nerve able to be spared. Margins clear. February 2007 - Three to fo ur pads a day, no erection with viagara. April 2007 - First Post-Surgical PSA 0.02. Down to one pad a day.July, 2007 - Six Month Post-op: PSA 0.04 No change in ED. October, 2007 - Nine Month Post-op: PSA back down to 0.02!Almost totally dry! Only slight improvement in ED - Will try injections if not improved by next appointment. January 2008: One Year Post-OP PSA 0.02 still dripping, but improving. Tried 500 dose of MUSE for ED, no luck. Will try 1000.


41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 2/25/2008 8:40 AM (GMT -7)   

To reiterate what others have said, my doc indicated there was such a low probability with low PSA of anything showing up on a scan, that the scan isn't considered a needed diagnostic.  Since I had lots of anxiety over the diagnosis, he said he would order scans to put me at ease.  Honestly, I appreciated the "look" since it covered lots of other stuff too. 

As far as the tumor in the prostate itself, the scans don't tell anything.  The biopsy is the most definitive information docs can get pre-surgery/treatment.  Since surgeons and radiologists don't do "lumpectomies" on prostates or just target affected areas of the prostate, but rather remove or target the entire prostate, it really doesn't matter where in the prostate the tumor is. Only a post surgery pathology can tell with certainty if there are extracapsular extensions (meaning the tumor has spread outside the prostate).  The earlier you are with diagnosis, the better your chances that your post surgery pathology will show negative margins (no penetration of the prostate capsule), though there are no guarantees for this.  It's really all just statistics at this point, but the good news is the stats are in your favor.  If you chose something like radiation, then the patient really never knows but the whole prostate and surrounding areas are treated to ensure braod coverage for the possibility of extracapsular extensions. 

At least that what I understood from my research...hope that helps some.

 


 
42 yo. now
 
5/07 PSA 4.65 at routine physical
6/07 biopsy positive for cancer...Gleason 3+4...diagnosed at 41 y.o.
6/07-9/07 manic research and interviews with physicians across the country in search of the "right" decision.  I went to Mass General in Boston, Loma Linda, University of Chicago and Northwestern.
9/17/07 - Radical Retropubic Prostatectomy Surgery at Northwestern Memorial in Chicago by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
 
Post op pathology was Gleason 3+4 with negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  
 
9/27/07 - Catheter removal...let the games begin...
 
12/07 - Threw out the pads.  I only had to use 1 pad per day for protection against minor drips. 
 
I started Trimix 8 weeks after surgery with success.
 
I hope someday I won't need injections, but I hope more that my PSA stays at 0 forever.
 
 
 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 2/25/2008 1:36 PM (GMT -7)   

Hi FairRider

Awhile ago I set up a separate thread to get members to indicate if they had certain scans taken after a positive prostate biopsy.  I was amazed at the small percentage of those who replied who actually had such scans (i.e., their urologist did not have them take such additional tests).  While it is a known fact that these scans are not 100% reliable, they are an important guide to projecting what stage of prostate cancer you are in.  I think it is irresponsible when a urologist does not authorize these scans.  I had a 29-core biopsy by a urologist who is the director of the prostate cancer group at a major medical center.  He asked me to have a bone scan and Endorectal MRI, both of which were negative. I think you should ask your urologist why he has not asking you to take these additional tests.  As we all know well, most urologists recommend surgical removal of the prostate and therefore they tend to the play down the necessity of these additional tests.  My urologist recommended that I have surgery (which I did not opt to have), but he nevertheless asked me to have these additional tests performed.  Good luck to you!

Dave


-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 

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