To bone scan or not to bone scan...

Hello fellow PC people,

Just discovered this site, approx. 1 month after diagnosis. I wish I had discovered you all sooner when I was totally freaking out! Better late than never, I suppose.

I'm 43 years old and recently diagnosed with PC (see my details below). My first pathology report had a Gleason of 3+4=7 which does not indicate a bone scan according to guidelines. However, the 2nd opinion pathology report came back at 4+4=8 which does indicate a bone scan. My urologist said that variation in the readings is to be expected, but also said would schedule me a bone scan if I wanted one. He seemed a bit luke warm about it and is much more interested in the upcoming MRI.

I am a bit worried about...

1. The exposure to radiation.

2. Finding a false positive or something else that detracts me from my treatment plan (surgery).

3. The fact that my urologist does not seem that concerned with it.

I guess I am having a dilemma if I should go forward with the bone scan or not. Perhaps the MRI is enough. Any advise?

Thank you in advance!

_________________________________________

43 years old
PSA: 7/13 (2.55) 8/13 (1.87) 3/14 (6.9) 4/14 (7.7)
Biopsy Reading #1: 10%, 1 of 12 cores 3+4=7
Biopsy Reading #2: 5%, 1 of 12 cores 4+4 = 8
Bone Scan: Scheduled for 6/12/14
MRI: Scheduled for 6/26/14
RP: Scheduled for 7/8/14

Post Edited (Izzy E) : 5/30/2014 11:58:16 PM (GMT-6)

Having read so many personal stories, stats and learning about the topic for the past 3+ yrs, I can tell you, that based on your stats (low percentage of cancer per core), age, etc, your bone scan would come back negative. What you need to worry about is that all the cancer is removed locally. Gleason 4 does have a potential to be nasty, so hopefully your surgery stats will be favorable. If not, than I am sure they will send you for post-op radiation, but again, given your low percentage of cancer per core, you have a very good chance of this cancer being contained.

If you do an MRI, you should request multiparametric MRI, as it has been proven very useful for PC staging: www.radiology.ucsf.edu/patient-care/services/prostate-exam-study

Ah, almost forgot. Welcome to HW. We hate to see you here, but if you need us, we'll try to help.

142 said...
Having a bone scan now will give you a baseline to compare against in the future. It will also be a point at which you'll need to pull back up all the memories of broken bones as a kid, as those will show up, and need to be explained to help any diagnosis.

As others will say, the odds are it will come back clean. Mine, after sorting out those early breaks, did. But once my PCa started advancing, they were able to better diagnose what was new.

I still wondered about the validity until the third one, where the first two proved very significant.

Yeah, radiation level is a concern, but early on in life I worked around nuclear plants as they started up, and flew at high altitudes several days a week for 20 years, so I've got plenty of things to blame it on.

Izzy, as usual I totally agree with 142.

My first bone scan in March 2013 establish a baseline that I had Oligometastasis (<=5 distant bone mets). My scan last week indicated the mets have cleared thanks to every 4-month Lupron since then doing its job and shrinking everything and yes unfortunately I do mean everything.

The standard bone can and DEXA bone density scan for baselines do not generate much radiation, it's the fancy C-11 and F-18 scans you don't want to over do

The MRI would give much more information than the bone scan. Make sure it is a multi parametric MRI with a 3Telsa as a regular MRI is practically worthless as is a bone scan for a psa under 20 and no signs of extra capsular extension or SVI. If you don't mind wasting money you can get a bone scan.
I'm not a big fan of getting a bone scan for a baseline unless you have confirmed Mets. You either have bone mets or you don't. The baseline is used to see if the Mets are growing or receding to indicate the effectiveness of the treatments you are getting.

Hi Izzy, Welcome here. I am glad you found this place, as my fiancé and I are as well. We are very new to this and Paul is only 47 so you men are in a very exclusive under 50 club. There are several others on here as well.

For your on peace of mind and for a reference it may be worth getting the bone scan now. Chances are small, but they are there. I assume they are also doing a CT or MRI of you abdomen/pelvic area? as stated below the MRI may be a better option if you are choosing to avoid radiation, as MRI doesn't use radiation at all.

Paul is very new to this (stats below) and we are now seeking a second path opinion as his cancer has infiltrated his lungs with hundreds of mets everywhere but is not even in his bones... very atypical as prostate cancer has a pretty well known path of mets and is usually acts in a very predictable way. His case is a bit different than yours though, his is near 100% of his prostate involved...

Send us a message if you like- he is palanon and doesn't write as much as me, but reads everything and we discuss this a lot.

Izzy,

I would scan, both bone and CT. You then know what you are dealing with. Also you have a baseline for later to compare.

Geoff