types of test should be performed before choosing treatment

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Date Joined Nov 2010
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   Posted 11/14/2010 5:37 AM (GMT -6)   
Just wondering what types of test Should be performed is robotic surgery was being considered. So far other than psa 4.4 and biopsy 4+3. There have been no other test. Should there be bone scans of other test done prior to Robotic surgery. Ii am reading about different types of biopsy. Color dopler, nonogram.....etc....Have a appointment tommorow with onocologist, just anxious on answer. thank you

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Date Joined Jun 2008
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   Posted 11/14/2010 8:58 AM (GMT -6)   
Klains, nonograms are an online predictive tool...not a medical test.  You can plug in your husband's numbers (PSA, Gleason score) and it will give you statistical information about your husband's disease.  There are a few nonograms you can use...Memorial Sloan Kettering's website has one.  I do caution you though that these nonograms are based on statistical averages and do not take into account individual situations.
A bone scan with a PSA of 4.4 is useless.  Bone scans are used when the PSA is at 20 or higher, and even then they're not definitive.  Our urologist did not do a bone scan when my husband was first diagnosed but he did order a CT scan, which showed nothing.
Color doppler is getting more and more attention but I'm not sure if it is a stand-alone test or is done during the biopsy.  Others will chime in on this one.
If you and your husband are meeting with an oncologist tomorrow, I imagine that he or she will walk you through any further testing before treatment.  Sounds like you are both leaning towards surgery.  If that is the case, your husband will have the standard pre-op tests which might include a chest xray, blood work, general physical (to check blood pressure, etc.).  This is done so that the surgeon knows about any pre-existing conditions that he/she may have to take into account (again, such as high blood pressure or breathing problems).
Hope to hear from you tomorrow after you've met with the oncologist.  Just out of curiosity, is there a reason why you're seeing an oncologist at this stage?

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   Posted 11/14/2010 5:52 PM (GMT -6)   
The bone scan and CT scan that many of us (at least in the US) have had, are done more to be sure there is not rampant cancer outside the prostate, but as Sephie mentions, if you have a low Gleason and low PSA, it seems they are not very useful. The Gleason 4 may provoke them. If your uro/surgeon feels that they are needed, he will order them.
The Color Doppler Ultrasound is either prep for or part of the biopsy, to help find the spots that need to be sampled. I can't see that doing one now would be of any use.
I would expect that a good oncologist will have his own protocol of tests.

John T
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   Posted 11/14/2010 5:57 PM (GMT -6)   
Ct and bone scans will not give any valuable information with your low psa. Some test to consider:
PAP: this blood test is a strong predictor of PC being systemic rather than local.
PCA3: This urine test can indicate the agressiveness of the cancer.
MRIS: Scan that can determine the location of the tumor and identify if it has escaped the capsul making surgery a poor option.
Color Doppler Ultrasound: Can identify the size and location of the tumor and if it is near any structures such as nerves or seminal vessicles that would make a successful surgery problamatic. May also indicate the agressiveness of the tumor based on blood flow.
Many unsuccessful surgeries arise because of the failure to identify the tumor location and any extra capsular extensions prior to surgery. If these conditions are identified prior, then radiation would be a much better option to persue as one will most likely have to have salvage radiation because of a reoccurrance.

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Date Joined Nov 2010
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   Posted 11/14/2010 6:39 PM (GMT -6)   
My advice. Keep reading and talking to people in the know and make darn sure you know what kind of quality of life you want to have after you have whatever treatment you choose.

I had a bone scan and a CT scan but they found nothing as was predicted. If insurance pays for it go ahead and get whatever they recommend.

Post Edited (fulltlt) : 11/14/2010 5:01:03 PM (GMT-7)

Regular Member

Date Joined Nov 2010
Total Posts : 79
   Posted 11/14/2010 7:06 PM (GMT -6)   
Thanks for all the info, Stephie. the reason we are going to see the onocologist was to get another opionion, also the onocologist is associated with another hospital. We are stearing more toward the surgery, because it will leave options later if it returns. We are actually debating robotic or open surgery. I also needs to see a endocrinologist because he may have acromegaly. ( a hormone overgrowth) Just found that news out this week. No other test have been done that is why I was asking what the normal test were. We have only met with the urologist and the radiologist so far. Each one was leaning toward the surgery. Because of his age. 56.

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Date Joined Jun 2008
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   Posted 11/15/2010 8:20 AM (GMT -6)   
Klains, thanks for responding.  Now is a great time to explore all the options and to meet with as many specialists as you can manage. 
Is the urologist you met with the one who would do the surgery or are you considering another doctor for this?  As to robotic vs. open surgery, the outcomes are similar.  It's more important that you go with the surgeon who has the most experience.  And, the surgeon is usually the one who decides which procedure would work best.  There have been instances where the surgery started out as robotic but was converted to the open type due to the surgeon having difficulty getting at the prostate (sometimes the gland is tucked far enough behind the pelvis that the robot can't get at it or the surgeon doesn't have a clear view of the area).  The major difference between these types of operation is recuperation time (and, of course, the size of the scars since open will have a single incision about 8 inches long from below the navel down to the pubis whereas the robotic has 5 small slits made in the abdominal area). 
At 56 years of age, the consensus usually is for surgery.  My husband was 58 at diagnosis and his doctors also agreed that surgery would be his better option.
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