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MRI vs. Bone Scan

Cherokee6
Posts: 32
Joined: Oct 2011

Coming up now on 4 years since my Radical Prostatectomy (12/14/09) I continue with an undetectable PSA (<0.1) which is typically a good sign. What has bothered me over the past 4 years is that upon diagnosis of my Prostate Cancer my PSA was only 2.2, which is the highest that it has ever gotten. My history is: Radical Prostatectomy, 40 Radiation Treatments, Hormone Treatments with belly shots for three years and daily bicludimide pill for the last two of the three years. My Gleason Score is 9, 12 of 12 biopsy samples positive for cancer, positive margins and seminal vesicle involvement. Stage T3bN0M0

I have been experiencing some lower back pain so my PCP ordered a Bone Scan which revealed additional uptake from the previous scan so they scheduled a plain x-ray. The final conclusion was the increased uptake was probably caused by degenerative issues such as arthritis.  PROBABLY? Not a very comforting conclusion.

After reading the following article online http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768452/ I realized that bone scans and plain x-rays were not conclusive and an MRI was much more definitive.  I contacted my VA Primary Care Physician and asked if it was possible for the VA to perform an MRI. Although the PCP felt the bone scan and x-ray results showed degeneration he agreed to set up an appointment for me to receive an MRI.

A few days ago I saw my VA urologist and produced the article. His first comment was that this was from a British Journal and not from the United States. My response to that was, “Yes, but their bodies are the same as ours!” After he reviewed the article he admitted that it was a good article and if he were me he would be requesting an MRI as a more conclusive test. My feeling is that with an aggressive Prostate Cancer I must be at least as aggressive.

I am scheduled for November 21st for the MRI and will report back with the findings.

tarhoosier
Posts: 190
Joined: Aug 2006

Cherokee:

 

The most precise and sensitive bone scan is done with an injection of Fluoride F-18 isotope. After waiting an hour or so the scan is done. This is multiple orders more effective a scan compared to the conventional Tc Technetium scan. This procedure and isotope is not done in every scan lab so some effort and  perhaps a little travel may be necessary. The MRI has the advantage of limting the radiation to the body. An F-18 scan and a 3-Tesla (3-T) MRI will be the best combo to measure everything in your innards. 1.0 or 1.5 T is the more conventional power and not as effective as the 3-T machine.

Cherokee6
Posts: 32
Joined: Oct 2011

The bone scan did involve an injection whereby I returned two hours later for the scan. Here are the results.

FINDINGS: There is increased uptake in joints of the upper extremities, first metatarsal phalangeal joints, bilaterally as well as heterogeneous uptake in the mid to lower thoracic spine, most consistent with degenerative changes. There is small focal area of increased radiotracer uptake in the superior aspect of the left acetabulum also consistent with degenerative changes A focal area of increased radiotracer uptake is noted in the upper aspect of the left SI joint. Although this may represent degenerative changes plain film correlation is recommended No other areas of abnormal uptake are identified throughout the remainder of the skeleton.

Thank  you for taking the time to respond to my post.

 

VascodaGama's picture
VascodaGama
Posts: 1621
Joined: Nov 2010

Cherokee

Congratulations on the continuous remission. I hope it stays that way once all the medication wears off.

I agree with Tarhoosier's above comment, however, it is common to get false negatives from MRI image studies when the PSA is lower than 2.0 ng/ml.
In any case, the 3-Tesla capability equipment (higher in resolution) is prefered to detect small colonies of cancer and that may be acceptable at VA doctors. Still better is to use the combo of a PET together with a 3-T MRI such as the sophisticated Siemens PET/DW-MRI machine. In such a case probably you would have to pay out of your pocket. Here are links to the above;

http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=104471

http://www.healthcare.siemens.co.uk/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/groups/public/@global/@imaging/@mri/documents/download/mdaw/mtk0/~edisp/flash_45_research_supplement-00183468.pdf

 Best wishes.

VGama  Wink

Cherokee6
Posts: 32
Joined: Oct 2011

Thank you for your response. I will visit the links suggested and review possible other options.

Cherokee6
Posts: 32
Joined: Oct 2011

 

On Friday I received a call from my Primary Care Physician telling me that the MRI that I had taken at the VA hospital in Bay Pines came back negative! Yeah!, but wait, should I take this as gospel or should I get a second opinion from someone that specializes in reading MRI's for prostate cancer? If so can anyone provide the name of someone that will do this for me? I realize that I may have to pay out of pocket for this but I am willing to do that. Sometime I think I’m being over paranoid but with a Gleason 9 it’s hard not to be. In three weeks I will be 4 years out from my radical prostatectomy & radiation. Hormone treatments stopped one year ago. My PSA has been undetectable since the prostatectomy.

 

Samsungtech1
Posts: 350
Joined: Jan 2011

Cherokee6,

You are right not to trust VA results.  In this case I would go with the results.  The doctors who read these are good.  Their license is on the line in case of a gross missed read.

They told me I had degenerate join disease in every joint in body.  I spent 20. Years in heavconstruction before I switched careers.  I believe them.  On the other hand it is really hard to ignore pain with this disease.  I am beginning to think that this worry will wear us out before it comes back. Stress causes heart disease.  It seems funny to me that we can die of heart disease because we worry so much about it coming back.

I was scared for the first three years, of course mine hadmetatsis to lungs and bladder.  I am over it now.  I do what I can, but this is not worth the paranoia.  After 20 years in heavy const. And too many close counts for anyone.  I figure I have been really lucky. When my children were growing up I use to tell them not to mess with mother naturebecause I had used up all the luck.

Good luck!

mike

Cherokee6
Posts: 32
Joined: Oct 2011

Samsungtech1,

Thank you for your response. Perhaps I am being overly concerned and your point about the doctors that read these things is well taken. With the VA I hold the firm belief that I must, "trust but verify", which goes back to an incident while in the service a long, long time ago. Thanks again for your response and have a wonderful Thanksgiving holiday.

VascodaGama's picture
VascodaGama
Posts: 1621
Joined: Nov 2010

MRIs are usually analized by specalist radiologists. They file their report and it is the doctor that "translates" it into "Patient's language". The Negative answer is too short to be absorved. The radiologist does not comment on negatives but on what is seen.

You can request for a copy (CD format) and send it to any nuclear department of a major hospital to get a second opinion. In any case, you should include previous results from other image studies and scans so they can compare the images. An important aspect of all the results is that small colonies of cancer with lesser than 1.5 mm cannot be detected in traditional image scans.

Well, for the moment you should celebrate and I congratulate you for the NEGATIVE to cancer report.

Best

VG  Wink

 

Cherokee6
Posts: 32
Joined: Oct 2011

VG,

Thank you once again for your informative response. I have retrieved my previous bone scans along with X-Ray that were taken by a civilian Imaging Center prior to receiving VA care and I will request the same from the VA. I am going to seriously consider a second opinion as suggested but for now I am going to take your adivce and celebrate my 4 year anniversary since my Prostatectomy with undetectible PSA. Have a wonderful Thanksgiving.

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