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Bone Scan question a little nervous here

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

I had a bone scan yesterday.. Ordered by my Othopedic for hip issues...  during the scan..  they asked me if I had fractured my leg and arm..the answer was no.. then they called in Dr to look at it and see and if he wanted to do more test..     I am waiting for the report from my Orthopedic..  So my question is does metestized show up as a like a fracture on bone scans. Is there a good chance for false positives on a bone scan...   Oh technologist on the way out said good luck..  Luck what do I need luck for.... 

History PSA 4.9 biopsy  2 cores 3+4 50%  2 cores 3+3 10% out of 12 cores . 40 treatments radaion finished begining of May..  urologist guesstimate contained in the prostate..  post Imrt PSA 4.6... Hip pain was suggested it is Athritis refered to Orthopedic  now waiting for bone scan results...

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

Haven't met with Dr yet but i went and picked up bone scan film (DVD) and read the viewing doc's report.  1st there was no mention of a fractured leg..  That was good. Don't know why the tech asked if I had one..  I do have a fractured left ulnar that I didnt know I had and it shows up on the bone scan..  I must be one tough cookie..  never felt a facture..  They think that since it is in my forearm that it is most likely not associated with mets ..  They suggested looking futher with more test to figure out what its. I do have some sort of a swollen node in that area had it for a few years..  Anyway as you all know I am a very happy camper...  

Lucky64
Posts: 29
Joined: Jun 2017

That tech shouldn't have said anything. Eeeesh

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

Had meeting with my Orthopedic... I was hoping the bone scan was showing a fracture that somehow I banged my arm and cause a fracture with out much pain. Dr ordered x-ray of the area after reviewing bone scan..  Good news. no fracture.. Bad news some sort of mass in the bone that lit up the bone scan that showed in the x-ray.  Dr says he is not to worried about it.. But he ordered a MRI of the area. I am trying not to be stressed about this..  Every Dr so far has said it is unlikely to be mets due to PC because of the location (Ulna)  and nothing has showed in the larger bones in arms legs, pelvis..  But however unlikely they can't seem to rule it out.  Prior to the bone scan my Urologist was't worried about mets due to PSA being 4.6 after 40 radiation treatments and my gleason being 3+4 on 2 cores 50% and 2 cores 6 at 10%

This is what my year has been like.. First I have 7 hearts stents from pevous years.. Last June diagnosed with Melanoma on my back ( insutu removed) August saw a waterfall in my left eye.. All sorts of test for TIA none.. Carotid though 70% blocked.. Follow up eye exam later in August.  Plaque in my retna must have broke off from carotid more tests.... Also Dr ordered heart monitor. Nuts found Afib....  October colonoscopy and endo.. Found tumor in my throat thank god it was benign. All the while I was being watched due to PSA level going up from 2.6 to 3.5 to 4.9. December Biopsy -prostate cancer 40 treatments of radiation..  May get extreme hip pain and had also got chomped by a tick ( could have started hip pain) got Lyme disease couldnt walk. Bone  scan due to athritis in hip and and my forearm lights up... Next week or two MRI due to something not playing right on bone in arm..   Get this I am a very active guy..  I play the upright bass in two bands.. Have been playing two to 3 times a week and I try to bounce all over the stage...    I think I pissed off the big guy..  I hope he lets me off the hook soon...      

Lucky64
Posts: 29
Joined: Jun 2017

Do what I'm doing: Speed up knocking off your Bucket List. Yesterday I started planning more vacations. Damn the money. Who knows how much time we have left? I'm 64, retired earlier this year and took Social Security early, just in time to get this damn diagnosis.

From what I've seen, a man has only 60-70 to enjoy the rest of his life because after 70, it's Decay Management". Sure, there's outliers, but after 70 we won't be hiking Machu Pichu or doing one last dive at the Great Barrier Reef. So live now!

My .02¢

Nick

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

Nick.. That was worth more than 2 cents. That is at least 2 bucks... That is some great advice..  I still play in bands.. I love music.. I love playing the upright bass..  Matter fact just got back from playing a 4th of july party..  I have to come up with more stuff in my bucket list..  I have been doing that my whole life living life..  Now just getting a little sore doing it..

VascodaGama's picture
VascodaGama
Posts: 3043
Joined: Nov 2010

Great bassoneman,

I enjoyed reading your posts. I love music too and played the “deep” at my school times. Not the upright bass but the electric guitar of the 60th copying the Shadows’ Little b, Apache, etc. At my age now I would prefer listen your tunes.

However, in regards to your list of scans, I think that you could get higher scores if you “play” with a more sophisticated exam like PET. This using the rightful tracer is more specific to PCa and can give you more assurances in the investigations.

Best,

VG

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

Vascodoa - I don't know how to request the PET.. I don't know if I am seeing the right Dr..  Due to my original hip pain my Urologist and Oncologist did't think it had anything to do with my PCa because of gleason and PSA.. so they suggested  I see a orthopedic for arthiritis the ortho wanted to be sure about the atheritis I think so he ordered a bone scan not expecting my forearm to light up.. The other things that lit up is both my shoulders but he isn't concerned with that he thought it was more degeneritive (sp)  ( they need spell check on here haha) bone due to age. The ortho did a xray on my forearm ulna and there is a oblong dark spot about 3 inchs long in the marrow.. about mid bone...  That is why he ordered the MRI..  Also about a inch above where he saw the spot I have some sort of a swollen node.. I have had the swollen node for over a year..  Am I seeing the right DR. should I get my Oncologist, Urologist involved in this? Maybe I should just call them and give them a heads up..     

    

VascodaGama's picture
VascodaGama
Posts: 3043
Joined: Nov 2010

The CT and MRI would not tell you the characteristics of the lesion but its location. these would also distinguish between solid and soft. PET is used in the intent of identifying what the lesion is made up. The tracer in PET is chosen according to what the doctor thinks it to be, because some tracers/radiopharmaceuticals are more specific to certain tissues than to others. For instance; PCA uses PSMA ligands or other labels typical in prostatic cells. Other tumours would use tracers and ligands more specific of their characteristics.
This is like playing the "deep"; you switch the tunes to fit the vocalist's timings. The doctors attending you may be tuned to a different wave than the one you want to hear. If the bandit is what concerns you most then request for a PET that cover the whole body including shoulders and arms.

Please note that I do not want to interfere with your doctor's guesses. Just trying to comment that they should focus in one matter instead of trying to figure out what a lesion could be among the vast possibilities.

Best,

VG

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

I think they are doing the MRI because they are not sure what the doc is seeing in the Xray if it is a tumor or a infection.  Also being on the ulna (forearm) because of the location not on the big bones like thigh or upper arm and my psa and gleason they think it has a low posibilty being PCa.  Yesterday I started having off and on pains in the area which I didn't have before....... Although it is hard to tell which pains are from what.. I take heart meds that cause pains in muscles...Playing the upright bass has a lot of pain that goes along with it.. I is like flogging yourself...  Show and tell...  https://www.youtube.com/watch?v=XCduaoZk2_0

 

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

Welp had the MRI of my arm today..  No Dr around to read it.. it is Sunday..  But I did get a cd of it..  And yup there is something there.. What I don't know but it is something and not a fracture..  But I guess I already knew that from the X-ray..  I meet with  Dr this Friday to discuss it although I will get the report on Tuesday or Wednesday from the reading Dr.Anyway until then I am going for the positive.. I read there are more benign bone tumor that can appear than cancerous ones. Did my PCa metestize to my arm? Well it is in my Forearm yes it could be but since it is in that location there is more of a chance that it isnt.. So guess worrying about it until I find the results won't change the results.  I do have to say though with heart disease things move very fast.. If you have something on a test that doesn't look good.. Boom your cardiologist is on the phone with you.. They even call me as soon as they get the results of a good test.. But I guess it can put my lights out pretty quick vs PCa..             

GeorgeG
Posts: 127
Joined: May 2017

All of my scans have things on them that are not PCA. I get a review of all of my old injuries and old age pains. I suspect that if everyone got a full body scan there would be a lot of sleepless nights. Try to relax and go do something fun. As you said, worrying can't change the outcome - except maybe make it worse. The mind body connection is very strong.

 

George

 

VascodaGama's picture
VascodaGama
Posts: 3043
Joined: Nov 2010

Your above link takes me to the Jim Sequin Band. Are you the one on the bass?

Regarding your forearm image, I also do not think that the lesion is related to PCa. Bone formation can create a thickening layer like a pool that turns darker in an image study. The MRI shows tissue contrasts that differ on its density. T1 and T2 weighting contrast with different tissues providing a picture that it is then interpreted (guessed) by experienced radiologists. The image in T2 would produce an intermediate-bright for fat tissue and bright for water/fluids. This would be your case at the forearm.
The T1 image is not so practical for detecting PCa but it also provides an weighting image where fat is bright and water/fluids is dark. For instance, an hemorrhage would be dark in T1 imaging. All of these is written in the report accompanying the CD you received. In any case you should try knowing the cause of the pain.

Best,

VGama

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

Yup I am the on the Bass.... I got the CD before the Dr read it... The Mri was done on a Sunday... no Dr there to read... I should have the report by tomorow. I am not a radiologist.. but stayed at a Holiday Inn once...

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

Don't know any more than I did a month ago.... Basically unlikey met.. But could be.. next step biopsy i presume...... Appointment with Ortho Dr Friday..

here is the report..

TECHNIQUE: Multiplanar MR imaging of the left forearm was performed on a 
1.5 Tesla magnet before and after intravenous administration of 19 mL 
Gadavist, gadolinium-based contrast.
COMPARISON: Bone scan from June 22, 2017
FINDINGS: 
The muscle and tendon signal intensity is normal.
There are no abnormal fluid collections.
The fascial planes, neurovascular bundles and subcutaneous tissues are 
normal.
Within the mid to distal ulnar diaphysis there is a 1.7 x 0.8 cm focus of 
T1 marrow replacement which is cortically based demonstrating increased 
signal intensity on the T2-weighted sequence and postcontrast enhancement. 

No soft tissue component. This 
finding correlates to the abnormality seen on recent bone scan. 

IMPRESSION: 
Marrow abnormality within the ulnar diaphysis correlating to the recent 
finding on bone scan. This is unusual in location for a metastatic lesion, 

however may represent an atypical metastasis given patient's history. 
Biopsy could be considered.

VascodaGama's picture
VascodaGama
Posts: 3043
Joined: Nov 2010

It may not be necessary but a biopsy will give you peace of mind.

Overall, the report rules out any abnormality of local muscle, tendon and neurovascular bundles that could be a cause of the pain. Internal hemorrhage does not exist too so that the issue relates to a problem in bone. I wonder why the doctor said that the Hip pain is Arthritis (described in your initial post). Did he guessed it or was his comment based on proper exams? 

Prostate cancer by tradition, metastases to bone starting at the pelvis and lower back (the hip) travelling then to the chest, upper back and shoulders. Its path follows a series of lymph nodes (barriers) that would become infested before it spreads to closer bone. Logically, the finding in the forearm should accompany other infested sites at the more traditional locations. I wonder about the image studies done before your IMRT of last May. Where you given a clinical stage at diagnosis? In what basis was the radiation treatment chosen/decided?

What lead you to a biopsy? Was it the PSA or were there already some symptoms at the beginning?

In any case, the radiologist's report includes bone formation (marrow replacement) as the final answer, which case is a natural process in our skeleton. Bones are in constant formation, occasionally more intense at some areas forming sort of pools of intensity (your case). However, bone formation occurs at the time of bone deterioration (balanced by osteoblast and osteoclast) which cause could be age related (osteopenia/osteoporosis), stress or fracture, effects of hormonal unbalance (low T or medication induced) or the invasion by a tumour.

You need to find the reason. I hope the problem is age related and that your treatment has free you from the cancer.

Best wishes,

VG

 

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

VG .. here are the results that lead to Radition.. Patient underwent a 12-core, TRUS-guided prostate biopsy on 1/16/17 for a PSA rise to 4.9. Pathology revealed 4/12 cores positive for prostatic adenocarcinoma. 2 cores contained Gleason 3+4=7, involving 50% of tissue from both the RB and RLB, and 2 cores contained Gleason 3+3=6, involving 10% of tissue from the RLM and < 5% of tissue from the RM. The remaining 8 cores were benign. 
Prostate volume was 59 cc, giving a PSA density of 0.10 ng/mL^2. 

No suspicious lesions noted on TRUS. Clinical stage T1c. Classified as intermediate-risk disease by NCCN guidelines (T2b or T2c; GS of 7; PSA 10-20 ng/mL).

I met with Orthopedic last week.. He is referring me to a ortho specialist that deals with with bone tumors..  From what he said the location of the affected area on my ulner is a pretty tricky site to do a biopsy.. Tons of nerves there.. Which could lead to issues with my hand and or arm.. I would lean to the wait and see approch if it is given me verses biopsy.. Playing that upright bass is very important to me..  I need the  complete function of my hand and arm to play that beastly beast.. I may have some hard choices coming up..  Or if I don't do anything and it is something.. Play until I have pain and deal with it then... Don't know..             

VascodaGama's picture
VascodaGama
Posts: 3043
Joined: Nov 2010

I understand your "tunes". You probably are choosing the best in leaving those nerves intact to avoid further trouble from a bone biopsy. A PET scan specific for PCa is not invasive and would help in identifying the origin of the lesion. Though the issue is just at the ulnar, the PET scan would give you a picture of the whole body (including the prostate area) which would serve you now and in the future for comparison with other exams.

The info from the diagnosis you share above (cancer found only in the right lobe) refers to a clinical stage T1c that is for localized early stage cases with low risk for extraprostatic extensions. This is what is causing ambiguity in regards to the lesion found at the ulnar. I think your doctor's reasoning is correct and he did well in getting the image studies to have a better understanding of the symptom at the hip. The biopsy data alone is not enough to judge the issue. 

Sincerely, I would guess that the pain at the ulnar has something to do with your activities playing the bass, just like many guys involved in sports got those kind of deep pain disorders. It could as well be unrelated to the lesion found in bone. Ulnar nerve dysfunction is a possibility. Here is a link with information regarding nerve-entrapment. You need something more specific to get a conclusion.

Best,

VG

 

 

bassoneman's picture
bassoneman
Posts: 58
Joined: Apr 2017

Met with bone  cancer Orthopedic surgeon today...  He look at xray, looked at bone scan, looked at MRI..  says well it could be Mets.. But it may also benign tumor.. It is a tumor in my ulner that he could say for sure that it wasn't a fracture.. He talked about about doing a biopsy.. It would have to be a open biopsy which means surgury drilling a hole in my bone.. For what ever reason needle biopsy wouldn't be a choice. The other choice is watchful waiting..  Which I asked him what he would do.. Although he is waiting to hear back from a radiogist.  He said he would wait for about 10 weeks and see if it remained the same size.  I also have low platelets at the moment 75..  And lymphocytes are down to .8 prob. due to Radiation treatments I finshed 12 weeks ago to the day....  So that may cause some bleeding if I had the biopsy done now..    The good thing I have going is mets don't usually appear in the ulner...  Also discussed a PET scan but he said it would show what the bone scan already showed.. From discusiions on here I don't think that is true...... There is a chance that I could have nerve damage from a biopsy... Which may effect my upright bass playing.. So wait and recheck it is....

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