Should a guy have a CT scan prior to Surgery?

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I use to be a fish
Regular Member


Date Joined Mar 2011
Total Posts : 57
   Posted 6/13/2011 11:00 AM (GMT -6)   
I have read about a few men on this forum who, upon getting a diagnosis of prostate cancer, wanted to have a ct scan or mri to be sure that their cancer had not spread before deciding on the best treatment in their case.  Would this only be recommended for men with high PSA scores and higher gleasons?  So far, the two doctors my husband has seen have not suggested he have any testing of this kind, but we hadn't asked either.  Should this be pursued?
 

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 6/13/2011 11:12 AM (GMT -6)   
I had a CT scan before surgery. But it wasn't to find more prostate cancer ~ it was to record my physiology prior to an invasive procedure. I don't know why more men don't have such tests prior to such procedures. The fact is that if you have a physical issue not related to prostate cancer then moving forward with surgery needs to be weighed against it...

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

JNF
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Date Joined Dec 2010
Total Posts : 3794
   Posted 6/13/2011 11:18 AM (GMT -6)   
I had a ct scan before radiation for the reason that Tony has mentioned. They wanted to look at everything. It also allowed them to confirm the size shape and location of the prostate and seminal vesicles. They also checked for any enlargements of any of the pelvic and abdominal lymph nodes. I assumed it was standard operating procedure.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

John T
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Date Joined Nov 2008
Total Posts : 4237
   Posted 6/13/2011 11:22 AM (GMT -6)   
sometimes there is confusion as to what scans do. As Tony said CT scans can identify other issues, but cannot identify anything in the prostate. They are used in advanced PC to identify major Lymphnode involvement. Many patients get an MRIS or MRI Fusion of the prostate to identify if the tumor is past the margin or is in a spot that would make surgery problamatic. A color doppler can do the same thing at about 50% of the cost.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

rcroller
Regular Member


Date Joined May 2011
Total Posts : 326
   Posted 6/13/2011 11:56 AM (GMT -6)   
There is another consideration for the use of CT Scans. Recently, there was some information that came out on the radiation levels associated with CT scans creating their own risk, if overused. In the past three years, I have had approximately 10 CT scans for kidney stones and serious bouts with diverticulitis. When I got my PCa Dx I wasn't so sure exposure to all that radiation didn't have something to do with it. When my Uro mentioned a CT prior to surgery I told him I would rather not as I had just had one for kidney stones the month prior and too many to be good  in the three preceding years. I agreed to the bone scan but declined the CT. He said they rarely show anything of concern anyway and went along with my wishes.
Age 53- PSA 2/11 3.5
4/21/11 BX Path Report: 3 of 12 Left PCa , 3+3, 3+4, 4+4
4/29/11 Received PCa DX, G-8
5/18/11 open RP Performed, Right nerve bundle spared
5/24/11 Post Op Path Report: G-7(4+3) 7%, pT3a N0MX, EPE, PNI+, SVI-, Left margin <0.1mm from inked margin
6/1/11 Cath removed, Incontinence-No, ED-Yes.

Post Edited (rcroller) : 6/13/2011 11:06:33 AM (GMT-6)


Snowbound
Regular Member


Date Joined Jun 2011
Total Posts : 224
   Posted 6/13/2011 12:06 PM (GMT -6)   
I had an MRI and bone scan prior to surgery. I would have loved to seen the images but they don't allow it anymore, the technician said that it raised to many questions and concerns among patients who don't know how to interpret the images.
Glen, age 50
PSA 5.43 at June 2010 physical
Biopsy: 8 of 12 samples positive, 75% in 1 core. Gleason 7
Radical Prostatectomy 12/3/2010
DIC complications during surgery
Pathology: 3.5cm tumour, no capsular invasion, lymph nodes negative
Catheter removed 12/26/2011
PSA currently undetectable!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/13/2011 12:10 PM (GMT -6)   
Snowbound,
If you asked to see the images it is totally unethical to deny you this right. It's your body not his. Probably illegal as well. I saw mine and there was nothing too difficult to understand.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

windycitytiger
Regular Member


Date Joined May 2011
Total Posts : 79
   Posted 6/13/2011 12:41 PM (GMT -6)   
My doc wants the bone scan not so much to look for metastesis but to establish a baseline scan for possible use down the road. He said that very few of us will have a bone scan without blemishes and to establish those points before any cancer spreads will help rule out potentially unecessary tests/procedures/treatments down the road.
Age 50
PSA 5.7
Biopsy 8 of 12, 6@3+3, 2@3+4
open RP scheduled for 7/12

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 6/13/2011 2:22 PM (GMT -6)   
I like what Tony says.

When i asked I was told their was no need.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 6/13/2011 2:53 PM (GMT -6)   
Dear FIsh:
 
Unless your hubby has high Gleason and/or high PSA the scan is highly unlikely to show any signs of prostate cancer in the bones.  So...I don'r recall his stats but it may be that his physicians feel this is unnecessary and not useful.  I guess you should ask them.
 
Snowbound, Tony is certainly correct.  Though maybe the technician was speaking for himself or herself, i.e. the tech was not permitted to show the results.  I can't imagine a doctor refusing this.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

natural44
Regular Member


Date Joined Dec 2010
Total Posts : 172
   Posted 6/13/2011 3:51 PM (GMT -6)   
I had one done prior to mine more so for myself to feel comfortable with the idea that there was not cancer all over the place inside me prior to them opening me up.....so for my own sanity it helped and is a good baseline for future references if needed.
age 44 when diagnosed 45 now
RRP 9-28-10
gleason 3+3
pathology report clear
11-1-10 PSA 0.02
3 month 0.00
6 month 0.00
12-1-10 noctural erections, not very strong maybe 20% none prior to Osbon pump use
3-30-11 Trimix 1st injection works GREAT! and more nocturnals and even some spontanious erections plus responding a little bit now to oral meds!!! The trimix really started things going!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/13/2011 3:51 PM (GMT -6)   
Snowbound,

I have been able to look at every scan taken of me thus far, in the company of the doctor's office of course. You certainly have a right to see them.

Fish,

I had the CT scan both after my initial PC dx, and several before having radiation. For the same purpose that Tony described above. Good luck, btw

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6980
   Posted 6/13/2011 4:00 PM (GMT -6)   
I had both bone and CT scans after biopsy.
 
In both cases the techs said they were not allowed by hospital policy to discuss the images, that I would have to wait for an evaluation by the physician. I was given the right to have copies of the images afterwards, but had to fill out a raft of releases to get them.
 
My doctor told me to get them, so I did. Wasn't much of a discussion.
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/13/2011 4:27 PM (GMT -6)   
Snowbound said...
I had an MRI and bone scan prior to surgery. I would have loved to seen the images but they don't allow it anymore, the technician said that it raised to many questions and concerns among patients who don't know how to interpret the images.
 
Hi Snowbound,
 
I looked you up on the thread titled "Where are people from?" and found that you are from Almonte, ON Canada.
 
Medical records ownership rights might be different in Canada, but in the US they are defined by legislation called HIPAA, Health Insurance Portability and Accountability Act.
 
At a high level in the US, the data contained within the medical record belongs to the patient and the physical form the data takes belongs to the healthcare provider.  This brief description adds to that:
As a general rule, a physician, a physician’s clinic, or group practice "owns" medical records subject to the patient’s expectation and right of privacy, and the doctor-patient privilege. The information within the medical record is considered the property of the patient, and the patient has an ethical right and generally, a legal right, to prompt and complete access to this information. By federal statute and regulations, (HIPAA, 1996), relatively new restrictions and regulations have been introduced and the practitioner is required to become familiar with the law. Ownership of patient medical records is also subject to the patient’s right to obtain copies of those records or to have copies transferred to another person.  Most states provide for an exception, excusing a refusal to deliver medical records to a patient if it is determined that information in the records could be detrimental to the physical or mental health of the patient, or is likely to cause the patient to harm him or herself or someone else.
 
Canada will undoubtedly have legislation which is accessible online to better understand your rights.
 
hope this helps...
 

natural44
Regular Member


Date Joined Dec 2010
Total Posts : 172
   Posted 6/13/2011 5:30 PM (GMT -6)   
I had one done prior to mine more so for myself to feel comfortable with the idea that there was not cancer all over the place inside me prior to them opening me up.....so for my own sanity it helped and is a good baseline for future references if needed.
age 44 when diagnosed 45 now
RRP 9-28-10
gleason 3+3
pathology report clear
11-1-10 PSA 0.02
3 month 0.00
6 month 0.00
12-1-10 noctural erections, not very strong maybe 20% none prior to Osbon pump use
3-30-11 Trimix 1st injection works GREAT! and more nocturnals and even some spontanious erections plus responding a little bit now to oral meds!!! The trimix really started things going!

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 6/13/2011 9:15 PM (GMT -6)   
I too had the normal set of scans after my diagnosis.

To date I have a hard copy of every single item that makes up my medical history concerning PCa, from the PSA tests for the five years prior to my diagnosis, to my last consult with my Onco. I also have a disc copy of every scan that was preformed. This has saved me very valuable time as I progressed along the path and dealing with different doctors.

I have also scanned every document and it resides on a flash drive that can be carried with me wherever I travel.

I feel very strongly that everyone should have this information at their disposal.

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09 Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
PSA .6 IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9
3/7/11 PSA 4.2
4/10/11 PSA 3.8
5/19/11 PSA 4.9

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 6/13/2011 11:38 PM (GMT -6)   
A few thoughts:
CT scans, like x-rays, expose the body to a small dose of radiation, there will thus be some docs who will not want to use scans unnecessarily.

There may be a reason to do a scan if the surgeon feels there is a need to check the layout of a patient's interrnal anatomy. (perhaps because of previous surgeries, overweight, size of prostate etc)

You need more than a simple CT scan to locate any cancer.

Patients may have a legal right to see their records, but clearly few of us have the necessary knowledge to understand all that we might see in them, thus it has to be a case of both seeing the notes, scans reorts etc and getting satisfactory explanations from the docs about aspects of them that we are interested in or concerned about.

Alf
Age dx 48
Apr 09 PSA 8.6
DRE neg
Biop 2/12 pos
Gleason 3+3
Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
Nov 09 PSA 0.1
Mar 10 PSA 0.4 sent to RT
13 Apr CT
RT 66Gy ends 11 Jun 10
Tired + weird BMs
Sep 10 PSA <0.1
Jan 11 PSA <0.1
Apr 11 PSA <0.1
Erection OK

Snowbound
Regular Member


Date Joined Jun 2011
Total Posts : 224
   Posted 6/14/2011 5:17 AM (GMT -6)   
I believe our laws are similar here. I had asked the technician who was doing the scan if I could look at it on the images on the screen. She told me she wasn't allowed because she's not a doctor and that makes sense since she wouldn't be in a position to discuss the results with me, although personally I was just curious about what it looked like at the tim. When I saw my UR for the follow up he didn't have a copy of the images, just a written report from the specialist saying everything was good. I could have (probably should have) gone after copies of the images, but at the time I was still in a state of shock and more concerned about the treatment options to get the cancer out of me.
Glen, age 50
PSA 5.43 at June 2010 physical
Biopsy: 8 of 12 samples positive, 75% in 1 core. Gleason 7
Radical Prostatectomy 12/3/2010
DIC complications during surgery
Pathology: 3.5cm tumour, no capsular invasion, lymph nodes negative
Catheter removed 12/26/2011
PSA currently undetectable!

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 6/14/2011 10:43 AM (GMT -6)   
The Dutch are very happy to tell you what uis going on, but you have to ask.
During my CT scan prior to SRT my wife came with me and during the actual scan she sat with the technicians watching it all on the screens and they explained to her what was going on and what she could see on the screens. During one of my sessions of SRT she also came with me, and while I was being "zapped" in the bunker she sat with the technicians in the control rooms and again they talked her through what was going on and what bits of my insides that it was that she could see on the screen.

(She was also in the room for one of my rectal ultrasounds prior to surgery, but that time she decided to stay in the far corner rather than watch the business end or the screen!!!)

Alf

mowman
Regular Member


Date Joined May 2011
Total Posts : 20
   Posted 6/14/2011 11:08 AM (GMT -6)   

hey fish ,my uro ordered a bone scan  saying pca would move to lower spine first. uro in his ;group; said he would not have ordered it because i was 'only' t2c and gleason 7 and it wasn't protocol to do so.

apparantly they can tell a lot from those numbers.

 


K2
Regular Member


Date Joined Feb 2011
Total Posts : 51
   Posted 6/17/2011 12:08 PM (GMT -6)   
I'm currently receiving IGRT as an adjuvant therapy and the machine scans your pelvis before every treatment - yea, in my case 38 treatments not to mention the actual cancer killing radiation administered.
 
I hadn't had a colonoscopy and was told before RT was better than after - my med-onc said it changes the appearance of the colon. As it turns out I'm the pround owner of a perfect colon. Too bad my prostate is sitting in a jar on a shelf in some biomedical wharehouse : | 
 
I did have a CT scan of my pelvic area and bone scan post RP - both negative. My med-onc said he made sure to have his father's CT scan prior to RP because it's a clearer baseline (they were probably checking for mets anyway) - apparently scar tissue and areas where lymph nodes are removed can, too a varying degree, be less optimal as a baseline. How much less? IDK.
 
K2
 
Age 51
pT3a  +EPE, +PNI, +LVI, +apex margin focally, N0, M0
RP 3-17-11, Gleason 3+4=7
Adjuvant IGRT began 6-12-11
PCa 6-31-11 prior to IGRT 0.03 (nadir)
 
 
 
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