Elgie Recently had his 6 month well he went way over his 6-month but anyway he had his F18 PET scan. His results came back as increased activity in the left humeral head. So now we have to schedule an MRI of the left shoulder area to see what that says. I was in the understanding that the F18 was the best detector of cancer. I guess I was wrong and now we have to wait to get this next scan and results. I believe it has been over two years since any increased activity. No changes in scans until this.
Jackie
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erjlg3
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Hi Eric! I may have told you that.....I find myself saying that....femeral.... It is the humeral. Thank you so much for your support always. You are a good man and I so much appreciate you. Big hugs.
Like you, I had the impression that a NaF-18 PET/CT was the definitive way to detect PCa bone mets (highest sensitivity and specificity).
I had a whole body NaF-18 PET/CT on 3/3/16 that found a 5 mm sclerotic focus within the right sacral wing "with associated tracer avidity highly suspicious for osseous metastasis." So my oncologist ordered a 3T MRI w/ Dotarem (gadolinium-based) contrast agent of my pelvis. Same imaging center, although different radiologist doing the interpretation. The MRI was done 5/4/16, with the conclusion "no evidence for enhancing skeletal metastases. The 5 mm sclerotic focus in the right sacral ala is nonspecific in appearance and shows no evidence for enhancement or altered T2 signal suspicious for metastatic disease."
As I understand it, this means that the spot found in the earlier PET/CT was also seen in the MRI, but because there was a lack of contrast agent pickup in the MRI and no T2 signal, if this represents a metatasis, it is below the level of MRI detectability (which I think is about 2 mm).
My conclusion is that MRI is the best way to definitively image suspected PCa bone mets. Why don't they start with whole body MRI? That may happen some day. MRI has the advantage of no radiation exposure, but is typically more expensive and not all imaging centers do whole body MRI. The technology for imaging PCa mets has been evolving pretty quickly in the last 5-10 years and that no doubt will continue. Bottom line, great to have so many imaging tools available!
No pain. Did the scan when a marker for bone resorption/osteoclast activity (serum C-telopeptide) went sky high (1700% of baseline). Oncologist thought it prudent to get a scan, even though serum alkaline phosphatase (a marker for bone building/osteoblast activity more typical of PCa bone mets) did not look especially worrisome. Plan is to repeat scan in perhaps six months.
Here's a useful study that found DWI MRI (presumably w/ contrast agent) had substantially better specificity (although lower sensitivity) than NaF PET/CT: ncbi.nlm.nih.gov/pubmed/230....
And below is a message I just received from a retired oncologist in Seattle (Ed Weber) who specializes in PCa and publishes a newsletter called PCa Commentary. It was your post plus my recent similar experience that caused me to ask Dr. Weber for his perspective on this topic.
Hi Dave, I am going to do a Commentary with my radiologist friends to promote a protocol of mpMRI for staging prostate and the immediate vicinity (ECE) and the anatomy of regional nodes with views of the lower thoracic and lumbar spine/pelvis for initial staging or high-intermediate and high-risk PC. This combo will eliminate the need for Technetium or NaF bone scanning as initial staging. This protocol is based on the fact that bone dissemination begins in the pelvis and lower spine, and the MRI is more accurate than the two other scans which depend on bone reaction and remodeling due to tumor, whereas MRI can catch the process earlier.
For very high-risk men at diagnosis and upon PSA recurrence, so far the C11 studies are required, but that is where the FACBC scan [just FDA approved] will come in. In these cases you want to know about the extent and location of nodal spread and the PET/CTs do that.
The article, for which I am waiting, addresses the fact at initial staging the pelvic/lower spine MRI is quite satisfactory and a body MRI ( which takes 40 minutes ) is not necessary. If the disease is found on the protocol it either is only there or there and elsewhere. If you need to localize a symptomatic spot then Tech or NaF would be used.
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