I'm so sorry to hear about
your relative -- I hope he gets an "all clear" from the bone scan.
Just wondering if anyone knows if bone mets would show up on a bonescan or an mri if psa reading a few months after surgery is 30?
They like to see a PSA of at least 20, so 30 might show something.
I know that a met would have to be a certain size to show up on a bonescan, but itsn't an mri more sensitive?
A bone scan is more sensitive than an MRI for this purpose. It allows the radiologist to see the metabolic changes that are going on inside the bone -- changes that might not be at all apparent from just looking at it. A bone scan is a typical starting point because it is the least expensive route. There are imaging techniques that are more sensitive than a bone scan: SPECT and a variety of PET scans: FDG, NaF18, F18Choline, C11 Acetate & Choline.
Also, if a met did show up, would hormonal treatment most likely be discussed?
Yes, almost certainly, whether a met is found or not. Hormone therapy will slow down the growth of the cancer no matter what the next step is.
If a met is found, I hope they would also discuss early use of immunotherapy, novel hormonal treatments, possibly even early chemo. Zometa or Xgeva to counteract bone loss from hormone therapy and prevent "skeletal events" (e.g., bone fractures) may be useful. Also, he should consider whether some of the many clinical trials may be appropriate for him. Lots to take in!
If no mets are found, hormonal treatments may be used to sensitize the cancer to potentially curative radiation treatments and kill off the cancer cells that survive.
I don't believe they can do radiation if there is no "target" to radiate.
If no mets are found, radiation has a chance of curing him. The target is the prostate bed -- the first place the cancer typically travels to. They use a kind of radiation called IMRT to spray the local area. This is often preceded by and followed by several months of hormone therapy.
If a met is found, radiation is used palliatively. SBRT is sometimes used to target identified mets. Xofigo (alpharadin) was FDA-approved this year -- it is a radioactive substance, taken systemically, that seeks out and destroys bone mets. However, it is only approved for use after hormone therapy begins to fail.
If a met did show up, how ominous would this be? Aren't there many cases where patients have lived many years after bone mets were found?
It means that the cancer is incurable with currently known methods. It proceeds slowly in some men, rapidly in others. A good indicator will be how complete and rapid his response is to hormone therapy.
Depending on what they find at the bone scan, he might be referred to a radiation oncologist. If a met is found, I hope he will seek the care of a good urologic oncologist and not just a surgeon. Wishing him luck with this...