When to get scan

[Ben2]

2 years after IMRT and 9 months hormone therapy for Gleason 8. Any inormation on whether I should have a scan to see if cells have spread? which scan? Thanks

[cfrees1]

Is your PSA rising? That is typically the monitor for whether recurrence has happened and if scans are needed. I am not at that stage yet, and I'm sure others can offer better advice on this, but my belief is that scans would be needed after PSA rises. Are you on ADT?

[Ben2 in reply to cfrees1]

Thanks for response. My PSA is 0.1, finished ADT 2 years ago after being on for 9 months neo-adjuvant and adjuvant. I thought PSA could stay low but cancer spread so scan was part of monitoring.

[AlanMeyer in reply to Ben2]

Ben,

There are some relatively uncommon varieties of prostate cancer for which PSA stays low. However I speculate that if your PSA rose above normal before treatment, then you don't have that variety of cancer and you can rely on the PSA to signal a recurrence. If your PSA was abnormally low before treatment, then something other than PSA might be needed.

For most prostate cancers, PSA is a much more sensitive indicator of recurrence than any kind of scanning. For most patients, an MRI isn't likely to show anything at all until the PSA reaches around 2.0. As I understand it, 2.0 is the minimum PSA after recurrence before which the Mayo Clinic will scan patients looking for lesions that might be treatable.

My PSA bounced around from 0.6 to 1.8 after my treatment with radiation at the National Cancer Institute. However, at no time during this period did the doctor scientists at NCI's Radiation Oncology Department propose more scanning. Instead, they went first to a monthly, then a quarterly, then a semi-annual PSA test until my PSA settled down to a low value (now about 0.07.)

Good luck.

Alan

[Hidden in reply to AlanMeyer]

My pre-treatment PSA was a paltry 2.7 and it actually had slipped a bit from the prior year's reading of 2.9. I am wondering how useful PSA testing will be after treatment. My low reading gave me hope that my biopsy would come back fine. No such luck. 5 of 12 positive. Gleason 8 in one, 6 in another and 7 in the rest.

[Hidden in reply to Hidden]

Wouldn't have been caught without that DRE.

[AlanMeyer in reply to Hidden]

That PSA does seem low given the biopsy results - though I speculate that there will still be some rise if there is a recurrence. However, at this point, it might be worthwhile to consult an expert if you can find one. The typical urologist or oncologist isn't going to have much experience with this. Ideally, you'd want to see someone at one of the big teaching and research hospitals who really specializes in prostate cancer, not just someone who does general urology or oncology. Even then, I don't know if the state of the art of medical science has much information about cases like yours.

Unfortunately, as I understand it, ordinary x-rays are of little use. MRI or PET scans are much more sensitive, but also very expensive. Insurance won't pay unless established medical science confirms that this is necessary at this time. So it's a problem.

[Ben2]

thanks-just what I needed

[JoelT]

After radiation treatment you need to wait to reach what is called a PSA nadir (the PSA number at which you eventually stabilizes. Once nadir is reached you need to monitor the PSA for changes. In your case the important numbers are changes in the PSA, not the number itself. What is your PSA history post radiation?

Joel

[Ben2 in reply to JoelT]

My PSA after 1 year after radiation and 5 months after stopping

ADT was 0.1 and has been that for last 12 months.

[patandemma in reply to JoelT]

patandemma@+JoelT

I have had 6 cycles Docetaxel and have been on continous ADT,both started in July 2016.

I am currently halfway through proton beam therapy directed at my proste _ (prophylactically) my para-iliac lymph npde + thpracic spine mets.

PSA going down stadil to 0.8 (2 weeks ago).

My question: From your rading ,what is the range of time or average time to reach PSA nadir AFTER IMRT or proton beam therapy ?

[JoelT in reply to patandemma]

First, for men who have been diagnosed with prostate cancer and have radiation it can take as long as a year for some to reach nadir. Most do find nadir in less time, but one year is not uncommon.

Given your treatment protocol I am not sure how you fit into the common picture. Given that you have also received docetaxel, I am not sure if the concept of nadir applies or not.

Assuming that you took chemotherapy because you have very aggressive cancer I personally would be hesitant to wait for 3 PSA rises or an increase of 2.0 over nadir.

Talk to your doctor about this, but I would tend to be overly aggressive in my own personal treatment given your cancer.

Joel

[patandemma in reply to JoelT]

patandemma@+JoelTT

Thanks for your reply to my question

After completion of radiotherapy,how fequently should PSA be checked to pinpoint when nadir occurs-monthly,3-monthly?

[JoelT]

Sounds to me as though your nadir is 0.1. This is the number that you will need to guide you going forward. According to the AUA you have a recurrence if your nadir rises an additional 2.0 ng/ml (over nadir) or if you have three three consecutive rises over nadir.

Joel

[drdanfee]

I think timing of scans should be a medical decision one makes with one's healthcare provider(s). That said, my own regimen with my oncologist is more or less to get an annual full body scan so that we can track the stage four bone mets in particular, as well as overall bone density.

[Scruffybut1]

First I would ask your Oncologist. I imagine a rising PSA would be indicative of either spread or PCa making own T to counter your treatment. CT scan I have just had but not a great type of scan as it slices views into thin sheets and can easily miss a lesion which could be on a slice not fully categirised. You don't appear to have bone lesios which therefore would lead to MRI.

David