Scans - if recurring, do these before, or after, initiating hormone therapy?

Background:
I like to know options before going into any situation. So, this is a little pre-investigation.

There's a distinct, non-zero probability of my case being recurrent. As I mentioned in a post on another thread, my MO has initiated the pre-approval process for Lupron and Prolia injections. This would only be appropriate if he's expecting my Monday checkup to indicate a recurrence in progress (I've been off-therapy for a year now).

I actually had a modest adrenaline dump when talking to the "business office" person, when I realized why she was happily reporting they'd obtained the necessary pre-approvals. Pre-approvals? Nothing has been planned, not to my knowledge. My doc has, apparently. Though perhaps he's only setting it up in case it becomes needed over the next year. This was rather shocking. Sheesh.

If a likely recurrence is indicated, there may be scans (Tech 99, CT, whatever) to look for any indications of whether recurrence may be local or not. With my case, I rather doubt it would be local, and even if it looks that way that's probably only temporary. The G9, primary type 5, stage 3 setting has always meant "cure" to be a long shot, though we gave it a good try.

Question:
So, would I need to do such scans before initiating hormone therapy? Might we initiate hormone therapy even before a nadir+2 is reached? Does it matter? They may want to perform the injections Monday at the appointment (certainly so by the way the business office rep was talking).

(I've been doing my best to remain unperturbed. This is not worry. This is not PSA depression as discussed elsewhere. This is doing homework.)

Thanks in advance for any advice.

Thanks, Andrew. That's rather what I've been concluding. Any scans driven by cellular activity (like T99, or any of the PET scans), would need to have, well, activity. A CT would not need that, if I understand correctly.

Yeah, you want the PET and other scans with the markers. I am not fully update on all the names of the scans you could get, but you want more than a simple CT.

In fact, depending what risk factors you doctor is looking at, you might wait till your PSA rises another point or so to give the scans a bigger target to find.

Hang in there,
Andrew

The only reason I can possibly think of to do scans before and after HT is to confirm the diagnosis.

I mean to say that there is never a reason to do a scan after HT, unless you are trying to find out if it has shrunk the mets.

mattamx said...
I have had failed RP and ART. My MO is letting my PSA go to about 5 and then do the scans to see if the mets are local or distant. Then I start the fun with HT. 😐

That makes some sense. Dr. Kwon's office at Mayo doesn't want to attempt the C11 Choline scan until the PSA is at least 2 or so. It can work at lower levels; I've conversed here with others who have scans there below that level. This would be out of pocket for me, so I'm going to need some serious convincing before spending about 3 grand. It would need to work, and to provide useful (treatment-guiding) information before doing it.

Oh, and having spent 3 years on HT already, I'm all too familiar with it. You can do it. Not fun, not desirable, but if necessary you really can do it. (One tip: if you enjoy sex today, get all of it in you can before starting HT; it pretty much demolishes that part of life, but weirdly you won't particularly care).

Axumin scan is very spendy, and my insurance won't cover anything like it. They consider C11 Choline too avant garde to pay for it!

Here's a pretty recent comment about the cost for an Axumin PET scan (forum name Spike1966 entry):

Report of Axumin PET\CT scan

From the article:

Spike1966 said...
Hey guys,

One more note for the scan, the total charges (before insurance) were...

PET scan: 7,010.00 +
Drugs: 12,272.00

BCBS insurance is pending; I'll report out when settled.

Holy carp. $20k!! Just what treatment decision would be worth that much money to determine?

After a bit over 12 months vacation from my first round of ADT, my PSA rose (quite quickly) to .7. My RO thought it worth having a PSMA scan, mainly because I could get it for no cost. I think the idea was to see if there were any mets which could be treated by SBRT. As it happened there weren't, but it did identify cells in the prostate bed and that is another question I will raise in a seperate thread.

However I do now wonder on the point of having expensive scans, because regardless of their findings, I don't think it is likely to change your treatment plan.

I have no doubt that in my case I am headed back for another round of ADT. In fact I expected that at my last RO meeting, but he suggested waiting 3 months till my next meeting (due in a week or so). I was happy to do that to avoid the hot flushes in the middle of the Aussie summer.

From now, I can't see much point in further scans unless I start to experience pain which could be treated if mets are identified.

Chas