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Bone & CT scans when biopsies are clear?

stonee913
Posts: 1
Joined: Feb 2013

I'm writing with a question/concern for my father who has had a steadily climbing PSA over the years, with 5 biopsies. On the 3rd biopsy, one sample came back positive for cancer out of the 24 collected. It was decided at that time to do 'watchful waiting" and monitor. They have done two more biopsies that were both clear with 24 samples taken at both. Most recent was last week - his psa is at 24. The doctor is now sending him for a CAT and Bone scan. Does this sound right to those of you with more experience dealing with treatment/diagnosis? I am wondering why these tests are being ran. My father is 68 and in perfect mental health, so he deals with the doctors himself, but he doesn't ask specific questions...

hopeful and opt...
Posts: 1278
Joined: Apr 2009

As a man who like your father is on an active surveillance protocol, here is my laymans opinion of what is going on.

First, the AUA does not recommend Bone Scans for men who have been diagnosed with a Gleason of less than 8, however for unexplained PSA’s over 10Bone scanning should routinely be done as part of a baseline evaluation.

There are various factors that cause the PSA to rise other than prostate cancer, urinary infection and manipulation of the prostate via exercise such as bike riding, hard stools or the doctor doing a  digital rectal exam before the PSA test.

 I suggest that your father speak with his doctor about writing a prescription for  Cipro to see if a potential tract infection can be cleared , and his PSA will decline significantly, before having a bone scan.

You did not mention what your Fathers Gleason is , or the amount of involvement, that is what percent of the core is cancerous.

It is very important to have a second opinion on the biopsy where the positive core was found by a world class pathologist since determining Gleason Scores and involvement are subjective

As a son of a prostate cancer father it is recommended that you have annual tests to include PSA testing and Digital Rectal exams. The national guidelines are to start at 40. If you are younger have a base line test at say 35 years old.

Also it is important for you and your father to eat heart healthy; many of us have changed our dietary habits since heart healthy is prostate healthy.

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P.S.

Your father can consider the following diagnostic test

 MRI

There is an MRI scan for prostate cancer that is done with a special coil in the rectum. This are certain major hospitals that have a Tesla magnet. The MRI with the 3.0 Tesla magnet, is the gold standard.
The most effective MRI for the prostate is called a MRSI (MRI/MRS) and includes the ability to identify cancer metabolites using spectographic analysis.....Basically using the spectoscopy with the MRI provides more accurate results, both the MRI and the spectroscopy are done at the same time.

The MRI is generally covered by insurance, however the spectroscopy is considered investigational and is not covered by medicare which I use.

The test indicates if there is any nodule involvement, if there is involvement in one or two lopes , wll show size of prostate, any evidence of extracapular extension, will stage your disease

 

VascodaGama's picture
VascodaGama
Posts: 1508
Joined: Nov 2010

Stone

In reading your question I think that the doctor requesting a Bone scan and MRI are doing it properly.

You have not shared the history of the tests results but the PSA of 24 is very high and probably it has been so along the years. That may justify the many biopsies done to look for a cause. However, you may ask your father if he has or had any symptom or difficulty in urinating. Such could be due to BPH, which causes high levels of PSA too.

Usually when the PSA is above 4, doctors recommend a protocol of antibiotics or anti-inflammatory (4 weeks), and only after they advance for biopsies. You could ask your father if he has ever taken such medication.

In any case, your father has been already diagnosed with cancer on one core out of twenty four and now doctor wants to locate the place where the tumour is hiding. Image studies are the only way to check for it. However, low PSA cases (<10 ng/ml) are commonly diagnosed negative because of the low resolution on the MRI machines. These do not “detect” tumours smaller than 1.5 mm.
In your father’s case the PSA is 24 which may justify the doctor recommendation for the image studies. Moreover, the following biopsies have been negative and the PSA continues high which is intriguing.

There is nothing to lose by doing such tests. They will serve the purposes now and as reference data in future monitoring of your dad’s case.

I would go for it.

Hopeful above is providing good advice regarding you for being the son of a PCa patient.

 

Best

VGama  Wink

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