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What tests previous to SRT?

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Posted 6/26/2012 11:40 AM (GMT 0)
My husband will be starting SRT soon.
We have been to radiation onc (not at sloan) and a med onc at SLoan Kettering.
The med onc wants to do a bone scan, and an endorectal MRI of the prostate bed.
The radiation onc does not think these tests are necessary do to the low PSA 0.27, and neg lymph, seminal
We have another RO appt, for a 2nd opinion
What tests are standard...

Thanks

Lin
Posted 6/26/2012 12:44 PM (GMT 0)
Both my oncologists -- medical and radiation -- are at Sloan. My med oncologist ordered the same set of scans before sending me to the radiation oncologist. The purpose is to rule out -- using the only tools available -- that the disease has not already become visible at distant sites. If the scans show nothing, that does not mean that the disease has not left the immediate prostate area -- only that it is not detectable. If the scans show distant disease, then radiation would not be done. At Sloan in my case we had maximum treatment possible:

Radiation to prostate bed
Radiation to lymph in pelvis
Six months hormones starting approx 3 months before SRT

Sloan believes in aggressive treatment for aggressive cancer. Their view was that my cancer is very aggressive, having returned so soon after surgery and being a Gleason 8. Best wishes.

NewspaperLover
Posted 6/26/2012 12:59 PM (GMT 0)
My husband's rad onc also suggested that his psa was too low to show anything on the scans. He didn't think scans were necessary. But the surgeon had them done anyway - I think because of our questions - and they didn't show much of anything. The MRI showed one possibly suspicious node which may be why they decided to radiate nodes, but I don't know for sure.
Posted 6/26/2012 1:12 PM (GMT 0)
Never forget the word liability in this discussion. Doctors almost have to do the scans to prove that there was nothing showing when they started.

I had a bone scan and a cat scan with contrast with a .06 PSA, and a DRE.

There are some cancer variants that produce small amounts of PSA as well, usually the high gleason ones.

I guess better safe than sorry is a way to look at it.

Good luck
Posted 6/26/2012 3:46 PM (GMT 0)
I'm not aware of a formal "standard", but as has already been mentioned, distant mets would likely negate value of RT, at a potential cost in side effects. Better know that up front.

When I started with an oncologist, he had me do a bone scan and used a recent CT scan (accepted as it had been done in a facility he is associated to), these being to establish a benchmark of my condition upon arrival to him.

Posted 6/26/2012 8:01 PM (GMT 0)
The likelihood of finding anything with the bone scan in your case is very remote, and one of the reasons why that procedure has been identified as a "not very worthwhile" procedure. I understand that the bone scan needs several million cancer cells in a location before it can show positive. So even if you have mets, it may not be able to show them up. But as others have said, it seems to be standard procedure and may relieve some liability. Personally, the only reason I was glad I got it is that it was the first time my entire body was scanned, and in case there were some other type of cancer somewhere, I got a decent reassurance that I am only dealing with PCa.
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