Bone scan results

[Nuray]

Had bone scan two weeks ago?daw my Onc today and she noticed slight dark patch on my lower vertebrae

[Sisira]

Hi Nuray,

The question you have raised is a typical issue we all face with bone scans. The bone scan has long been the standard means for detecting bone metastases. However, any trauma to bone will also cause a positive bone scan. The MRI is very useful in differentiating trauma from bone involvement with cancer and should be used if the bone scan is at all ambiguous. When prostate cancer invades bone, it can cause new new bone formation. This happen because prostate cancer activates the osteoblast, the key cell involved in bone formation. The osteoblast releases a protein, called bone specific alkaline phosphatase, and the serum level of this protein increases as prostate cancer invades bone. ( Any test result should be validated by proper clinical examination ).

To be more familiar with your case I went through your profile briefly. It is worth reading again Alan Meyer's reply to understand all about PSA readings in managing the PCa decease.

I hope you can compare and contrast your pathology with mine and learn some points to better understand what is really happening in your case. I read extensively on PCa in an effort to understand my own PCa and to be the manager of my own case. Here it is :

I was diagnosed in March 2015 at the age of 68. Staged T2cNoMx and GS : 4+5=9. Treated immediately with RP + IMRT + ADT ( Zoladex, continuously for 2 years ending April 2017 ). Zoladex is a LHRH agonist similar to Prostap ( Leuprorelin ). My PSA before surgery was 7.9ng/ml and one month after treatment started went undetectable. Thereafter when checked every three months, up to now remained at 0.008ng/ml. Since this April I am out of the above primary treatment regimen but I take daily 1 capsule of Avodart ( 5AR Inhibitor ). I am on proper food, some supplements and regular exercise since they support managing this decease more effectively. With the Bone Scan I faced the same problem before doing the surgery. My bone scan detected suspicious metastatic uptakes in bilateral shoulders, T4 vertebra and sternum. A MRI was taken to evaluate these, which did not confirm same but interpreted them as possible trauma to those bone spots. ( God only knows! ). I have had shoulder joint pains over a long period of time. Since I am in remission at present I will reinvestigate sometime later. In contrast to my status you have already experienced a relapse. I have no knowledge of your initial PSA, pathological factors other than your GS : 4+7 . I am also not sure whether you took Radiation and ADT ( Prostap ) immediately like me as adjuvant treatment after prostatectomy. Prostap - how long?

In this situation one important thing we have to remember is even before our diagnosis thre is the possibility of PCa cells to escape from the prostate gland and enter our blood system and the lymphatic system. This is called micro metastasis. More easily and preferably they settle in the bones, next in the lymph nodes, and also may migrate to the lungs and the liver ( rarely ) and may be to any part in the body. Sooner or later when they begin to grow, we start getting the symptoms ( bone pains, PSA rise etc. ) Since my reply is going to be too long, I do not wish to discuss anything with regard to Treatment. I you have any further questions please feel free to ask and I will only be too glad to help to the best of my ability.

Best of luck

Sisira

[Nuray in reply to Sisira]

Firstly thank you very much for your detailed response Sisira,firstly I two was diagnosed in in September 20014 with cancer?early 2015 I saw very highly recommended consultant at London a Barts hospital? After having bone scan and MRI scan he assured my that my prostate cancer was confined within the prostate glan?as one of my cancer cores was clearly on the Edge of my prostate glan to?but seeing the bone scan came back clear thankfully?the consultant asked me what treatment I'd preferred Opted for removal of my prostate cancer completely?that was disgust early Jan 20015 he said they was no reason to rush and have my operation as my prostate cancer was confined ect?I waited two more months and had the operation? before surgery my Gleaso 3+4=7 prostate adenocarcinoma,4/12 cores with pain and neural invasion MRI left anterior apical lesion -T28,No Mo after surgery,my biopsy results confirmed there was breakage with the prostate capsule?post Histology results Gleason 4+3=7 adenocarcinoma stage T3a (extra-capsular spread for 2mm at left posterior base).Posterior positive intraprostatic limit for 1mm in the region of left posterior apex with perineurial invasion? So sisira nine months clear undetected PSA then next three months PSA stated rising fro 0.4 to 0.8 then 0.13 then started Prostap injection for six months had my last one 9th June and 36 sessions of Radiothereapy to the prostate bed at 66ray then saw my Onc on the 20 July with my current bone scan sisira reqards Nuray now because of bone scan showing slight shadow had quick X-ray on the 20 July also and due to have my MRI scan 17 Aug same day see my Urologist to..