Bone scan is negative. What's next? What should I expect?

Mikee:

With your PSA at or around 8.6 you'll probably be able to look at all of the different therapy options.  The bone scan being negative is obviously a good thing but if you have Gleason scores of 8, 9 and 10 I am a little surprised that you haven't had a CT of the pelvis/abdomen.  The CT does a better job(obviously not perfect) of picking up any organ problems and lymph node issues.

Are you seeing a oncologist or a urologist right now.  If its an oncologist you'll probably get a pretty fair suggestion on which road to follow because he shouldn't have a dog in the fight other than for your well being.  If its a urologist I'm sure he'll suggest surgery. 

David

Oncologists are usually seen if there are some complications with your therapy but they are great to see if you can for a true unbiased opinion on which way to go as inital therapy is involved.

If you truly have some high Gleason scores like you think you do you should do your DD but don't wait around too long making a decision.  Us high Gleason guys need some therapy sooner rather than later.

Some other things to consider are how many sticks were positive and what percentage of each stick on your biopsy.  What is your staging T1c or such, it all matters in your decision making.

David

 

mikee219 said...
I guess I get all that information at the meeting on Friday. I hope waiting a week isn't too long. What do you mean by DD?

   I know you feel like things are coming at you too fast right now.  Waiting a week or even months will make little difference on your final decision and outcome.  Slow down if you can.

Even if you have a very agressive situation, you have plenty of time to ask questions and make a good decision.

There are various scanning methods, some newer ones that may be somewhat more precise (conceptually speaking). Nothing so far is perfect or 100% definitive, in others words it is very possilbe to have a clear scan and not be guaranteed you don't have PCa somewhere. Prostatscint can even give false positives sometimes (written about in books), so maybe don't consider that method or realize it could happen.
Naturally if it shows up on a scan you have enough there to be "seen" and the minimun number of cells that that might be (heard from radiologist years ago-so don't quote me directly) 1-billion cells.

There is talk from the medical industry and maybe with good reasons, that scanning like every patient is wasting resources in insurance costs, probably because the majority of PCa presentations (cases) the persons have usually low psa, low stats, some have 'indolent' PCa or close to those parameters and will have clear scans in probably ultra high percentages. In effect maybe a scan is not needed in assessment of their condition. (Not my words, their talk on this).

Good old Bob here with my lousy stats, had clear ct and bone scans (I even got the real film in hand), it was reviewed by two other rad-onco-docs and agreed looks clear. Now what do the Partin tables and nomograms say comparatively about those odds???

Dx-2002 bpsa 46.7 (total urinary blockage) probably had prostatitis undiagnosed(had symptoms), 12/12 biopsies 75-95% in everyone, gleason scores found 7,8,9's about equally on both sides of the gland.
ADT3(neo adj.)+Radiations-Neutron & Photon-ADT1-3 for 2yrs., quit, started Des 1-mg 1.5 yrs., quit and no drug for 2yrs., just restarted Des as psa changes since Summer 2008, psa declined 2 wks. after taking Des again, dropped twice already, waiting for further psa's in future to compare.

When exploring the options which may be available to you, include your primary care physician in the discussions - because he/she is the person most familiar with your health history and who should also be aware of specialists in the area with whom you might want to consult. Each of us is a bit different in the diagnosis and strength of the cancer, so what's right for me may not be right for you, etc. Stay strong!