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Abnormal bone scan at low PSA

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Posted 4/30/2010 2:44 AM (GMT 0)
Things going from bad to worse for me. BCR one year after RP. Getting ready for SRT, and I have an abnormal bone scan also picked up on MRI. Lesion on the lower spine. Uro called me at 9:30 this evening to tell me. Don't quite know what to think. This come out of the blue. Gleason is 8, but PSA has to be less tha 1. Last test one month ago only .31. Uro is ordering another test. Has anyone had an abnormal bone scan at a low PSA level?
Posted 4/30/2010 3:11 AM (GMT 0)

BB_Fan,

So sorry to hear of your BCR and bone scan indication.    I was googleing around and came across this 2005 article from the Journal Clinical Oncology:

http://jco.ascopubs.org/cgi/reprint/23/9/1962.pdf

Maybe it has some info that may help you or point to other sources of info.

This dang PCa is truly an evil beast...   I pray for strength and successful resolution to these latest battles.

pasayten

Posted 4/30/2010 11:11 AM (GMT 0)
BB, a spot on a bone scan is not uncommon...my husband's showed a spot on his right collarbone. A follow-up CT showed nothing. Bone scans will show every injury, spot of arthritis, etc. Don't know about the MRI though - what has your doctor recommended as the next step? Is "lesion" your word or the doctor's?
Posted 4/30/2010 11:41 AM (GMT 0)
Hi Sephie, Dr used the term "lesion" to describe the spot of the scan/MRI. Said it was on the lower spine, typical spot of PCa spread to bone. Dr (Surgeon who did my LP) said that the lab recomended a further test. He mentioned it to me but I didn't write it down. His nurse is going to contact me today about it. I will discuss with radiation oncologist this morning.
Posted 4/30/2010 12:09 PM (GMT 0)
BB,

I assume you did not have a scan prior to surgery.

Nevertheless, as Sephie said, lesions are not always cancerous. Therefore, while I know its not going to be easy until you take the next test and get the results, at least try to have some faith.

Wishing you the best.

Joey G
Posted 4/30/2010 12:19 PM (GMT 0)
Thanks Joey will try. I think the thing that freaked me out the most was having my Dr call me at 9:30 at night. He's very busy, probably the best robotic surgeon in CT. If I want to ask him a question I have to go through his nursing staff or wait for a 6 month appt. No scans prior to surgery.
Posted 4/30/2010 1:02 PM (GMT 0)
BB, the fact that your doctor called you at night - while alarming (I know, I've been there) - does not necessarily indicate a serious problem. When my husband's "hot spot" was found on the bone scan, it was the rad onc we were working with whole called to tell us about it. Granted the spot was on his collarbone - a long way for PCa to travel with no other spots showing up along the way. She consulted with our uro/surgeon and they both agreed that it needed to be checked further - that's where the CT scan came in. Rad onc and urologist didn't feel bone scan was necessary but agreed to a pelvic CT and bone scan with contrast.

In answer to your original question about abnormal bone scan with low PSA the answer is yes - my husband's bone scan was done when his PSA read .3 and they found the spot at that point.

Let us know how your discussion with the rad onc goes. .
Posted 4/30/2010 1:02 PM (GMT 0)
BB, no, you do not have good news there. But, until they know what that "lesion" really is all about, its not a done deal. I had to deal with a suspicious lung lesion at the same time as my open surgery, but I had to wait another 6 months in recovery before they would deal with it. When it was all said and done, not only did the lesion has nothing to do with my PC, it was totally benign and posed no future problem.

With your PSA so very low, it doesnt make sense that its directly related to your PC, but PC is so fickled, its possible that it is. I am sure you will relieved to have that tested further to give you some piece of mind.

I know how I would be feeling if it were me, so I feel for you, brother.

David in SC
Posted 4/30/2010 3:44 PM (GMT 0)
This is why I told the docs about places I knew they'd likely see a hot spot - arthritic knee, busted arm, bad shoulder, etc. I only wanted them to tell me things I didn't already know.
Posted 4/30/2010 4:31 PM (GMT 0)
bone scans are notoriously innaccurate. They have about a 40% rate in picking up mets unless it is really massive and have a lot of false positives. With a psa of under 40 there is only a 1 in 200 chance that the scan will pick up anything. Because of the high rate of false positives the shouldn't be given for psa less than 20. I don't know what futher steps can be taken to verify it, maybe a biopsy of the bone.
I would get a 2nd opinion from an medical oncologist specializing is PC before you start any treatments.
JohnT
Posted 4/30/2010 8:03 PM (GMT 0)
Met with radiation oncologist this AM. SRT on hold for now. He wants to see the scan and MRI, and talk it over with surgeon and medical oncologist. With all my other stats (high gleason, quick recurrence and rapid PSADT) he said the lesion was probable cancer. He talked about a biopsy if diagnosis was inconclusive and was setting up a CAT scan. Next steps may be IMRT for the tumor, if that is what it is, and then HT.

I will get a second opinion. I had the MRI and bone scan sent to a medical oncologist I saw at Dana Farber.
Posted 4/30/2010 8:16 PM (GMT 0)
BB, that sounds to me like a good plan you got in place from this point on. Please keep us posted, and I hope only for the best for you.

David in SC
Posted 4/30/2010 8:17 PM (GMT 0)
BB, maybe I'm naive but I'm surprised at this news. I think your decision to send the test results to Dana Farber is a very smart thing to do. I'm stunned by what your rad onc said especially since he hadn't yet seen the results of the MRI or bone scan - that's quite a statement to make. Regardless, I hope you hear from Dana Farber real soon and I hope the news is good.
Posted 4/30/2010 9:16 PM (GMT 0)
Sephie, Purg and others: Thanks for your support. The weather in New England is going to be fabulous this week-end, mid to high 70's. I'm going to the shore for the week-end with my wife, try to forget about MRI's and scans, and perhaps take on swin in the LI sound. Hope you folks enjoy your week-end where ever you are. Signing off. BB
Posted 5/2/2010 12:48 AM (GMT 0)

BB I have a question.Did you have a bone scan before surgery?

I had a hot spot on my bone scane before surgery and it turned t

o be nothing. I wish your luck.

Posted 5/2/2010 1:24 AM (GMT 0)
Hi: Just wanted to let you know I am in the same way. I Had radiation 2years ago, Gleason was 8, PSA 80 something. Have been on lupron since before radiation. PSA was below 1 until last may, PSA started going up added casodex. PSA went down momentarily and than started to rise again. Went for bone scan in December, lesion on right femor. No symptoms. Going for another bone scan in MAY. Hopefully lesion will show is nothing, Oncologist said if bone scan still shows something will do a bone I think he called it biopsy. Know where your coming from, sorry you have to deal with this. Is scary, but nothing I can do. Have tried to accept what comes of it comes of it. I am also 55 .
Posted 5/3/2010 1:00 AM (GMT 0)
Kak. sorry that we are in the same boat. It's a crappy thng for young guys like us. Don't know if I could wait for 5 months to know for sure. Where do you o for treatment?

Had a nice get-away this week-end Spent a couple of great days on the beach. Took couple of quick drips in the ocean. Spent some time with family and friends.

Well tomorrow the games begin again.
Posted 5/3/2010 3:52 AM (GMT 0)
Hi: For Treatment I am on hormone therapy lupron/casodex, but PSA is still climbing. Basically I have a referral for a chemo oncologist, but have been waiting for 5 months and it will probably be another at least 2 months I am not a priority and chemo is a treatment for pain , mostly it sounds like. I was told at this stage they will just treat as I cannot be cured. I had radiation so surgery is no longer an option. at first it was really hard, but what can I do so I decided to live each day, day by day fight with all I have and go on. I try not to think about it a lot. I was told if it has spread and there is pain they can possibly treat with spot radiation and maybe chemo down the road. It's a tough thing, but I am in good spirits and every day new things are found for treatment and I plan to be around , as long as I can, and maybe I will be the one they test the new cure on. Hang in there, live each day to the fullest, love your family and enjoy them. I just became a Grandpa for the first time and I plan to be able to take the little guy fishing when he's old enough.
Posted 5/3/2010 10:38 PM (GMT 0)
kak. glad to hear that you are holding up well, and congatulations on your new grandson. Things just seem to be happening quickly now. I have to slow down and relax. Had a nice week-end.

Have not heard from the doctor yet, but received the lab report in the mail. I'm hoping for the best.
Posted 5/18/2010 9:36 PM (GMT 0)

BB_Fan,

I re-vitalized an old thread to ask this question.  Your case seems to have some atypical characteristics and it has got me curious.  I hope that you don't mind me asking a few questions, but this is for my own understanding and learning.

I was surprised (as I know you were) to hear of your rising PSA post-surgery.  The clinical data provided in your signature did not give much of an indicator that this would happen.  Two pieces of clinical data not included in your signature are a) the number of biopsy samples taken and the number with cancer, and b) the percentage of cancer in each sample.

Would you mind sharing this info for learning purposes?

thanks...

Another BB-Fan. 

I happen to be a college hoops fan (not so much the pros); how about you?  I've been to seven Final Fours...lots of fun, and an exciting environment.

Posted 5/19/2010 6:36 PM (GMT 0)
Casey, rising PSA was a bit of a shock to me, particularly one year after surgery and a nadir of <.01. My biopsy did not send up any danger signals. 8 cores were taken, 4 from each side. PCa was found in 30% of 4 cores from one side. Pathology report indicated that tumor volume was only 9%. I will add this to my signiture.

I am actually more of an NBA fan, and big into fanstasy hoops (we should set-up a PCa fantasy basketball league next year). I do live just a few miles from UCONN in CT. I see a lot of the mens and woman's basketball games and follow the teams.
Posted 5/20/2010 2:23 AM (GMT 0)
Thanks for the added info...as I said, I'm just curious to understand more about some of the before & after situations. If you would have told me 1 core cancerous with 5%, I would have been shocked. I would still say that while you are not a statistical outlier, you are on one side of the curve. Wishing you the best with your next phase...

UConn's Coach Calhoun is a PC brother, you know. I saw him win the big dance in 1999 in St. Pete at the Tropicana Dome (baseball field!), and again in 2004 in San Antonio (best city to host Final Four with the Riverwalk).

take care...
Posted 5/20/2010 2:32 AM (GMT 0)
Mets detectible on a bone scan with a PSA of 20 or less is only 1%.
Posted 5/20/2010 2:58 AM (GMT 0)
yup...that's out there on the edge

I will be following your case with interest and best wishes...
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