Bone scan. Thoughts?

[mediocra]

My dad just had his second bone scan following completion of 6 rounds of docetaxel. PSA has fallen from 2230 to 0.06. I've attached a comparison of the first (left) and second (right) scans.

He has 2 lesions that persist. The caveat is that these 2 lesions were read as appearing like Paget disease on the first scan (second scan not yet read). I'm no radiologist, but they certainly don't have the classic punched-out appearance of metastatic lesions. Initially, I don't think any of us (esp his oncologist) really thought he had coexisting Paget disease, not with PSA that high.

We are planning on going straight into another form of therapy (probably abiraterone) along with continued ADT. Would it be worthwhile to pursue a bone biopsy to see what those lesions really are? If cancer, could he potentially get radiation there? I was also thinking about a PET scan, but I've read several places that a PET wouldn't be expected to show anything at a PSA as low as his is.

Thanks

[Hidden]

The limitations of PET scan with low PSA don't apply in this case because there are already known metastases that have shown up on a bone scan. It's unlikely that they would be gone.

[Tall_Allen]

That is one helluva great response to docetaxel - both PSA and radiological! Perhaps the abiraterone will shrink the remainder. Perhaps wait to see if they shrink, and if they do, you'll know it was PCa. You already know there are multiple bone mets - what do you hope to gain by more scans?

[mediocra in reply to Tall_Allen]

If they are/were cancer all along, would they be amenable to radiation (you have also mentioned considering radium-223 in another post)?

I understand not performing diagnostic tests if it won't change management, but the question of possible coexisting Paget has been puzzling. In fact, when the radiologist oncologist was planning treatment, he asked for a second read on the scan with the additional clinical information regarding the PSA and cancer. The radiologist still didn't change their interpretation with respect to the above 2 lesions.

[Tall_Allen in reply to mediocra]

I don't understand- you just said the radiologist, on re-examination of the evidence, ruled out Paget's disease, so why are you still considering it?

Xofigo is a good choice, but I suggest he does it before he starts abiraterone, or at least use a bone-preserving agent with them. The combination of Xofigo and Zytiga has been found to increase fractures. I think Provenge and Xofigo may pair well.

[mediocra in reply to Tall_Allen]

The radiologist still said those lesions looked like Paget disease, even after the PSA/cancer information.

I will ask the oncologist about Xofigo, but it looks like it's only approved for CRPC. He has been receiving monthly Xgeva throughout his treatment.

[Magnus1964]

That is a great response to chemotherapy. With A PSA that low I would not worry about a biopsy. Enjoy the test results and go on ADT.

[Bebby1]

HiMy husband did not have repeat bone scan for 6 weeks as oncologist said nothing much would be evident

I’ve noted from this site that Drs are very different in approach and follow up

Good luck to you

[monte1111]

What a great difference. Great pics. Hope things keep going your way.

[j-o-h-n]

I flunked out of medical school so I had to refer to Doctor Google.

Paget's disease

of bone interferes with your body's normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, the disease can cause affected bones to become fragile and misshapen. Paget's disease of bone most commonly occurs in the pelvis, skull, spine and legs.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/22/2019 6:54 PM DST

[AlanMeyer]

Knowing nothing about Paget's Disease I looked it up and found a useful article on the Mayo Clinic website: mayoclinic.org/diseases-con... Have a look at the "Diagnosis and Treatment" section as well as the "Symptoms and Causes". It sounds like, if it is Paget's Disease, it may not be very hard to manage it.

Meanwhile, as everyone else has noted, I think your dad's response to docetaxel was spectacular! I think that there's a good chance that he'll be able to control his prostate cancer for a long, long time.

I wish him the best.

Alan

[Howard53545]

great