1. What does the bone scan look for? Hot spots on the bones to identify cancer?
It finds areas of bone overgrowth. Overgrowth is caused by many things that irritate bone tissue, and it is not specific to metastases. Arthritis and bones broken in childhood are among the things that may show up. The MRI or CT scan will provide further clues. Of course, with PSA that high, all "hot spots" are suspicious for cancer. There are two ways to know for sure (1) a bone biopsy or (2)if the lesion is reduced after being on hormone therapy, or if hormone therapy reduces bone pain.
2. The Pelvic MRI, how is that different, what can that see?
They are looking for enlarged pelvic lymph nodes or misshapen ones. LNs larger than 1.2 cm are highly suspicious, smaller than 0.8 cm are not suspicious, and in between is equivocal. This is not a great way to find them all, but they are really just looking for high probability ones at this point.
3. I've read something like if the cancer has metastasized, you have a better outcome if it is in less than 5 spots? Is that true and why?
That is called "oligometastatic" cancer. It is probably true that fewer detectable mets mean that it is in an earlier stage of progression. The number of mets dictate whether early use of chemo is likely to increase survival -- if there are 4 or more distant mets, starting chemo earlier is more likely to be effective. If there are fewer mets, early chemo has shown no survival benefit.
The big question is whether radical prostate treatment (called "debulking" or "cytoreduction") increases survival at all (irrespective of the number of mets). We don't know the answer yet, but some retrospective studies look promising.
/pcnrv.blogspot.com/2016/08/is-prostate-specific-radiation-still-of.html4. What questions do I want to ask about
the final reports and results?
Ask how they will determine if the suspicious spots are mets or whether that is necessary. You want to ask about
next steps and which kinds of doctors to see to help you decide. To understand the range of choices read:
/pcnrv.blogspot.com/2017/06/newly-diagnosed-metastatic-m1-but-still.htmlIf his stage is N1M0 (see below), he can still potentially be cured with whole pelvic radiation or surgery+ePLND.
Since he is already taking Firmagon, there is no rush to decide.
You can also ask whether any of the bone mets are in weight-bearing bones that might later fracture. If so, he may want to consider a single "zap" of SBRT radiation to prevent that. It would also help relieve any pain it may be causing.
5. What does local versus distant metastatic cancer mean?
Local means the cancer has spread from the prostate into surrounding organs, like the rectum and bladder. It is designated as stage T4. If it has spread into the pelvic lymph nodes, it is sometimes called "loco-regional" and is designated as stage N1. Distant metastases may be to lymph nodes elsewhere (stage M1a), bone (stage M1b), or visceral organs (stage M1c).