Does everyone undergo a CT San and Bone Scan

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compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 11/12/2009 8:26 PM (GMT -6)   
Newbie question:
 
If one has a biopsy and it shows PC, does that automatically result in a CT Scan and Bone Scan?
 
Mel

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/12/2009 9:01 PM (GMT -6)   
In my area, those tests are usually ordered only with Gleason 7's and above. Will depend on your doctor.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


geezer99
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Date Joined Apr 2009
Total Posts : 990
   Posted 11/12/2009 11:53 PM (GMT -6)   
It seems to be pretty standard even though as noted these are very uncertain measures unless the cancer
has greatly progressed. I don't know if this is defensive medicine or just a case of doing the best that can be done
with present technology.
It certainly does provide a frightening introduction to your diagnosis.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 11/12/2009 11:58 PM (GMT -6)   
My doctors did not do any of the scans, saying they weren't appropriate or recommended based upon my diagnosis.

Age:  60 (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 (1/2 light pads per day)

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; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0

 


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 11/13/2009 12:07 AM (GMT -6)   
I have only experienced diagnosis once, and my doctor ordered a CT and Bone scan right after the biopsy results were in.

For what it's worth, the Rad Oncologist wants me to brings a copy of the discs of both scans with me next week for our first consultation meeting.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 11/13/2009 12:29 AM (GMT -6)   
My husband had both CT and bone scan within 7 days of diagnsis Mel. This was a protocol of our Specialist, and all his patients upon diagnosis.
Creed_three - Husband 51 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x 5% core of 12 positive at biopsy. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable <.1 PSA since, specifically, June 2007-0.01, Oct 2007-0.02, April 2008-0.02: Oct 2008-0.03, Nov, 2008-0.02, April 2009-0.03. 


dogbot
Regular Member


Date Joined Aug 2009
Total Posts : 147
   Posted 11/13/2009 4:39 AM (GMT -6)   
Here in England I had a Mri scan only, no bone scan. I was told that the Mri scan showed no spread outside the prostate. I also had an ultra sound scan on my kidneys which again was normal.
Diagnosed February 2009. Gleason 6, Psa 7.2, 12 core biopsy, and then Mri scan, which showed organ specific.
DaVinci at Addenbrookes, Cambridge, England 18th May 2009.  Nerves removed one side.
Catheter in for 8 days, no pain, no post op problems apart from an infection, cleared with antibiotics.
Some aching around the penis, which still occurs.
6 week psa 0.1, post op pathology all good, confirming pre op tests. Ed a problem, no treatment as yet.
Light ladies pad during the day, just to control a slight dampness and a Tena for  men pad at night for occassional leakage.
Awaiting 3 month consultation at the moment.
Sept 09 - still awaiting consultation. 99% dry during the day, tena pad at night just in case.
Sept 18th 09. PSA less than 0.1
Sept 29th follow up consultation at Addenbrookes. Staff happy with progress.
Nov 11th update. One small stress dribble in the last 2 months. Still some muscle stiffness in pelvic area.
 


Modelshipwright
Regular Member


Date Joined May 2009
Total Posts : 215
   Posted 11/13/2009 7:48 AM (GMT -6)   
My Urolohist ordered the CT and not the bone scan, I assume for the reason stated earlier, that the bone scan rarely shows anything with a Gleason and staging similar to mine.

Regards,
Bill

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 11/13/2009 8:08 AM (GMT -6)   
CT scan done right after diagnosis...bone scan done when we were facing a possible
recurrence this past summer.

No other tests were done between diagnosis and surgery ... except for the usual physical
exam required before the operation.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/13/2009 8:50 AM (GMT -6)   
Had bone scan after diagnosis for a base line...no CT scan. The uro said the bone scan is used as a base line reference, much the same as establishing a base line with PSA. Made sense to me at the time.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 11/13/2009 8:58 AM (GMT -6)   
I had a bone scan and chest Xray.... I think this is my Drs startard procedure. No CT.

Jeff T
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 11/13/2009 9:08 AM (GMT -6)   
I had a Bone scan and CT scan, but my PSA was 23. First Bone scan showed a bright "hot spot" in my shoulder.
The Doc asked if I had injured myself there and pushed right below my clavicle - exactly where
the butt of my rifle lands. I had been shooting the day before. D*mn Squirrels!
I had to drink that goop and get nuked a second time. I guess they had their revenge.
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 10/31 3 months, Still no activity, nada, zip
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/17 2 months: Still 3 pads per day.
10/31 14 weeks: Still 3 pads per day. At this rate I'll be fine in 2012.
Post Surgery PSA - 9/3 6 weeks- 0.05, 10/13 3 months- 0.04 undetectable.


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 11/13/2009 12:13 PM (GMT -6)   
Bone scan only.
I told them beforehand where they could expect to see arthritis and the like.
Diagnosed at 54
PSA 8.7 Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7 Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09 Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence Pad free week 5
PSA 6/6/09 <0.1 PSA 9/10/09 <0.1


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 11/13/2009 2:02 PM (GMT -6)   
My uro looked at both the bone scan and the CT. He particularly examined the CT because I had had hernia surgery and he wanted any clues about what he was going
to find when he started cutting. (the clips holding the mesh stand out nicely)

Jeff
Not only does a 30-06 hurt the shoulder, it doesn't leave much for Brunswick stew. A pellet gun works just as well. My 40 year old son is an animal lover and
uses a paintball gun. I found this out when I saw squirrels with blue spots running through his back yard.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1211
   Posted 11/13/2009 2:36 PM (GMT -6)   
I'm in Canada, and perhaps because these scans can be expensive, but don't usually reveal much information except in advanced cases (or so I was told), I had no scans of any kind before the RRP. Perhaps that is the downside of a Government, cash strapped, health care system.  When I had a recurrence, 2 years post RRP,  the only scan they did was to find the proper location to place the tattoos for correct positioning during RT treatments.
 
Magaboo

Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09, = 0.05; July 09, <0.04


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 11/13/2009 3:54 PM (GMT -6)   
Hey Geezer,
By just chasing them away the problem is simply relocated, although the colors must brighten the neighborhood.
Any I get are quickly taken away by the turkey vultures or coyote. Back to nature.
Stew anyone?
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 10/31 3 months, Still no activity, nada, zip
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/17 2 months: Still 3 pads per day.
10/31 14 weeks: Still 3 pads per day. At this rate I'll be fine in 2012.
Post Surgery PSA - 9/3 6 weeks- 0.05, 10/13 3 months- 0.04 undetectable.


defender3
Regular Member


Date Joined Nov 2009
Total Posts : 98
   Posted 11/13/2009 8:54 PM (GMT -6)   
FWIW - My doctor, out of Urology Associates of Fredericksburg, VA, ordered both a CT and Bone scan. His reasoning was to establish a baseline that could be referred to for years to come, determine if the cancer may have spread and to provide me additional data points as my wife and I try to decide which treatment is right for us. I was diagnosed on 2 Nov 09 and had my CT on the 6th of November at Medical Imaging of North Stafford (VA) and my bone scan today, the 13th of November, at Mary Washington. I asked for and received a disk of my CT pictures and will pick up my bone scan films and results tomorrow. My follow-on consultation will be the 1st of December.

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 11/14/2009 12:12 AM (GMT -6)   
Welcome defender3
Your stats look very good, giving you a number of good options. If you like, you may want to start your
own thread.

Remember that we are here for you and for whatever you want to ask
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 11/14/2009 5:50 AM (GMT -6)   
I had a bone scan, MRI and CT scan. I do agree with the others usually a gleason 6 does not warrant such testing and I am sure insurance companies would not go for it anyway.

peace to you
Dale

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/14/2009 8:26 AM (GMT -6)   
According to Dr. Strum and others whom collectively have seen many patients and have a well rounded knowledge of PCa, seen patients in various PCa stages, says that alot of these scans are wasted money, especially on the low stats type of patients, super rare to be found with bone mets and such. Thousands of dollars spent on these tests that could be used better elsewhere.

To be clear- you can have micro-mets or small amounts of PCa in bone or tissue and it likely does not show up on scans until it is around 1-billion PCa cells and higher ('mass'). No scan is good enough is the truth on PCa, combidex scans (Holland)might have more worthiness in locating (John T knows first hand about it).

My scans were found clear with these stats: bpsa 46.6 12/12 biopsies 75-95% in everyone, gleasons found 7,8,9's (two sets about identical). In my case you should have a scan with these types of numbers, found clear....(meaningless in actuality)...does not mean it could not be somewhere else or in micro mets levels. (see Partin tables etc.....odds are very bad). I was happy to see it as clear, but learned that this has less meaning than it appears on the surface.
Knowledge is wisdom in PCa. Now if found with positive on scans...atleast known up front what one is facing and likely hormone therapy(or other protocols) given, thereafter or maybe spot radiations if such warrants that protocol (not a cure proceedure-fyi).

Post Edited (zufus) : 11/14/2009 6:31:09 AM (GMT-7)


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 11/14/2009 1:24 PM (GMT -6)   
Did not have one. Biopsy was gleason 7. upgraded to gleason 8 after surgery. My psa was under 4 and thinking was nothing would be found.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
12 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 11/15/2009 7:27 PM (GMT -6)   
I think the responses from this thread indicate that many doctors treating PC really don't understand it and use standard protocols without questioning their value.
A CT scan is practically useless in PC; it will only pick up PC if it is larger than 10mm and this means your psa would be through the roof as this equates to billions of PC cells. Bone scans would only pick up PC that has matastized past the lymphnodes; again very high psa.
It's the largest waste of money and is definately defensive medicine or lack of knowledge.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 11/15/2009 9:53 PM (GMT -6)   
Per the SOP of my surgeon...

I had no Bone Scan, no CT. Just my pre-op lab, EKG and 2 view chest.

 


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. 75% of one core.
da Vinci at Wash U, Barnes on 11/02/09
Pathology Changed Gleason to 4 + 3 = 7. Gleason 7 present in all 4 quadrants
All(4)periprostatic Lymph Nodes Negative, All(10)pelvic Lymph Nodes negative
Seminal Vesicles tumor free. No prostate extension


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/15/2009 10:13 PM (GMT -6)   
JohnT, I feel the same way you do on this subject. It does seem like a major waste of money and resources to do automatic Bone and CT Scans after a Prostate Biopsy. I am trying hard to remember if one was ever reported positive after a biopsy by anyone that is a regular at HW. If there has been, must have slipped my memory. My dr's practice only does them for Gleason 7 and above, but I even question the wisdom of that. I would be more inclined to think that high grade Gleason 8-10 might be more appropriate. Just a thought
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/16/2009 11:18 AM (GMT -6)   
Your Q:  If one has a biopsy and it shows PC, does that automatically result in a CT Scan and Bone Scan?
 
A:  No.  Appropriateness of CT scan and bone scan depend on additional info (PSA and Gleason score).  Scans are appropriate if there are signs of aggressive PC.
 
American Urological Association publishes a "PSA Best Practices Statement" (updated 2009), which includes these statements:
 
Regarding bone scans:  "Routine use of a bone scan is not required for staging asymptomatic men with clinically localized prostate cancer when their PSA level is equal to or less than 20.0 ng/mL."
 
Regarding CT scans:  "Computed tomography or magnetic resonance imaging scans may be considered for the staging of men with high-risk clinically localized prostate cancer when the PSA is greater than 20.0 ng/mL or when locally advanced or when the Gleason score is greater than or equal to 8."
 
 
Many urologists do not keep up-to-date with AUA guidelines, and many have been mentored/trained in the pre-PSA era (or early in the PSA era) when the non-symptomatic PC was only caught in the late stages (once symptoms did appear) and spread was more likely by the time it was discovered...so you can see how quite naturally 'old school' doctors might tend to automatically prescribe these scans.  Current PC thought leaders consider scans a waste of scarce resources for low risk cases.

Post Edited (Casey59) : 11/16/2009 9:32:15 AM (GMT-7)

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