Jerry L. said...
I'm always learning things with this disease. I thought with a G7 or above (and other data) that docs would want to know if it escaped before treatement (surgery vs. radiation)
Hi Jerry L.,
I'll try to help clarify...my reply is really no different than an aggregation of what's already been said here, but maybe I can explain more clearly.
Of course the doctor would like
to know if cancer has escaped the capsule before surgery (in particular), but this is not
precisely possible. The best available tool for the majority of cases is the Partin Table/nomogram (LINK
) which help show the precentage of likelihood of organ confined PC based on clinical case characteristics (pre-treatment PSA, Gleason and Stage) compared to thousands of similar cases from the past.
If PC has escaped and a large
tumor has formed, then it would
show-up on a whole body scan or bone scan, but those scans simply do not
have the resolution capability to show something smaller. Therefore, the guidance is that scans below particular clinical threasholds are almost never worthwhile. Different organizations recommend different thresholds, but the organization which I think trumps the others is the American Urological Association. The AUA's guideline "Prostate Specific Antigen Best Practice Statement -- 2009 Update
" has the following:
pg 32 -- Routine radiographic staging, such as with bone scan, computed tomography (CT), or magnetic resonance imaging (MRI), or surgical staging with pelvic lympn node dissection is not necessary in all cases of newly diagnosed prostate cancer.
pg 34 -- 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.
pg 35 -- Computed tomography or megnetic resonance imagning scans may be considered for the staging of men wiht 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 or equal to 8.
Some older urologists may be in the "habit" of prescribing scans as a standard step, but patients from the past (say, 20 years ago) used to typically present with much worse case characteristics than is typical today. Whereas it would have been much more appropriate 20 years ago to send just about every man with biopsy-confirmed for scans, that is simply not true today...and in fact it is considered a big waste of healthcare resources today.
There are always, of course, anecdeotal exceptions.
Furthermore, one factor that is changing is that some of the newer scanning techniques—some which have been further refined even since the 2009 AUA Update—are changing the landscape of this guideline. But most of the replies in this thread are rooted in this AUA recommendation.
Does this help?