advice re:bone scan

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Mocha
New Member


Date Joined Mar 2008
Total Posts : 2
   Posted 3/22/2008 8:31 AM (GMT -7)   
Hi!
I'm new here.... my husband was just diagnosed with prostate cancer last week Wednesday (3/19). His urologist immediately scheduled him for a bone scan, appt. is this coming Monday morning. I've been reading alot of information on the internet (we were snowed in yesterday- had plenty of time!) and would like some advice from those of you who have "been there".

A short history- he was not symptomatic, red flag went up when results of a health screening in December yielded a PSA of 7.3. He had a biopsy done recently, results indicated stage T2a, B0. That's all I really know. Dr. would like to have bone scan done to rule out any spread of disease. My question is- is the bone scan really necessary? From what I've read, with a PSA below 10, it's unlikely to give us any more information than we already have. Any thoughts?

We live in a smaller, rural area and the urologist my husband went to is the only one in town. We have options for second opinions in bigger cities near us. If anyone has experience with either the UW Hospitals in Madison, WI or Froedtert in Milwaukee, I would love to hear your input. As it is, we're thinking that treatment at a research-based, larger institution would be preferable to treatment here in town. And if we're thinking about a second opinion anyway, couldn't we just take the information that we currently have to discuss with the physicians there and then determine the plan of action? Couldn't we just hold off on the bone scan until we get more advice? We definitely feel we would like to have a team of specialists behind us, rather than the local urology guy (not that he might not be good- I personally haven't met him, and this is all new to me. My husband thought that all of this came at him way too fast!!)

Thanks for all of your help! And happy spring (esp. if you live where there is green grass and flowers instead of a foot of fresh snow on the ground!!)

Mocha

DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 3/22/2008 8:59 AM (GMT -7)   

Greetings from sunny Texas!

I just (10 minutes ago) arrived home from your beautiful, but snowy state...a day later than planned due to that snow yesterday.

Second opinions are never a bad thing.  Most doctors will not offer one, however, without seeing the medical records....biopsy results in this case.

As for treatment, my personal bias would be to at least check out someone in one of those larger areas, as you stated.  Not that a urologist/surgeon (if surgery ends up being part of this) in a small town might not be great, but typically specialists in larger areas have more experience....more patients with similar situations.

Regarding the bone scan itself, it is done to determine if cancer has metastasized in the bones.  If the results are positive, the suggested course of treatment might be different than if the results are negative, etc.  The bone scan itself takes just a few minutes and does not involve any pain or discomfort....just some mental anguish as one waits to learn the results a day or two later.

Even if the bone scan results are negative, it is still possible that spreading may have taken place to the lymph nodes or to the tissues just outside the prostate (the margins as they are called when surgery is done).  If the bone scan is positive, then spreading has definitely taken place.

My urologist/surgeon got his medical degree from UW Madison and I like him a lot, but I know nothing about the school/hospital.

Best of luck to you and your husband.

DanMan Bob



Danman Bob
Age 57
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14
Biopsy result - 9 of 12 sticks showed cancer
Despite high Gleason score, cancer was confined to the prostate
Possible post-surgery radiation therapy...decision likely in late April 2008, depending upon PSA at that time
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of March 2008)
Began using Viagra 3 times a week December 2007 to stimulate blood flow
Began using Osbon Erec-Aid Esteem manual pump for therapy mid-February 2008
Will probably begin using bimix injections in addition to Viagra and pump in May 2008

Post Edited (DanmanBob) : 3/22/2008 10:04:36 AM (GMT-6)


GreenAcres
Regular Member


Date Joined Jul 2006
Total Posts : 474
   Posted 3/22/2008 9:33 AM (GMT -7)   
Hi, Mocha. We, too, live in a smaller town and our urologist rushed us immediately into a bone scan and X-rays. Scared us a bit when a couple of 'hot spots" in glowing red showed up, but they were only from bone spurs and a long-forgotten injury.

The thing with a biopsy is it can miss a lot with those tiny needles pulling out even tinier sections of the prostate. So, scores post-treatment (pathology on the gland itself) can change dramatically - ours did. So, scoring at this point can still be just a guessing game. That's not meant to scare you, because the numbers can certainly be downgraded, too.

After all our local testing, then we started doing our research with plans to seek treatment in a larger city. We believe it is wise to accept all the tests to rule out any possibilities. It will only help your treatment decision when you get to that point.
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


Mocha
New Member


Date Joined Mar 2008
Total Posts : 2
   Posted 3/22/2008 10:10 AM (GMT -7)   
Hi!
Thanks for your speedy replies! I realized that I had forgotten to share my husband's age (55) and Gleason score (6).
I wish we would get the results of the bone scan quicker- it's scheduled for this Monday (3/24) and we don't meet again with the dr. until the next Wednesday (4/2)!

Guess that's why I thought we had some time to mull it over.....

Mocha

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 3/22/2008 10:37 AM (GMT -7)   

Hi ~ Mocha & Loved Ones ,

 

Welcome   to…   ~ HealingWell ~

 

and

 

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Click  on  link  below for important information that will help you ~ help us!!

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Welcome New Members ~ to HealingWell

 

The information (link) listed above is to help you get around the forum!

 

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Welcome ~ New Friend from all the members here... on HealingWell.com

 

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kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 3/22/2008 10:43 AM (GMT -7)   
    My Dr. orders a bone scan as a routine test when he has someone with a postitve biopsy.  Mine did show a spot on one rib that may have been a old injury.  A second rib panel x-ray series showed there was nothing there.  As for me, I would do almost any test if it can give them any additional information.  I do have good insurance do cost does not matter to me.
   
    Good Luck.  KW
    43
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00.
    ED workable and usable with Viagra.
    Feb. 20th, 2007 - Feb. 4th, 2008  Cystoscope, Two Collagen injections,Second Opinion Consultation for Incontinance at OU Medical Center, Bio-Feedback training, Chiropractic, Accupuncture  to try to resolve ongoing incontinance (4-6 pads a day)  All PSA's 0.00.
    Feb. 4th, 2008 - Appointment with Original Dr. to discuss options and recomendation for surgical fix for incontinance.
    Feb. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
 
     


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 3/22/2008 10:44 AM (GMT -7)   
Hi Mocha,
And welcome to best site on the web for patient to patient interaction that I could find. Being able to talk with other people who's footsteps I follow was invaluable to my experience with cancer. A bone scan will give you peace of mind, at least it did for me. I had a high PSA, but a negative bone scan. I find that knowing additional information is better for me as I can make informed decisions after researching what I know. Dan't be afraid to post your thoughts here. You will get a perspective from caring people. Whatever treatment options you choose, you will find many experiences with it here.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 3/22/2008 11:39 AM (GMT -7)   
Hi Mocha. Glad you found us. There are some wonderful caring people on this forum. After my biposy, Gleason 7 My Uro sent me for a bone scan. It was not painful, just one shot to get the dye in your system. Being still for about an hour for the scan was nerve wracking. As for the results of the scan, I had did some homework on what to look for and when I stepped into my Uro's office I saw my scans on the viewer. I saw a couple of spots before he said anything and almost fainted. He then asked me about old injuries and remembered several broken bones. He then told me the cancer spreads out and gets into the pelvis first. He then sent me for X-rays of the spots and they were negative. I agree with the others and think you should get another opinion. You should go to a hospital where they have a multi treatment approach to treating cancer. In this setting you get to talk to Doctors that have different approaches to treating your cancer but, in the end it will be your decision as to what to do for your treatment. Good luck to you and keep in touch.
age at dx 54 now 55
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
wear one for insurance now
ED still a problem
last PSA undetectable
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 3/22/2008 11:48 AM (GMT -7)   
Hey Mocha,

Welcome to a place for comfort, support and information.

There are several options for treatment of prostate cancer, as you have probably already discovered. Choosing a treatement requires getting all the information we can possibly assemble. Getting second opinions from experts is one way to do this. Many times specialists are biased toward their own specialty so its good to see as many different ones as possible.

The most important thing to do no matter what treatement you choose, is to use the best doctor you can find. You have to take control of you own recovery, research you options, make a plan and not look back.

Please stay with us. We can all get well together...

Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
"Patience is essential, attitude is everything."
 


goinlong
New Member


Date Joined Mar 2008
Total Posts : 15
   Posted 3/22/2008 12:28 PM (GMT -7)   
I drove 2.5 hours in a snow storm yesterday from Minneapolis to the Mayo Clinic in Rochester, MN for a second opinion. They did a bone scan and I'll be going back for an MRI. I feel the more smart doctors I can get on my team the better. The more info we have the better our decisions will be and I'll have agreater peace of mind knowing if it has spread or not.

So I'm a believer in second opinions and lots of testing.

creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 3/22/2008 2:34 PM (GMT -7)   
Hi Mocha,
 
I am not sure if this is possible for you, if you go ahead with the bone scan, to obtain the results by phone or in person so you have your own copy if you decide to get further opinions?  Although there is anxiety in having a bone scan now,  it may ease your mind rather than waiting. We had it done, and then waited around the bone scan room for 2 hours  to collect the report. When they realised we were not going anywhere without the scans/reports (and obviously would be opening them), the reporting doc called us in and read the results to us, which was reassuring. We then had a full copy which we could take elsewhere and we did, although all 3 docs we consulted with were good and helpful.
 
My husband however,  had old injuries which showed up as "hot spots" so be prepared for this - the bone scan will take up and reveal any old bone scars, old fractures, tissue damage, surgery etc and this needs to be explained and interpreted in the light of a person's past history. So try not to panic. It is an anxious time, but for many specialists, a bone scan is part of the routine assessment, and for others, it is not always routine. I was glad in the end that we got one. Our surgeon did it routinely on all his patients.  However I did have to have 3 people (including the final Surgeon!), interpret the results for me, before I was satisfied that all was well, and it was all well. Welcome, and all the best as you go through all these tests. It is a hard time while all this is going on.
Kind regards, Lana


Creed_three (Lana & CJ)
 
Husband CJ aged 50 yrs (49 years at diagnosis and surgery)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing, on Tuesday 17th April 2007 (Sydney, Australia).
Gleeson 3 + 4 = 7.  Cancer confined. 1st PSA 0.01 (June 07) 2nd PSA 0.02 (Oct 07) undetectable. Next PSA March 08.

Post Edited (creed_three) : 3/22/2008 3:42:24 PM GMT


War-eagle
Regular Member


Date Joined Sep 2007
Total Posts : 219
   Posted 3/22/2008 4:08 PM (GMT -7)   

Mocha,

You have come to best place to gather information from others that are own this journey. I have had 3 bone scans. The first was to see what was going on, if anything, because of my high PSA. The second and third were to check the progression of the "little monster". I am glad we did the first one so we had a base line to look back at when we discussed treatment options. Information is the key to choosing your treatment options. I have also had PET, MRI, CT, and x-rays. The x-rays should go along with the bone scan to determine what, if any, the hot spots are. We hope and pray that you are "spot free". Gather a good team of doctors. Urologist and Radiation Oncologist are a good start. Right now my team consists of 4 doctors. I see my Oncologist every three weeks and the others every six months, but they all communicate with each other. This is key.

Let us know the results. You are in our prayers.

A big War Eagle to you both,

Walt


Age: 54
PSA 43 7/2005
Biopsy 12/14 Gleason 7 & 9
Divinci 9/2005 - spread to bladder
HT - 10/2005 (Eligard every 6 months)
RT - 10/2005 (38 treatments)
PSA 0.12 to 1.9 2/2007
Bone Scan and CT 4/2007 Bone mets
Casodex 4/2007
Zometa infusions 4/2007
PSA 4.8 8/2007
PSA 6.34 12/2007
Radiation (15 treatments) started on bone mets 12/2007
PSA 6.72 1/2008
PSA 8.23 2/2008 - Starting prednisone for 30 days
PSA 14 2-29-2008 - start chemo on 3/12 
 
"I will persist without exception - I will find a way where there is no way"


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 3/22/2008 6:20 PM (GMT -7)   
National Comprehensive Cancer Network guidlines for Bone Scans recommend that bone scans be reserved for men with PSA greater than 10 or Gleason score of 8 or more. They are also recommended for stage T3 or T4.
It's unusual for cancer to show up on a bone scan unless  PSA is above 20.

norskie
Regular Member


Date Joined Jan 2007
Total Posts : 376
   Posted 3/22/2008 8:01 PM (GMT -7)   
Mocha

I too am from rural Wisconsin and choose to get an second opinion at UW Madison even through I was diagnosed at a rather large clinic. I was impressed with how fast they got me in to see one of the prostate specialist doctors which really focus on this disease. While I have had good results on all fronts from incontinence and ED I appear to be headed for follow up radiation because even through post pathogy report looked clear and good and my fist two PSA follow ups were undetectable I just recieved my latest results today and they are now at .4 and have risen about .1 every 3 months since last July, so I have an appointment this next week to see what the next steps will be with the radiation specalist. They feel real confident that I must have a localized cell or two that survied so some follow up radiation should take care of it. If you want to see what I went through and my experience you can find my story under Norskie Journey on this site. Also you can contact me by clicking on the little envelope on the left side and it will take you to my address and I will be more then happy to answer any question about my Madison experience that I had. Good luck this is a great site with caring and helpful folks.

Norskie
norskie
Age 49, PSA 6.22 on 9-26-06
Biopsy 11-01-06, 2 of 13 cores 10% cancer, 2 other cores abnormal Up-dated 20% prostate cancerous
Gleason score 3+3=6 After Pathology report 4+3=7 a couple agressive Grade 5 cells found
Da Vinci surgery 01-09-07 UW Madison
Pathology Report- cancer 100 % capsual contained 1-18-07
Catheter removed 1-18-07 suffered bladder spasms Catheter reattached 1-18-07 Catheter removed 2nd time 1-24-07
1st & 2nd Post PSA Blood Test .1 and less - Undetectable
3nd Post PSA Blood Test 01-17-07 .3-Next action awaits me.
Next PSA Scheduled and meeting with Radiologist set for 3-27-08
Incontenence-Pad free since end of May 07 4 1/2 months post surgery 
ED back to 95% prior to surgery - no medication required.

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