Advanced Prostate Cancer
5,195 members4,855 posts

Arthritis or bone mets on scans?

I visited my oncologist today. I have had pain in my right hip where I was diagnosed with metastatic prostate cancer in June 2016. Scans then showed 4 mets, on both hips, rib & T10 & T11 vertebrae. Because of pain in my right hip, I had another scan recently which supposedly shows that the metastatic cancer can only be seen on my T11 vertebrae after ADT, radiation, & chemotherapy treatments. The scans show severe osteoarthritis on my right hip so my oncologist has recommended a hip replacement. I asked the question about how can you tell the difference between arthritis and mets and he said that is a good question and now wonders if I did not have mets on my right hip at all? I now wonder about the other mets. Has anyone else had this question answered? Also has anyone else had a hip replacement under these circumstances?

28 Replies
oldestnewest

A biopsy is the surest way. But if you are on ADT and it shrinks, that's a sure sign it was prostate cancer.

3 likes
Reply

If it is arthritis, activity is in certain areas of bone, the joint only , within acetabular cavity for hip. I seen X-rays for 40 years.

2 likes
Reply

How can you differentiate between mets and degenerative bone on the iliac crest?

Reply

To Brightman, My dx was 2015, after RT & 3yrs of Adt , I got severe bursitis in both hips but acute in the left hip. I couldn’t stand on or bend that leg.. I got an x-ray expecting a hip replacement advice.. Instead the Dr said I do have mild degeneration in that left hip, but nowhere near getting a replacement.. I was elated.. then he said the problem is not the hip. The problem is that your lowest 5disc have nearly no disc left between them... so Ive got that going for me. I now have DJ D = degenerative joint disease. I’ve lost 10 % bone density in the previous yearly bone scan . I get a new scan on the 16th so I’ll see what my lose is this year. I feel like the increadable shrinking man . won’t I end up a slug in a few years with this rate of bone loss.? They told me 10% is in the normal range.. Maybe for us APC patients that is true. I know the fear of every bone or joint pain of possibly being mets of pc. I try not to image that on myself . We know osteo is on us cardio disease can now jump us, we live in that knowledge. All of these geriatric conditions are excelled due to these life extending treatments.. Altough I’m not a candidate now for a hip , that could be in my future. Please let me know what happens with you.. Good luck Sir ...

2 likes
Reply

DJD is nothing. Anyone over 50 years has that. It means nothing.Do not worry about the the disc being almost gone. It depends on angle of spine when X-ray or imagery was done. Disc space is water in a capsule if you really what to know.40 years of experience. Remember, hip pain is felt in groin.

2 likes
Reply

Thanks, Drcrunch, Good to know djd is nothing. I do have the groin pain also .. It’s also pops .. many things that I’ve experienced in these past 3yrs with APC and now I’m 57 are as you stated normal aging things for us over 50 . The orthopedic that went over my x-rays said that my big problem is my lower disc. I’ve had lower back pain since I was a teenager. My mom had 2hips,1 knee replaced . She says her lower spine is calcified completely . Ain’t aging grand ! I do believe that APC speeds up the onset and severity of geriatric diseases like osteo and even dementia..and cognition. Don’t you agree that no T , adt , RT and chemo all weaken and deplete our teeth , bones , joints and muscles. ??????

Reply

Lower disc problems are felt in legs, not lower back. Most lower back problems are sacro iliac problem. Therapy or exercise can help. If pain is on left side , cause is usually getting out of truck or SUV. Also stairs in home cause it . If right sided pain is chronic, it is usually a soft couch or recliner. Get rid of it.

1 like
Reply

I’m left side. Thank you for your experienced opinion Sir. Makes me feel better.. enjoy your weekend.. ..Thank you for taking the time to reply to me...

Reply

Thanks Lulu700. I had a right hip replacement on July 26th and am recovering well, walking unaided and driving my car etc. The hip pain has largely gone, just aches in my legs which my oncologist thinks is neuropathy from the chemo which I finished in Feb 2017. The orthopaedic surgeon waited until the orthopaedic oncologist he works with came back from 3 months overseas because the MRI I had back in June supposedly showed traces of PCa. The previous scans done for my oncologist (except for the first few after I was diagnosed in June 2016) showed no cancer there but my orthopaedic surgeon wanted to be sure. The pathology after my hip surgery showed no cancer present. So that is what still makes me wonder whether the severe arthritis in my hip was not cancer in the first place? The most recent scan my oncologist had me do earlier in the year showed that there was only one area of PCa - in my T11vertebrae ( which had reduced in size & no longer in T10) and not to be seen in my left hip or 6 th rib. My oncologist is cautious, but I assume from all that and my psa being 0.01 - and has been from the beginning with treatments, that my treatments are working so far. However, During my hip procedure, my surgeon couldn’t insert a catheter, so was sent to a urologist (who luckily fitted me in that afternoon as he was operating on other patients) found that scarring on my prostate from radiation was impinging on my uretha, so fixed it temporarily & since is ok. So I am following that up with my own urologist on October 9th. So my path is not as tricky as yours My bone scans have been positive at this stage. Hopefully things are improving for you. Cheers.

1 like
Reply

Sounds like good news with the hip. Amazing what they can do .. I too have scarring or fibrosis at my Rt cite. If I hold pee tooo long I get some pain . Impingeing the urethra , that is bad .glad the dr helped with that .

Reply

It is not possible to answer your question with out knowing what kind of scans and what kind of contrast agents.

That you fail to mention this leads me to think no one has explored all your options with you.

Go get a consult with Dr. Almeida at the Pheonix Radiation Group.

2 likes
Reply

Excellent reply, cesanon.

1 like
Reply

Thanks for your reply cesanon. I live in South Australia so a long way from you in US!! I had a two planar examination of the pelvis followed by a delayed whole body and regional planar scan as well as a post contrast CT scan of Chest, Abdomen & Pelvis. These are the 3 rd lot of these I have had since being diagnosed in June 2016.

1 like
Reply

There are several pet/CT scans you should investigate:

Auximin, carbon 12 choline, carbon 12 acetate, and psma.

They react specifically to prostate cells as opposed to bone cells.

3 likes
Reply

You are really far south of us brother. Quite a trip to Phoenix.. you’re in it for the long hall .just as the rest of us. Does anyone know.?How harmful are all of these continuous nuclear and other scans are for us? I,imagine not good. I suppose the answer is they pale in comparison to the end stage scourge of APC. Do what we got to do..... take it easy.. Brightman...

2 likes
Reply

I am so sorry you are having to go through the 'is it or isn't it?' anxiety. Biopsy is best. Scans showed my husband had mets in his hip and needed pinning. Our ortho and primary care guy didn't think the cancer was as bad as our oncologist and radiologist believed. They did the pin and biopsied the reammings. No evidence of cancer. Hubby then needed hip replacement. Again, the 'experts' said it was mets. Guess what? NO, NONE, ZERO evidence of mets in any of that. My husband did have mets in his mediastinum region but zip in those bones. I don't know what the answer is. He passed away almost 18 months ago and I am still seething at the arrogance of the radiologist and oncologist.

3 likes
Reply

Sorry for your loss. If he had no mets, what what cause of death, if you know

Reply

After the hip replacement, he became septic and then everything started to go....

2 likes
Reply

That’s incredibly brutal to even hear about... Septic is not often survivable... . I,pray for your health and happiness. I’m sorry for this pain .. You have a right to be angry but Don’t stay there too long. My thinking as a husband that doesn’t want to leave his wife. I have doomed and gloomed about what happens to her once that I am not here... I will be very happy to hear that you are making peace and living with some level of peace. That will give me hope that my sweetheart will be OK also at some point after the grieving process is exhausted. God bless you wavedancer.... I’m praying for you..

2 likes
Reply

Thank you for posting this, Brightman! I've had periodic joint/muscle discomfort for years which I've written off as arthritis. Now I'm not so sure. I've got a bone scan Monday and review with the oncologist Thursday and I'll definitely ask that question. A very timely post!

1 like
Reply

Whoohoo , I too have a bone scan Monday..best of luck to you...

1 like
Reply

I had a bone scan about 2 weeks ago and that did not show any mets but plenty of arthritis. I have had pain in my lower back for more then a year so I am skeptical. Will be getting an Axumin scan on May 4th.

1 like
Reply

Arthritis is pumped with APC.. there best friends..

Reply

i looked up Anti Presenting Cell but with my limited medical knowledge I was not able to understand what that will mean. Could you explain??

Thanks

1 like
Reply

I’m just making fun of all of our other maladies that are made worse by APC treatments and no T. It’s a saga....

1 like
Reply

Advanced prostate cancer.APC . the terms are so long , we use abbreviations .and acronyms. Sorry about that.

Reply

Advanced prostate cancer =APC

Reply

Thanks Lulu700. I should have known what APC is but my brain is like my bones thin and full of holes.

Reply

You may also like...