Why do some have bone scan but some do not?

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coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 12/9/2008 6:49 PM (GMT -6)   
I have a buddy that was just diagnosed with PC yesterday.  His doc has ordered a bone scan and CT scan.  My doc never mentioned either test in my case.  He had a biopsy last week but He doesn't know his gleason score yet?  What drives the doctor's decision to order a bone and CT scan?  confused


Age 50
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
ED, need a little help from Levitra
First post op PSA 11/11/08, 0.00

Post Edited (coxjajb) : 12/9/2008 7:41:35 PM (GMT-7)


Ralph Alfalfa
Regular Member


Date Joined Nov 2008
Total Posts : 469
   Posted 12/9/2008 7:57 PM (GMT -6)   
My doc ordered one and said it was to see if the Big C had metastisized to any other regions. SOme wind up with it in their seminal vesicles, bones, lungs, bladder,etc. The CT will probably be done with contrast which will involve a bowel prep the night before and the morning of. The bone scan is time consuming. They inject some sort of solution in you and have you come back 4 hours later. If the bone scan is done properly they will do an entire body scan and then do one of his ribs(hands behind your head). This is the way I did it. Anyone else can chime in .

Good luck to your friend.

Bob
 AGE:57
 Dx: October,27(the day after my birthday)
 Psa 14.5
 Gleason:(4+3) 7
 Bone scan:Negative
 Cat scan: Negative
 Biopsy: 4 of 12 positive, left side, pre-cancerous on the right.
 Confined to prostate.
 DaVinci scheduled for Jan. 2009.Dr. Scott Montgomery, KC Urology,
Shawnee Mission Med. Center. Kansas


Ralph Alfalfa
Regular Member


Date Joined Nov 2008
Total Posts : 469
   Posted 12/9/2008 7:59 PM (GMT -6)   
oh,
and good luck to you,also. You may want to ask your doc why he didn't order those tests.

Bob
 AGE:57
 Dx: October,27(the day after my birthday)
 Psa 14.5
 Gleason:(4+3) 7
 Bone scan:Negative
 Cat scan: Negative
 Biopsy: 4 of 12 positive, left side, pre-cancerous on the right.
 Confined to prostate.
 DaVinci scheduled for Jan. 2009.Dr. Scott Montgomery, KC Urology,
Shawnee Mission Med. Center. Kansas


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 12/9/2008 8:07 PM (GMT -6)   

My urologist made the order based on my PSA and Gleason score. I had a CT scan with contrast and a nuclear bone scan. Bone scan was head to toe and took about 20 minutes to complete. CTscan was pelvic area only and only took a few minutes. Test were done to rule out metastasis or to prove the extent prior to recommendation of treatment. Final recommendation was radiation with full pelvic and prostate focal due to suspect lymph node in pelvic area.

Don

 


Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09
 
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/9/2008 9:28 PM (GMT -6)   
Usually the level of PSA is a guide as to whether a bone scan and /or CT is ordered. In general, it is unlikely that there are metastases with a PSA below 20 and the lower the PSA the less likely there is to be spread. For this reason many docs will judge that with a PSA of say under 10 then the scans are a waste of time and money. On the other hand many docs will order the scans for those with lower PSA as a matter of course.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

Post Edited (BillyMac) : 12/9/2008 9:14:26 PM (GMT-7)


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/10/2008 8:40 AM (GMT -6)   
My bone scan was ordered by my doc...not because of concern of any mets...but in his opinion to have a base line to compare with down the road if needed. Although the suspecious uptake on the ribs is being watched. Had another CT scan this last weekend...waiting on results. But not related to PCa.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/10/2008 9:46 AM (GMT -6)   
I have seen doctors perform on both sides of this coin, too. It seems logical to have the test. And I recommend to all the newly diagnosed to have one, or ask for one if necessary ~ prior to selecting a treatment. MY PSA was around 20, and I had one. But m doctor told me he always requested one. Les I think your doctor gave the best answer. Once a person has been diagnosed, getting baselines by having every test your insurance will pay for makes sense. If you think about it, in three or four years down the road a relapse occurs, comparig a new test to one you set for baseline is a great step foward.

This test is somewhat expensive and some doctors do use PSA and Gleason before suggesting this test. From my experience here, Gleason and PSA are not 100% indicators of metastatic disease. I have seen Gleason 6, PSA 4.7 turnout metastatic Gleason 8 after surgery. This was just one case, that individual did get that bone scan after treatment.

Again, you can ask for it!

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


John Bonneville
New Member


Date Joined Sep 2008
Total Posts : 15
   Posted 12/10/2008 4:09 PM (GMT -6)   
In OZ it is pretty much standard for a low PSA <10 not to require a bone scan. But some doctors still do it.
Diagnosed March 2007, Age 57
Positive DRE, 12 Core Biopsy, 6 cores positive PCa,
Gleason 7 (4+3), Stage T2B
Rx 9 months LHRH ADT Lucrin, Neo Adjuvant,
Gold Seed implants 2 weeks prior to EBRT
70gy 3D Conformal EBRT

PSA: Nov 2006 = 6.0 ng/ml
May 2007 = 5.6 ng/ml * 1st Lucrin IMI
Aug 2007 = 0.85 ng/ml* 2nd Lucrin IMI
Nov 2007 = 0.45 ng/ml * 3rd Lucrin IMI
Jan 2008 = 0.29 ng/ml * 8 weeks EBRT and TURP in May
June 2008 = 0.12 ng/ml
Sept 2008 = 0.14 ng/ml
Dec 2008 = 0.1 ng/ml

* No incontinence, mild ED, which resoponds well to generic viagra.


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 12/10/2008 4:13 PM (GMT -6)   
From what I have seen this is standard procedure if your biopsy is at the high end of intermediate, or even high end of early detection. I have also read that the tests will not show anything unless the disease is really advanced. Unfortunately, I don't think a lot of credence can be given to them that just because they are clean that the person is completely out of the woods on spread. They are though of some comfort that obvious metastization is not present.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/10/2008 4:41 PM (GMT -6)   
RB...actually the Bone Scan is highly sensitive but not specific. Basically means that it will pick up very accurately any bone changes, but won't tell you if the bone changes are due to injury, cancer or any other type of bone changes that are taking place (like arthritis found in my hips and spine). As a result just like any test, further testing is required if the bone scan picks up something....How well I know...I am still being tested as a result of my bone scan (because of the ribs) and the jury is still out on that.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 12/11/2008 12:16 AM (GMT -6)   
After my diagnosis, my Urologist did not order a bone scan or other testing - just the recommendation for the da Vinci procedure to remove the cancer.  Our primary care physician and Urologist-specialist probably offer the best advice, because they know us and our medical history.  I was one of the lucky guys, because my PSA score was on the low side and the cancer was diagnosed early.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0

 


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 12/11/2008 1:48 PM (GMT -6)   
My doc's indicated to me that at my PSA level there was no need for scans. But, I was having some pretty severe shoulder and heel joint pain, and it scared the wits out of me. So I basically pushed them into doing the scans (both thankfully negative) for peace of mind and to have a baseline. Ins paid for both without a problem.
50 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08
Negative margins, no extra-capsular involvement
One nerve spared
No follow-up PSA yet (next week).
my ED mantra to the wife: "I'm down to my last nerve, and you're getting on it!" (well, hopefully eventually)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 12/11/2008 8:25 PM (GMT -6)   

Bone scans are pretty reliable, CT scans won't pick up small small tumors in lymph nodes, only the large ones. Even though my scans came in clear my Doc still thinks there is a high probability of lymph node involvement because of my high PSA, and is scheduling me for an MRI in Holland that will pick up very small tumors in lymph nodes.

It's a good idea to get scans just to make sure, it definately will affect your treatment options if something else is found.

Johnt


Diagnosed 10-08 at 63 with PSA of 33
PSA was 4.4 in 1999 and has risen steadily.
Had 13 biopsies and an endorectal MRI, all negative until 10-08. Two cores out of 25 with a gleason 6
2nd opinion with an oncologist said cancer found was insignificant, but suspected larger tumor somewhere.
Doppler ultrasound with target biopsy indicate a large tumor in the transition zone, gleason 7.
Bone and CT scans negative.
PSA3= 43; high normal is 35
Currently evaluating treatment options, surgery is not an option as a high probability of positive margin exists.
John T

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