Concerning Bone Scan Results

TopDog82

Hello Everyone. First, a little background.... I have a family history of prostate cancer: my father, two of his brothers and my (younger) brother all have or had prostate cancer before me. They each chose different methods of treatment, including prostatectomy, external radiation, and cryotherapy. I've had diagnosed BPH for 10 years now going back to an acute urine retention episode back in 2012. I've had green light laser surgery and two TURPs to reduce my prostate.

After a concerning increase in my PSA back in March of this year (2022) from 3.6 to 4.3 in six months, my urologist ordered a prostate MRI. The MRI showed a 0.5cc lesion PI-RADS 4 in the right lateral peripheral zone. It also showed no osseous lesions in the pelvis, no enlarged lymph nodes and seminal vesicles within normal limits.

Following that, urologist did a TRUS-guided biopsy and collected 12 samples. 6 (all from one side) were normal, on other side, 3 were Gleason 3+4, one was Gleason 3+3, and one was normal. So, now I knew I had cancer. Not much of a surprise given my family history, MRI results, and PSA.

Next, he ordered a bone scan, which I had on Wednesday last week. The bone scan showed: "Multiple foci of uptake in the bilateral ribs concerning for osseous metastasis in the differential with prior trauma/rib fractures. Consider CT chest for further evaluation." and now I'm barely able to hold it together. Rational part of my brain says this is just past rib trauma. Another data point is the my Alkaline Phosphatase was 92 back in March also. Everything I can find says it's highly unlikely that they would be Mets given my PSA, Gleason score, and normal ALP, but the emotional part keeps fighting back.

eonore

Hi Topdog,

I wouldn’t be too worried Scans are interpreted, not read The interpretation is highly dependent on the skill and experience of the radiologist who is doing the review. In my case, after recurrence, my Doctor ordered a Pet scan The radiologist saw metastatic disease in my lymph system and skeletal system. My doctors told me salvage radiation was off the table and only palliative therapy was in my future. Like you, I had a number of data points that told me that this was unlikely, and I was put off by their lack of curiosity. I promptly got my **** to Dana Farber, saw Dr. D’Amico who agreed with me. Two days later, the radiologist at Dana concluded that my Pet scan was entirely normal. I then had salvage radiation and a six month course of Lupron, and have been undetectable for three years.

I do not know where you are located and where you are treating, but if insurance and finances allow, I would try to treat at a cancer center of excellence. In the meantime, based on all your data points, it’s probably your old injury. Try not to worry too much.

Eric

Clevelandguy

Hi,

If it was me what I would do is monitor the rib situation with periodic scans in the future to see if more suspect areas appear or existing ones enlarge. If you have had previous rib trauma in that area what the CT scan saw could be related to that. Sometimes a simple xray is used to look for bone abnormalities. There are tests for Alk Phosphate that can determine if its from an organ or your bones. I have included links for your information.

https://www.webmd.com/digestive-disorders/alkaline_phosphatase_test

https://www.cancer.org/cancer/bone-cancer/detection-diagnosis-staging/how-diagnosed.html

Dave 3+4

Old Salt

Sorry, I can't provide any wisdom here, but I will say that those two posts offer excellent advice.

I do hope that further investigation will alleviate your concerns.

VascodaGama

Hi, Topdog,

I wonder your age.

Though your intermediate Gleason score 7 and negative MRI for lymph nodes and seminal vesicles are of low profile (clinical stage T2 N0), in my opinion the risk to have positive metastasis exist due to the long affair with prostate issues and your PCa family history.

I think that the positive Bone scan should be checked further even if the blood test comes out negative, because this result sets you with a T4 N0 M1 case . You can get a second look on the films by another radiologist but a biopsy of one or two lessions could give you peace of mind.

Threatment options for a T4 differ from the choices for a T2. Can you tell us what kind of intervention has been recommended by your doctor?

Best wishes and luck in this journey.

VG

TopDog82

https://csn.cancer.org/discussion/comment/1698330#Comment_1698330

Thanks. I will definitely check out centers of excellence. I live in Maryland, so not too far from Johns Hopkins facilities. My current urologist said he will give me a referral for a 2nd opinion from one their doctors, but that was before the bone scan.

TopDog82

https://csn.cancer.org/discussion/comment/1698365#Comment_1698365

I'm 62, about the same age my dad and his brothers had their diagnoses. Prior to my bone scan, the doctor was recommending brachytherapy, since I was classified as Intermediate Risk, Favorable. He was also going to give me a referral to a Johns Hopkins doctor for a possible prostatectomy, in case I wanted to go that route. I'm supposed to see my urologist tomorrow, only 4-5 hours after my CT is scheduled, so I'm worried the results of the CT won't be available to him by then though, so I may ask to reschedule to later in the week.

TopDog82

Hmm....CT scan wasn't any clearer. Radiologist saw several foci of various millimeter sizes on several ribs, most (maybe all?) of which he says "retrospect similar to the prior exam done 10/9/2020" (I had a chest CT for cardiac calcium scoring). Then he says, "These correspond to foci of hypermetabolic uptake on bone scan are most likely represent prostate cancer metastases. It is not entirely clear if these represent foci of prostate cancer metastasis or benign bone islands. Benign bone islands suspected." He amended his report 10 minutes later and added, "F-18 PMSA PET/CT could be helpful in evaluating these osseous lesions as well as any other areas of metastatic disease." So, it looks like whatever these are have been around for at least 21 months with little change I think. As an aside, it would help if his language/writing was a little clearer.

eonore

Hey Topdog,

I would make appointments with a radiation oncologist and a surgical oncologist, both of whom specialize in prostate cancer, at Johns Hopkins. They will get the scans to someone who does nothing but read these types of scans all day. A nurse at Dana Farber told me it was not uncommon for scans to be over read. With your low PSA, and your Gleason scores, it is unlikely that you are carrying such a large tumor burden. No reason not to treat at the best facility possible.

Eric

TopDog82

https://csn.cancer.org/discussion/comment/1698463#Comment_1698463

Thanks, I'll be trying to call them tomorrow. My regular uro doc has put in an order for a PSMA PET scan for me. I called to schedule and they told me they will get back to me to schedule after they get insurance approval. Hopefully, that doesn't take to long.

VascodaGama

I agree with Eric's opinion above. The PET scan would also provide additional data important in the final decision. However, at John's Hopkins they can help you with a second opinion.

Best,

VG

TopDog82

I finally got my PSMA PET scan scheduled for the 10th and I have an appointment with a doctor at Hopkins on the 17th. I'll update after both.

eonore

Good work, Topdog. You are approaching this the right way.

Eric

TopDog82

Latest update is that my PSMA PET scan showed no detectable cancer outside the prostate, which is great news. Now I get to go down the road of deciding whether I want radiation or prostatectomy (with possibility of radiation also). If I choose radiation, I get to choose what type. Medical oncologist (made appointment before I got results of PET scan) today told me that in my case, they were all equally effective in curing the cancer, it was just a matter of which side effects I wanted to have.

eonore

Congratulations on the good news! Now you get on with job of treating your cancer. Both choices, radiation and removal statistically have very similar outcomes in terms of treating your cancer. The issue is side effects. Possible side effects from surgery are immediate and very real. The skill and experience of the surgeon are very important. Modern day radiation, I believe, produces far less side effects and an easier recovery. I speak from the perspective of someone who had both surgery and radiation. If radiation had been a first option for me, I would have opted for it.

Anyway, talk to the docs, do your research, and whatever decision you make will be the right one. I recommend Dr. Scholz’s book, the Key to Prostate Cancer.

Eric

TopDog82

https://csn.cancer.org/discussion/comment/1699329#Comment_1699329

I met with the surgeon from Hopkins today. Of course he said he thought surgery was best for me given my age and health and urinary issues. I'm now leaning that way. I think he told me he'd performed over 2000 robotic prostatectomies, so no concern with experience there :-). We also talked about risks and side effects and he gave me what seemed like good, honest information.