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Why do some have bone scan but some do not?

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Posted 12/9/2008 7:49 PM (GMT -5)
I have a buddy that was just diagnosed with PC yesterday.  His doc has ordered a bone scan and CT scan.  My doc never mentioned either test in my case.  He had a biopsy last week but He doesn't know his gleason score yet?  What drives the doctor's decision to order a bone and CT scan?  confused
Posted 12/9/2008 8:57 PM (GMT -5)
My doc ordered one and said it was to see if the Big C had metastisized to any other regions. SOme wind up with it in their seminal vesicles, bones, lungs, bladder,etc. The CT will probably be done with contrast which will involve a bowel prep the night before and the morning of. The bone scan is time consuming. They inject some sort of solution in you and have you come back 4 hours later. If the bone scan is done properly they will do an entire body scan and then do one of his ribs(hands behind your head). This is the way I did it. Anyone else can chime in .

Good luck to your friend.

Bob
Posted 12/9/2008 8:59 PM (GMT -5)
oh,
and good luck to you,also. You may want to ask your doc why he didn't order those tests.

Bob
Posted 12/9/2008 9:07 PM (GMT -5)

My urologist made the order based on my PSA and Gleason score. I had a CT scan with contrast and a nuclear bone scan. Bone scan was head to toe and took about 20 minutes to complete. CTscan was pelvic area only and only took a few minutes. Test were done to rule out metastasis or to prove the extent prior to recommendation of treatment. Final recommendation was radiation with full pelvic and prostate focal due to suspect lymph node in pelvic area.

Don

Posted 12/9/2008 10:28 PM (GMT -5)
Usually the level of PSA is a guide as to whether a bone scan and /or CT is ordered. In general, it is unlikely that there are metastases with a PSA below 20 and the lower the PSA the less likely there is to be spread. For this reason many docs will judge that with a PSA of say under 10 then the scans are a waste of time and money. On the other hand many docs will order the scans for those with lower PSA as a matter of course.
Bill
Posted 12/10/2008 9:40 AM (GMT -5)
My bone scan was ordered by my doc...not because of concern of any mets...but in his opinion to have a base line to compare with down the road if needed. Although the suspecious uptake on the ribs is being watched. Had another CT scan this last weekend...waiting on results. But not related to PCa.
Posted 12/10/2008 10:46 AM (GMT -5)
I have seen doctors perform on both sides of this coin, too. It seems logical to have the test. And I recommend to all the newly diagnosed to have one, or ask for one if necessary ~ prior to selecting a treatment. MY PSA was around 20, and I had one. But m doctor told me he always requested one. Les I think your doctor gave the best answer. Once a person has been diagnosed, getting baselines by having every test your insurance will pay for makes sense. If you think about it, in three or four years down the road a relapse occurs, comparig a new test to one you set for baseline is a great step foward.

This test is somewhat expensive and some doctors do use PSA and Gleason before suggesting this test. From my experience here, Gleason and PSA are not 100% indicators of metastatic disease. I have seen Gleason 6, PSA 4.7 turnout metastatic Gleason 8 after surgery. This was just one case, that individual did get that bone scan after treatment.

Again, you can ask for it!

Tony
Posted 12/10/2008 5:09 PM (GMT -5)
In OZ it is pretty much standard for a low PSA <10 not to require a bone scan. But some doctors still do it.
Posted 12/10/2008 5:13 PM (GMT -5)
From what I have seen this is standard procedure if your biopsy is at the high end of intermediate, or even high end of early detection. I have also read that the tests will not show anything unless the disease is really advanced. Unfortunately, I don't think a lot of credence can be given to them that just because they are clean that the person is completely out of the woods on spread. They are though of some comfort that obvious metastization is not present.
Posted 12/10/2008 5:41 PM (GMT -5)
RB...actually the Bone Scan is highly sensitive but not specific. Basically means that it will pick up very accurately any bone changes, but won't tell you if the bone changes are due to injury, cancer or any other type of bone changes that are taking place (like arthritis found in my hips and spine). As a result just like any test, further testing is required if the bone scan picks up something....How well I know...I am still being tested as a result of my bone scan (because of the ribs) and the jury is still out on that.
Posted 12/11/2008 1:16 AM (GMT -5)
After my diagnosis, my Urologist did not order a bone scan or other testing - just the recommendation for the da Vinci procedure to remove the cancer.  Our primary care physician and Urologist-specialist probably offer the best advice, because they know us and our medical history.  I was one of the lucky guys, because my PSA score was on the low side and the cancer was diagnosed early.
Posted 12/11/2008 2:48 PM (GMT -5)
My doc's indicated to me that at my PSA level there was no need for scans. But, I was having some pretty severe shoulder and heel joint pain, and it scared the wits out of me. So I basically pushed them into doing the scans (both thankfully negative) for peace of mind and to have a baseline. Ins paid for both without a problem.
Posted 12/11/2008 9:25 PM (GMT -5)

Bone scans are pretty reliable, CT scans won't pick up small small tumors in lymph nodes, only the large ones. Even though my scans came in clear my Doc still thinks there is a high probability of lymph node involvement because of my high PSA, and is scheduling me for an MRI in Holland that will pick up very small tumors in lymph nodes.

It's a good idea to get scans just to make sure, it definately will affect your treatment options if something else is found.

Johnt

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