Oncologist Ordering A Bone Scan - Should I Be Worried?

I wouldn't panic. Likely just normal protocol for the oncologist and highly unlikely to show anything. At your PSA level, it would be highly unlikely that anything bad is floating around your system.

To be very harsh, it's likely an unneeded procedure and I would question why it's being done.

I wouldn't take it as anything other than the doctor over testing. The doc might justify it as creating a, "base line," but if it shows anything other than the fact you have bones, I'd be very, very surprise.

Andrew

Don't panic as the bone scan is just SOP for most doctors. I would bet that it will show nothing and that is exactly what the doctor want and expects to see as well.

These days - doctors have to be exceedingly careful and the bone scan is being careful and doing his due diligence. The test itself is easy. Get a shot, go have some lunch or something, come back with an empty bladder and lay on a table while a machine takes pictures of your bones. Kind of boring really unless the Tech will chat with you and give you a blow-by-blow of what you and they are seeing. Mine was cool because he had a student looking on. He quizzed her and I got to answer as well. (I got more correct than she did!)

DonC
_______________________________________________
Age 61 @ DX, 62 Now
DRE: enlarged w/"ridge"
Pre-Op PSA: 6.8
Biopsy: 5 of 14 positive, 12%(3+3),11%(3+3),20%(4+3),5%(3+3),4%(3+3)
da Vinci: 10/17/2014 Both Nerves Spared
Cath: 17 days
Post-Op Path:
Histologic Type: Adenocarcinoma
77gr - 4.5cm x 4.7cm X 4.2cm - 10-20% Involved by tumor
Largest module: 1.6cm Bilateral Lobes
Gleason Grade: 3+3=6 (down from a 4+3=7 in biopsy)
TNM Staging: pT2c pN0 cM0
EPE: Absent, SMI: Absent
Margins: uninvolved, Lymph Nodes all benign
Bladder Neck Negative for Carcinoma
Perineural Invasion - present, Vascular Invasion - present
PSAs: (Roche ECLIA Meth.):
01/22/15 - <0.1 (Three Month test!!!)

To me this is perfectly normal. I was a 3+4 and I had a bone scan.

Active surveillance is not really an option for a G7, but ultimately the choice is always yours.

I wouldn't be worried. It is very rare for a bone scan to show anything at your PSA.

Tall - I understand. I'm far from going blindly into whatever one doctor says is the only way to go. And my consults are all with well known leaders in their speciality with names that come up frequently on this site.

But most of my research has been on surgery and brachy. Will investigate SBRT and Dr. Katz.

For most of us, following biopsy, the next step is contrast CT scan and bone scan, just to confirm the diagnosis from the biopsy. Think of it as confirmation and cross-checking. The worst part is drinking about a quart of nasty stuff.

halbert,
That may have been your experience, but it really does not apply to "most of us." Exposing people to extra radiation is a hazard and is not routinely done. It doesn't confirm or cross-check any biopsy findings. Just another expensive and unnecessary test.

- Allen

halbert said...
"For most of us, following biopsy, the next step is contrast CT scan and bone scan, just to confirm the diagnosis from the biopsy. Think of it as confirmation and cross-checking. The worst part is drinking about a quart of nasty stuff."

This was my experience as well. I was biopsied with Gleason 6, 3 of 12 cores. My Uro ordered a bone and CT scan.
Also, when i attempted to make an appointment with Dr Zelefstky i was told before seeing me, he would require the bone and CT scans as well as the MRI and slides. He wanted the actual discs in addition to the reports.

We will never reduce our hyperinflated health care costs in the US while patients are complicit with doctors in ordering expensive tests that prey on fears and cause fears. Let's remember that bone scans do not detect bone mets, they detect bone overgrowth, which is only sometimes, and rarely, due to PC. In the meantime, clinicians get into a spiral of ever more expensive tests to determine what the hot spots are, causing the patient all kinds of worry.

At UMichigan recently they found, "Applying the American Urological Association recommendations (ie, image when PSA level >20 ng/mL or GS ≥ 8) to current clinical practice, we estimate that <1% of positive study results would be missed, whereas the number of negative study results would be reduced by 38%."

In Sweden, they did an interesting campaign where they "shamed" doctors by publishing a list of inappropriate imaging studies that were ordered. It worked. Over a ten year period, they reduced inappropriate imaging from 45% of low risk men to 3% of low risk men. It's worth a try in the US. It could relieve a lot of unnecessary suffering.

Prostate Cancer Imaging Trends After a Nationwide Effort to Discourage Inappropriate Prostate Cancer Imaging

- Allen

Prato,

Mine was like yours. I got a chest x-ray, CT scan and Bone scan all in one day. The radiologist loved me for that as he could cross reference them all at once and give me a clear bill. (Which at my PSA I was expecting anyway. Did show that I need to lose weight but I also knew that already.)

I was leaning towards surgery anyway as I, like you, are just one of those that it works best for ME.

Works Out - you are on the right track with your other specialists. You primary doctor wants to be sure you take this seriously - and you should. Finasteride (Proscar) is used alone or in combination with another medication to treat benign prostatic hypertrophy - BPH. You really do not know your "real" PSA so these tests are a good first step.

The radiation levels from these tests are just not that high to cause worry. Like Casper said - LDR levels are so much higher. But that is just a treatment and you are just in the stages of figuring out if there is any treatment needed.

Take the tests, they should have or soon will do a DRE to actually feel around. If they become worried, like they did for me, a biopsy will come next. Also nothing to worry about. These are all tests to see if there is something to treat.

Hang in there and don't panic yet. You and your doctor are doing the right thing. You are taking action to see what is going on in there. Your choices of treatment are not even presented yet. t may be just BPH or it may be PCa. The issue is that you don't have anything to base your decision on. Get the data from the doctors and go from there.

Remember - if you panic, P-Man and I are out here to help you worry.

Keep us informed and keep the faith.

DonC
_______________________________________________
Age 61 @ DX, 62 Now
DRE: enlarged w/"ridge"
Pre-Op PSA: 6.8
Biopsy: 5 of 14 positive, 12%(3+3),11%(3+3),20%(4+3),5%(3+3),4%(3+3)
da Vinci: 10/17/2014 Both Nerves Spared
Cath: 17 days
Post-Op Path:
Histologic Type: Adenocarcinoma
77gr - 4.5cm x 4.7cm X 4.2cm - 10-20% Involved by tumor
Largest module: 1.6cm Bilateral Lobes
Gleason Grade: 3+3=6 (down from a 4+3=7 in biopsy)
TNM Staging: pT2c pN0 cM0
EPE: Absent, SMI: Absent
Margins: uninvolved, Lymph Nodes all benign
Bladder Neck Negative for Carcinoma
Perineural Invasion - present, Vascular Invasion - present
PSAs: (Roche ECLIA Meth.):
01/22/15 - <0.1 (Three Month test!!!)

Allen , that certainly explains why they wouldn't give me a bone scan in Sweden prior to surgery?

Cheers, Doug

You should't worry, but you will. Yes a great many medicos order a bone scan as a protocol. Yes it is an unnecessary test. a lot will order a CT also another unnecessary test with your stats. As is not limited to g;6, but also a soft 7 {3+4]such as yours. With your anxiety AS will just cause more, so that is probably out.
I would suggest looking into al the treatments that have been suggested get one done , the sooner the better, not be cause its urgent to do so, but because you will be happier when it is all over. You can get on with your life and find something else to worry about as anxieties genesis is within itself, not any particular data in life. I am not painting you with as wide a brush as Pratos and others here, as yours seems to be considered, but without relief. This season in your life will be longer than it needs to be, due to anxiety, but eventually will pass. Your greatest asset is for you to push up,pun?, your exercise program to mitigate the anxiety as you will daily discover hoe healthy you are,sans your pesky pca. Comparatively so. No shame on that, its called life, we all deal with it in our way. Good luck! The fact that your thread is titled such, tells me, as You also seem to do research apart from the forum, that you know it is nothing to worry about, but you cant help but find the "what ifs", example being your fathers case, and just want more comfort, which in the final analysis can only come from that which is inside of you.