Advanced Prostate Cancer
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To Scan or not to Scan

I have a conflict between the opinions of 2 doctors concerning taking baseline imaging now that I've done my last chemo infusion. I'm now coming up on 6 months into treatment.

One doctor says I need to get a CT and a bone scan as a baseline for future comparison.

The other says it's unnecessary and just more radiation that I don't need. He says to just watch the PSA and how I feel. If we suspect progression from those, then do imaging.

I'm inclined to agree with the doctor that says don't do the bone scan and CT for a baseline. Whenever my doctor wants to do some kind of test or imaging, I always ask: How will the results of that effect the treatment? If it's just to get more information or out of curiosity, that's not enough.

Right now, all indications are that my disease is not progressing. How will taking a bone scan and CT scan effect my treatment plan at this point? Or will it just give me more anxiety trying to analyze what it means? I don't think I need these images to tell me my cancer is progressing and I know what the next step in treatment will be when that happens.

I do have a bone scan, CT scan, MRI and general x-rays from diagnosis already.

So unless there is valuable information from these scans that help me make decisions about my treatment moving forward, I won't be getting more of them until it's necessary.

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I had my scans as part of my diagnosis and then underwent radiation and chemo. My local oncologist waited a year before my next scans and used my PSA tests, which I have monthly, to keep a watch on me. He actually recommended quarterly PSA tests, but I was more comfortable with monthly, so that's what we decided to do. When I had my next set of scans all was unchanged from my initial scans.

Given my Gleason 4+4=8, my oncologist at MD Anderson recommended monthly PSA tests that I mail to her and scans every 6-months. She calls it 'aggressive monitoring'.

While I'm not a doctor, I would suggest they probably think waiting is ok for a period of time. How long has it been since the scans you had when you were diagnosed?

Wishing you all the best!

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Thanks for the reply. My last scans were in February and March. The one doctor is talking about doing them again in September so that would be around 6 months. I think the results need to tie into treatment somehow or it doesn't make sense to me to do them.

What treatments are you currently on and would scan results cause a change in your treatments?

I think for me, if my PSA and ALK PHOS start rising and/or pain starts to show up, I go right to secondary ADT regardless of scans. So the outcome is the same and that's what I'm looking at. I guess if I was having pain and the PSA and ALK PHOS were not going up, it would make sense to see if maybe there was something else causing it.

If I get the scans, then what specifically would I do treatment-wise with the information?

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I'm on Lupron. I had radiation for bone pain in my spine when I was first diagnosed a little over 2 years ago. And I had 6 rounds of chemo that I mentioned previously.

My PSA has slowly risen for the last year. It reached 0.8 back in February. Stayed there for 3 months. Then jumped to 1.2 where it has remained the last 3 months.

My doctor at MD Anderson said this week we would wait until it reaches 2.0 and then add Zytiga. Or possibly join a clinical study that will add Zytiga and another treatment (I'm not sure what the other drug is).

And we will continue scans every 6 months, or sooner, if I have pain or the PSA jumps significantly.

Hope this helps. Good luck with the results from your chemo!

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I'm so thankful that you all put your thoughts out here :)

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Hi Gregg, I am by no means an expert, but I have read that the disease can progress with a low PSA and no pain, so a scan may be the only way to tell. I'm not sure, but this may be for some guys, whose PSA is not informative. My scans were 7 months apart. I was reluctant on one hand to have them, but keen on the other to see what the chemo had done. As per my recent post, it's still not that clear even after the scans, but it has reduced my anxiety level.

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Hi Gregg.

I just started Xtandi. My doctor had me do new bone & CT scans as a baseline. We'll check PSA monthly, & have new scans after 3 months to look for any changes.

I think your situation is similar because the one doctor wants scans that show your status following your chemo treatment, as a baseline that future scans can be compared to.

Neal

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Yo Gregg (as we say in Philadelphia), my Onc said no need for any scans due to the PSA being so low. In case it rises then he'll order new scans. I'm praying that it doesn't elevate.

Nick

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Here are the number and frequency of my scans -both Nuclear Bone Scans and Adominal CT Sans.

On initial diagnosis, before and after Brachytherapy, before and after IRMT. All of these were within 13 months of initial diagnosis.

Then in May 2004, scans when PSA exploded to 32.4 and resulting metastatic Prostate Cancer. Then a set of scans eights months later at the conclusion of a six month chemo trial.

Then over the next five year, 15 more sets of scans. Then finally the last scan six years later.

I have had a total of twenty-three scans since March 2003. One might think overkill with scans, however, after the chemo trial which resulted in resolved mets, we want to track any return of metastatic lesions. Fortunately, there has been no return and new lesions.

Keep kicking the bastard.

Gourd Dancer

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I laugh every time I see your......Keep kicking the bastard 🤣

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Hey Gregg I think you've answered your own question (not to scan). If it were me I would scan (more info the better). Like I've said before, "I've had so many scans that I'm starting to speak Scandinavian".

Good Luck and Good Health!

j-o-h-n Wednesday 08/09/2017 11:50 AM EST

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Lmao

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