Question regarding scans

All PC cells give off PSA so a PSA is a very good indicator of how much PC is in his body. Additional scans don't provide any more info than the blood test at this point. If the PSA has dropped, the mets are reduced.

A scan is redundant and expensive.

Andrew

Teamchris,
I am inclined to agree with Andrew if blood tests continue to show decrease in PSA and no other indicators of need to change tx. However, not having blood work since July seems ludicrous! How can your oncologist determine whether or not the chemo is still working?? The blood panel shows more than.PSA. It has a lot of indicators to determine next tx and if a CT SCAN or bone scan is needed.
If it were me, I'd be considering a new medonc. But first, INSIST on a current blood panel!
Beth

Not all "blood work" is alike. I'm sure his WBC and RBC was monitored during therapy, as were other "danger signals" like creatine, liver enzymes, etc. Monitoring for efficacy is a different thing than monitoring safety - Because chemo is destroying cancer cells, they are releasing PSA, so early results may show that PSA is going up instead of down, even though the chemo is working. You don't want to stop it early just because PSA is rising.

Six infusions 3 weeks apart is the standard protocol for Taxotere. There is a balance between killing the cancer, toxicity, and driving selective pressure for Taxotere-resistant subtypes. Of course, one may be re-challenged with it after a few months. Usually it keeps working for a few cycles if used this way. Then there's Jevtana.

I absolutely agree that when first-line hormone therapy (e.g., Lupron or Firmagon) isn't getting a complete response that it's probably a good time to bring in Xtandi or Zytiga or both. However, they are only approved for metastatic castrate resistant PC, so Teamchris would have a hard time getting it outside of a clinical trial before PSA rises. And I think that all Xtandi and Zytiga both may work better than either alone, but that is also only available in clinical trials. Unfortunately, most of the good stuff is not available for hormone-sensitive men.

- Allen

Teamchris,

I had a similar diagnosis like your husband's. At the time of the diagnosis I did an MRI, a CT scan and a scintigraphy (bone scan) to determine the exact initial status of my disease. Then I started with ADT and did six cycles of Docetaxel. Towards the end of the six cycles I switched my ADT drug to Firmagon (which I think is a highly efficient drug).

Every month since my initial diagnosis I had a full blood test, which looks at about 25 variables, including PSA.

After 6 months, about 1 month after we finished chemo, I did again a bone scan and a CT scan. This allowed us to compare the initial status with the status after the chemo. This comparison showed that the chemo had been very efficient, several lesions had completely disappeared and the tumor burden was significally reduced. I was VERY glad to see that with my own eyes! After the stress of the chemo I could see for myself that it had been worth every challenging moment and that I was clearly better. After the initial brutal shock of the diagnosis this gave me hope.

I continue to have a monthly PSA test and will do another round of scans in a couple months (six months after the end of chemo, 12 months after initial diagnosis) to see what the tumor is doing.

I can not understand why you would not do a round of scans after the completion of the chemo of your husband. Chemo is a big and expensive gun and you want to know what you have hit with it. Not taking images is like flying a fighter jet with all controls turned off (or maybe just the altimeter on, which would be your PSA - still not a great way to fly an attack). This disease is complex and the treatment has to be adjusted to the specific situation of each patient. And the basis of a successful treatment is to know as well as possible what is going on.

PSA is certainly a very valuable indicator. But I do not believe that it gives you the full picture. If the PSA of your husband is still detectable there is cancer activity. You want to know where this is happening. There are locations that may not be dangerous for the foreseeable future. And there are places in the body where a metastasis can fairly quickly create problems.

You can of course say that you might as well just wait until a clinical problem occurs. But I do not think that this is a wise approach. I at least want to know as much as I can about my enemy in order to know what my options are if he makes a move.

And even if PSA is way down and everything looks fine it is just great to see for yourself the effect of the treatment. This may be routine for your doctor - but it isn't for you and your husband. So even if from a strictly medical point of view it is not really necessary to do these scans I believe it is important for you and your morale to do them. This is a nasty disease and we need all the positive things we can use to fight it.

Bottom line: If you and your husband feel that you would like another round of scans after the completion of his chemo you should insist. He is the patient, he decides.

I wish you all the best - m.

Post Edited (Madagascar_63) : 10/9/2015 4:59:51 AM (GMT-6)

Certainly, if there is pain or evidence that organ function is impaired, a scan makes sense to guide palliative radiation.

Madagascar, I disagree with your metaphor and question the actual utility of the scans. There is no evidence that prophylactic palliative treatment of mets is any better than post facto palliative treatment, in fact, it's possibly worse as it exposes nearby organs to unnecessary irritative radiation.

In fact, we absolutely do know what is going on without extra scans. There are systemic circulating tumor cells that form small metastases - even if they are too small to see. The important question is what we can do about it, rather than where they all are (which we can never know with current technology.) There is no value to a diagnostic procedure that has no implications for treatment. In fact, they only generate anxiety in the patient, and, of course, raise costs.

Clearly, you were happy to see the before and after scans. But if PSA did not go down, would you have been happy? That said, there are valid research purposes for taking extra scans if there is a clinical trial going on.

- Allen

Some guys have advanced prostate cancer that gives off little to literally no PSA...not the norm I know...but in this circumstance, peridodic scans help monitor progression.