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  • New Diagnosis- Bone/CT Scans?

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    Old 09-15-2020, 03:50 PM   #1
    mbeach
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    New Diagnosis- Bone/CT Scans?

    Hi, my Dad is 83 and received his prostate biopsy, gleason 7 4+3 with PSA of 8.1. Dr. wants a Bone and CT scan before determining treatment. This has my Dad really worried. Dr. mentioned surgery was not an option due to his age of 83 and PSA 8.1. After some research it seems scans are not usual for gleason 7 or PSA under 10. My Dad's PSA has risen from 5.1 to 8.1 over the past few years.

    Maybe my preliminary research is wrong ... Are Bone and CT scans commonly used in this situation? Wondering why surgery was immediately ruled out?
    Thank you for any insight and knowledge.

     
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    Old 09-15-2020, 04:36 PM   #2
    Sw1218
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    Re: New Diagnosis- Bone/CT Scans?

    Quote:
    Originally Posted by mbeach View Post
    ...Maybe my preliminary research is wrong ... Are Bone and CT scans commonly used in this situation? Wondering why surgery was immediately ruled out?
    Thank you for any insight and knowledge.
    I'm so sorry about your dad. Yes, bone/CT scans are used as a precaution to make sure there's no evidence of spread outside of the prostate to the bones or tissues. that's a good thing that he's doing these scans. i'm not sure about your dad's situation, but i do know that at ANY age, surgery is not always the best option.
    __________________

    D.O.B. | 12/18/1973
    02.28.2019 | Dx 45
    Elev. PSA | 11.9
    GS | 4+3 = 7
    Treatment | HDR Brachytherapy & 6 mths of Casodex 50mg

     
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    Old 09-15-2020, 06:00 PM   #3
    DjinTonic
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    Re: New Diagnosis- Bone/CT Scans?

    Quote:
    Originally Posted by mbeach View Post
    Hi, my Dad is 83 and received his prostate biopsy, gleason 7 4+3 with PSA of 8.1. Dr. wants a Bone and CT scan before determining treatment. This has my Dad really worried. Dr. mentioned surgery was not an option due to his age of 83 and PSA 8.1. After some research it seems scans are not usual for gleason 7 or PSA under 10. My Dad's PSA has risen from 5.1 to 8.1 over the past few years.

    Maybe my preliminary research is wrong ... Are Bone and CT scans commonly used in this situation? Wondering why surgery was immediately ruled out?
    Thank you for any insight and knowledge.
    Remember we aren't doctors. It was determined that bone scans were overprescribed and I believe they are not usually done for less than G8 with a PSA below 20. However, there may be exceptions. For example, if your dad's 4+3 biopsy cores had a large percentage of pattern 4. And there may be other factors, e.g. suspicion that the cancer is long-standing.

    Some men in their 70s do have RPs, but surgery is usually not be advised for someone in their 80s.

    Hope that helps,

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk: 2.4%, 10-yr PCa-specific mortality: 3.3%
    uPSA: 0.010 (3 mo.)...0.013 (2 yr. 10 mo.)

     
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    Old 09-15-2020, 07:24 PM   #4
    Southsider170
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    Re: New Diagnosis- Bone/CT Scans?

    Quote:
    Originally Posted by mbeach View Post
    Hi, my Dad is 83 and received his prostate biopsy, gleason 7 4+3 with PSA of 8.1. Dr. wants a Bone and CT scan before determining treatment. This has my Dad really worried. Dr. mentioned surgery was not an option due to his age of 83 and PSA 8.1. After some research it seems scans are not usual for gleason 7 or PSA under 10. My Dad's PSA has risen from 5.1 to 8.1 over the past few years.

    Maybe my preliminary research is wrong ... Are Bone and CT scans commonly used in this situation? Wondering why surgery was immediately ruled out?
    Thank you for any insight and knowledge.

    Usually screening PSA tests aren't done for men over 80, because of the slow march of prostate cancer. Perhaps your father complained of PC symptoms, which was the reason for PSA test and biopsy in the first place?

    Taking a look at a CT and bone scan might indicate another cause for dad's complaints and he could have other conditions at the same time or even metastatic PC.

    You are correct that generally speaking, the rule is that lower PSA limits and gleason scores usually don't mean scans will be called for. But those limits vary from doctor to doctor and patient to patient.

     
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    Old 09-16-2020, 05:36 AM   #5
    IADT3since2000
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    Re: New Diagnosis- Bone/CT Scans?

    Quote:
    Originally Posted by mbeach View Post
    Hi, my Dad is 83 and received his prostate biopsy, gleason 7 4+3 with PSA of 8.1. ...
    Maybe my preliminary research is wrong ... Are Bone and CT scans commonly used in this situation? Wondering why surgery was immediately ruled out?
    Thank you for any insight and knowledge.
    Hi mbeach, and welcome to the Board!

    Your doubt after your research on the CT and bone scan is right on the money! Is it possible for you to get a "second opinion?" Unless there is something the doctor is seeing that you have not related, doing such scans on a patient like your father would be extremely unusual and extremely unlikely to yield a useful result. In my own case, with a PSA that was over 100 at the time, a situation where the scans were warranted, both scans were negative.

    The problem with such scans is that they require a relatively large tumor(s) to show anything. The CT scan needs a tumor about the size of a pea to be useful, and the technetium bone scan requires about 10% of involvement in bone at the site to yield a positive signal. Both are extremely unlikely for a PSA and Gleason score like your dad's. There are far more sensitive scans, but they are expensive, and they would almost surely show that your dad had no distant metastases. Therefore, their use is reserved for other circumstances. If you or your dad are good at diplomacy, you might gently probe to find out why your doctor is recommending scans for circumstances that do not fit the published and widely accepted guidelines for such scans. You might say something like "I've heard that older patients like my dad have a low risk of metastases, and we think we would be willing to do without the scans for now. Is there a special circumstance that would make them advisable?" (That also applies to younger, in fact all patients, but perhaps mentioning "older" would be a way of being diplomatic.)


    Getting a "second opinion" is par for the course for prostate cancer patients, and good doctors who are the first that patients consult understand this. It would be best for you or your dad to find that other doctor yourselves, rather than asking the first doctor for a recommendation. Prostate cancer support group leaders in your area, such as those listed at ustoo.org (the largest prostate cancer education and support group organization), or a coalition leader if your state is in the National Alliance of State Prostate Cancer Coalitions, may be able to help.

    Surgery is pretty much ruled out for patients after around age 70, depending on health, because prostate cancer surgery is a major operation, and older men just don't do as well at handling the surgery. Fortunately, these days, modern radiation is at least as effective as surgery in curing prostate cancer, and is very well tolerated by older patients.

    There are other forms of therapy that could fit your dad's circumstances well. One form is a mild version of what is known as androgen deprivation therapy (also as hormonal therapy, or Testosterone Inactivating Pharmaceuticals - TIP). Actually, that form doesn't stop the production of testosterone and DHT (dihydrotestosterone) but blocks much of their effect. The mild form is not as effective at controlling the cancer, but, as one expert has often said, it is about 80% as effective with only 20% of the side effects; that makes it a good fit for some older patients. That form of therapy would be best managed by a type of doctor known as a "medical oncologist" rather than a urologist.

    Good luck!

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 99 6/5/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength.

     
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