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  • Just received my biopsy results - meet Urologist on Friday. What do I need to know?

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    Old 05-08-2021, 08:03 PM   #16
    DjinTonic
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Quote:
    Originally Posted by MrJohnny View Post
    Djin,
    He did not specify. Is there a specific type I should ask for?
    Thank you,
    John
    One of the best is the Gallium 68 PSMA, which was recently FDA-approved, but somewhat limited in geographic availability. The other is Fluciclovine F 18 (commercial name Axumin PET/CT), which is more widely available. You can google these to read about them.

    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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 05-11-2021, 09:49 AM   #17
    MrJohnny
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    All,

    I'm at the hospital now for my scans and I am confused and trying to figure out how I misunderstood the urologist about which tests I was to receive. Please advise!

    I was scheduled to go to the PET scan/NM department. I arrived and they tell me I'm not getting a PET scan, it is a bone scan. I've been injected with the radioactive stuff and now waiting for 3 hours for it to settle before they scan my bones.

    Given my biopsy results, listed earlier in this thread, shouldn't I have gotten a PET scan? Why, in your opinion, just a bone scan?

    While waiting for the bone scan they did do a CT scan. Why that and not PET?

    Something was lost in translation during my conversation with the urologist and I'm a bit unsettled. Should I be?

    Thank you.

    John

     
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    Old 05-11-2021, 12:14 PM   #18
    IADT3since2000
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Quote:
    Originally Posted by MrJohnny View Post
    ...

    I was scheduled to go to the PET scan/NM department. I arrived and they tell me I'm not getting a PET scan, it is a bone scan. I've been injected with the radioactive stuff and now waiting for 3 hours for it to settle before they scan my bones.

    Given my biopsy results, listed earlier in this thread, shouldn't I have gotten a PET scan? Why, in your opinion, just a bone scan?

    While waiting for the bone scan they did do a CT scan. Why that and not PET?...
    John
    Hi John,

    Talk to your doctor again about this after the scan. The PET/CT scan is pretty expensive, and many insurers won't pay for it unless there is a prior negative standard CT and technetium isotope bone scan. That may be what is happening here. Your doctor may be going through this process to get to the PET scan. It is possible he does not think the PET scan is necessary.

    It is also possible you are getting a very sensitive and specific F18 (flouride 18 isotope) bone scan. The only problem with it is that it is not good at detecting metastases in soft tissue.

    Good luck, and keep your spirits up.

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 12/2/2020). (Current T 93 12/2/2020.) 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. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 05-11-2021, 01:31 PM   #19
    MrJohnny
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    Re: Just received my biopsy results - meet Urologist on Friday. What do I need to kno

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi John,

    Talk to your doctor again about this after the scan. The PET/CT scan is pretty expensive, and many insurers won't pay for it unless there is a prior negative standard CT and technetium isotope bone scan. That may be what is happening here. Your doctor may be going through this process to get to the PET scan. It is possible he does not think the PET scan is necessary.

    It is also possible you are getting a very sensitive and specific F18 (flouride 18 isotope) bone scan. The only problem with it is that it is not good at detecting metastases in soft tissue.

    Good luck, and keep your spirits up.

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 12/2/2020). (Current T 93 12/2/2020.) 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. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.
    Jim,

    Thank you for the response. After reading your post I talked to the technicians and you are 100% correct. I am getting a standard CT and a technetium isotope bone scan. They said exactly what you posted regarding doing these first as well as insurance issues/cost.

    I really appreciate your explanation and your last sentence of cheer. It was exactly what I need to hear.

    Respectfully,

    John

     
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