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Old 07-06-2008, 03:49 PM   #1
IADT3since2000 IADT3since2000 is offline
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Diagnostic bone and CT scans: worthwhile?

So many of us undergo both of these scans following a diagnosis of prostate cancer; they are virtually routine.

Today's edition of Parade Magazine included an article titled "The Danger of Too Many Tests," and it prominently featured CT scans, also noting a concern about unnecessary radiation. Of course, most of us get a CT scan following diagnosis.

When the biopsy and other evidence indicates the patient has high-risk prostate cancer (me), those CT and bone scans are a quick and relatively inexpensive check whether there is substantial spread of the cancer into the bones and lymph nodes. But most of us diagnosed these days have low-risk cases.

Here's what is said about the CT scan in the book "A Primer on Prostate Cancer - The Empowered Patient's Guide," Strum and Pogliano, 2005, p. 62: "Unfortunately, a CT scan of the pelvis and of the abdomen is routinely ordered in virtually all newly diagnosed men with PC. However, it is our contention, based on published literature, that this is a serious waste of healthcare dollars while exposing the patient to unnecessary radiation and inconvenience.... For at least 90% of men undergoing baseline staging procedures, a CT scan of the pelvis is not indicated. In 99.9% of all newly diagnosed patients with PC, a CT of the abdomen is definitely not needed...." The Primer advises routine bone scanning if the PSA is over 10, but points out that for newly diagnosed patients with a PSA not exceeding 10, there is an abnormal bone scan in only half a percent of patients. (pp. 60, 61)

It's obvious that the authors of the Primer are in the minority, but what they have written makes sense to me. It's at least worth a little discussion with the doctor. He may be prescribing the scans just because it's defensive medicine protecting him against an ill-founded lawsuit.

Any comments?

By the way, with a baseline PSA of 113.6, a Gleason of 3+4=7, stage 3, all biopsy cores positive and most 100% cancer, my CT and bone scans were both negative. I've run into many high-risk patients with the same results. That said, doing both scans made sense for a case like mine.

Jim