Advanced Prostate Cancer

Are yearly Pet/Ct scans wise?

Hi, I have 4 small spots in the bones that for now, appear to have been checked through intermittent hormone treatment. I have been monitoring the mets yearly for 3 years by way of Fluoride 18 Pet/Ct scans and I am due to have another set of scans next month.

My question is--is this a wise thing to do considering the amount of radiation?

jal

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I am struggling with that issue also. I have Ductal prostate cancer that often does not raise your PSA. The oncologist is weighing the benefits of scans in addition to PSA vs the long term damage of additional radiation. Currently they are studying my pathology samples to determine how much of the cancer will give off PSA.

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I have been wondering the same thing but have been thinking.....tracking the cancer was more important. I would love to see the answers also......as LG goes every 6 months for the sodium fluoride PET scan F18.

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One view of tests is that one should avoid those for which one has no plan if the result turns out to be worrisome.

What would be your response if the spots have grown?

I had a few small bone spots, in addition to a significant lesion at L5. I investigated radiation on the basis of oligometastatic disease (i.e. few mets). The PCa oncologist dismissed all but the L5, which he treated. The bone scan report had described all as being consistent with bone mets.

-Patrick

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Is that supposed to say one should avoid if there is no pain??? Or is the plan the correct word?

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"Plan".

It's tempting to run tests just to keep an eye on things, but if there is no intent to act on the results, why bother? Particularly if there is exposure to radiation. & tests can be stressful.

The way middlejoel's question is worded makes the test seem optional - as though results will not affect current treatment [IADT].

-Patrick

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Patrick, what was the basis for your oncologist to dismiss the suspected spots?

jal

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Joel,

Experience, I think. For the person who prepares the scan report, every blemish is suspicious.

When my oncologist pulled up the picture on his computer, I could see that L5 was osteoblastic (white), whereas the other areas were not. Only a follow-up scan would show whether he was right to dismiss them.

-Patrick

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I would not worrying about it. From 2003 to 2010, I had 18 Nuclear Bone Scans and Abdominal CT Scans. I'll have my 19th in November, only because its been a little over 6 1/2 years since the last one. For the record, I had two mets to my spine at L2 and T3, both are resolved. Last treatment of any kind was Lupon last given in February 2010. I started taking 4 mg of Androgen two years late and continue today with T ranging from 480-535. PSA remains at undetectable. Currently I see my Medical Oncologist three times a year and have 3 pages of follow up lab work for the trial which I had undergone.

Keep kicking the bastard,

Gourd Dancer

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Thanks so much Gourd Dancer! :)

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Hi there, this is good news and encouraging for us! May I ask what worked on resolving the L2 and T3 spots? Did radiation work at all? Or just ADT? Thanks a lot

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Neither. The mets resolved through a six month chemo trial. Frankly, it was understanding that this is the only way to resolve and replace with new bone growth. Radiation and Lupron are purely palliative design to lengthen time and reduce pain. The protocol which I under went:

Each course of chemotherapy lasts for 8 weeks. Patients were treated in weeks 1, 3, and 5 with doxorubicin 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with ketoconazole 400 mg orally 3 times a day daily for 7 days. In weeks 2, 4, and 6, treatment consisted of paclitaxel 100 mg/m2 intravenously on the first day of every week in combination with estramustine 280 mg orally 3 times a day for 7 days. After completion of 3 courses of chemotherapy, hormone management [medical castration plus casodex (at the completion of chemotherapy)] is initiated at the start of chemotherapy

GD

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Thought you might to see this from 2013. I am one of the nine mentioned.

Cancer Chemother Pharmacol. 2013 Jun;71(6):1629-34. doi: 10.1007/s00280-013-2163-4. Epub 2013 Apr 21.

A phase II trial of androgen deprivation therapy (ADT) plus chemotherapy as initial treatment for local failures or advanced prostate cancer.

Amato R1, Stepankiw M, Gonzales P.

Author information

•1Division of Oncology, Department of Internal Medicine, University of Texas Health Science Center at Houston (Medical School)/Memorial Hermann Cancer Center, 6410 Fannin St., Suite 830, Houston, TX 77030, USA. robert.amato@uth.tmc.edu

Abstract

PURPOSE:

Long-term hormonal ablation in prostate cancer is associated with decreased overall health and quality of life. Few reports emphasized the role of chemotherapy in the management of early stage prostate cancer. This study analyzed the safety and efficacy of androgen deprivation therapy (ADT) plus chemotherapy as initial treatment for patients identified as local failures or not eligible for prostatectomy or radiation therapy due to advanced disease presentation.

METHODS:

Enrolled patients received ADT in the form of leuprolide every 12 weeks for 24 months with bicalutamide initiating after the completion of chemotherapy. Chemotherapy consisted of ketoconazole and doxorubicin for weeks 1, 3, and 5 and estramustine and docetaxel and for weeks 2, 4 and 6. During weeks 7 and 8, no treatment was received.

RESULTS:

Forty-six patients were enrolled, and forty-five patients were evaluable.

Median progression-free survival (PFS) was 23.4 months. Median overall survival (OS) was 53.7 months. Out of 45 patients with measurable disease, 22 patients had an objective response: 9 patients achieved a complete response; 2 patients achieved a partial response; 10 patients achieved stable disease. Frequent grade 3 adverse events included elevated ALT (17 %), hypokalemia (13 %), and hypophosphatemia (13 %). Grade 4 adverse events were rare and included low bicarbonate (2 %), hypokalemia (2 %), leukocytopenia (2 %), and neutropenia (2 %).

CONCLUSIONS:

The treatment demonstrated clinical benefit in all patient subsets with minimal reversible treatment-related adverse events. Subgroup analysis suggests that having prior local therapy resulted in greater PFS and OS.

ncbi.nlm.nih.gov/pubmed/236...

GD

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My concerns would be more on what are you doing to REMOVE THE METS, and then there’s reason for the scans. If you’re not doing to remove / reduce the mets the scans are useless..

Best of luck

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