PET Scan vs CT and Bone Scan

PET scans are much more expensive than the others. Often, when looking for mets, they will use a combination of PET/CAT together.

david

A bone scan will pick up larger bone mets. A CT scan may show structural abnormalities like enlarged LNs or bony accumulations that look suspicious.

In the US, the only PET scans that Medicare or insurance will cover are the FDG PET and the NaF PET, and then only if the doctor does it as part of a registry for experimental procedures. The FDG PET isn't very accurate until later stage disease. The NaF PET will only show bone mets, but is not useful for soft tissue or LN mets.

The C11 Choline PET is FDA approved, available at the Mayo Clinic but not covered by insurance. The C11 Acetate PET is available at a few more places - UCLA, Almeida in Phoenix, U Kansas, and maybe a few others. The FACBC PET is only available at Emory U in a clinical trial, as far as I know. These scans will be paid out of pocket.

Europe is way ahead of the US with all this.

- Allen

In my case we did the normal bone scan not the more accurate C-11, F-18 etc since I already knew I had a few bone mets and knowing I had more smaller ones not visible on a normal bone scan would not change the treatment Lupron plus Xgeva.

If I ever get to the point of doing spot radiaiton for palliative reasons (no pain at moment though I have mets at T4 and at T9 and right sacroiliac) or whack a mole radiation, I suspect the radiaition oncologist would want the more high powered scans before initiating the zap.

Until I am eventually castrate resistant there are very few clincial trials for someone responding well to Lupron. I am considering one in Colorado that tests a new type of additive.

Here are excerpts from an email exchange I had on FW: NCT01992016 - How does this AZ study compare to the testing Mayo is doing?

"So, it is comparing apples and oranges. Two different modalities with goal of improving detection of prostate cancer using PET imaging. Our study uses the standard FDG agent used for regular PET scans, but he would take ranolazine for 5 days to see if that can affect the cancer cells’ glucose metabolism enough to be better detected on the PET. The Mayo study uses carbon-11 acetate instead of the standard FDG. In terms of which one is better at detecting the cancer, the answer is we don’t know since this comparison has not been done.”

The trial would pay for the scans but I would be on my own dime for travel and lodging in Aurora Colorado for a week or more.

I am not sure if I will do this or not, will discuss with my medical oncologist this week, but stalling them til the weather gets better in Colorado vis a vis what I have in Florida.

To expand your question, I also had MRIs to the spine and pelvic area.

The MRI to spine showed that the spot that glowed brightest on the bone scan at T7 & T8 was actually a benign hernaited disc with spinal compression that I never knew I had since I have no pain, and labelled minor metastasis.

Now that I no longer have adjacent mets at T7-T8-T9 spot radiation may be possible whereas when we all thought I had 3 adjacent vertebrae with mets, radiaiton was initially not deemed a viable option.

However the pelvic MRI showed that what appeared to be a minor dot not symmetric with the left sacroiliac was actually what radiation oncologist termed classic prostate cancer metastatic to bone. Given that, he was not pushing radiation until the Lupron has more time to shrink it.

I am scheduled to see him again in a couple months and will see what he advises regarding spot or whack a mole radiaition. I suspect it will remain do nothing unless I have recurring pain and then palliative only.

LupronJim

Thanks, Tall One.

A quick glance shows they use terms like "Progressive disease manifest (within 6 weeks of screening) by either imaging modalities (bone scan, MRI or CT) OR biochemical progression (PSA)" and "Metastatic progressive disease" but I will contact them to make sure it is okay to participate if I am not yet castrate resistant.

Since I am rapidly approaching my one year anniversary of starting Lupron on 3-28-2013, that sometimes precludes me from clinical trials too, but appreciate the heads up.

LupronJim