Bad News. Would appreciate input.

[BarronS]

Bone scan that I looked at last night showed that there were no metastatic lesions on my dads bone scan. He had the old WBS done. The previous one he had was a CT scan on his lungs that ended up showing lesions to 2 spots in his vertebrae and a few on his ribs. It also showed positive margins around the prostate and some seminal invasion of the bladder wall.

My problem is that I've been researching bone scans and they seem absolutely awful when it comes to false-negatives and seeing lesions on the spine. It seems that the new standard should actually be PET/CT scans for metastatic prostate cancer. I'm also confused why he just didn't order this in the first place as I would think it would be more beneficial to be able to compare two similar tests that could actually measure the lesions and how the bladder was doing. This further leads me to believe that the my dads oncologist is stuck in the 1970's. I just messaged him this morning and requested a PET/CT scan to check the bladder and the margins around the removed prostate.

Thoughts? Am i being crazy? Anyone have a negative bone scan and then a positive PET/CT scan?

[BarronS]

Sorry about all the typos and overall flow of my sentences. I binged researched last night and got no sleep. Going to try and get 2 hours before i have to go in.

[tallguy2]

Every bone scan I’ve had in 7 years with this disease has been negative. It’s the CT scan and the the PET scan that you want.

[NPfisherman]

If his PSA is still .2, then it may show nothing if met lesions have shrunk...the Gallium PSMA scan measures down to .5 and the Axumin scan is accurate at PSAat about 2 and above...I would get the PET/CT and ask the RO to look closely at where last lesions were and compare.... Good luck....

Fish

[tallguy2 in reply to NPfisherman]

With a PSA of 0.15 my PET with Axumin pre-and-post chemo scans were invaluable to me. So what I am saying is please consider the PET with Axumin, even with very low PSA numbers. It was approved both times for me.

[NPfisherman in reply to tallguy2]

Glad it worked for you...when I had it initially I was told your PSA had to be around 2 to insure accuracy...if only they had a scan where you could be below .03...that would open up better options to attempt cures..Axumin is a huge improvement from bone and CT scans which showed nothing on me... Happy Easter....

Fish

[tallguy2 in reply to NPfisherman]

And a happy and blessed Easter to you, too!

[Tall_Allen]

In the US, Axumin is approved for recurrent PC with a PSA of at least 0.2 after prostatectomy. Most other PET scans will show nothing at PSAs below 2.0. PSMA-based scans are experimental and are only available through clinical trials. Bone scans usually show nothing at low PSA. FDG PET scans are pretty useless for early prostate cancer.

Most PET indicators are excreted through the urinary tract, so they will show false positives in the bladder.

[Schwah in reply to Tall_Allen]

TA, I thought that the PSMA scans are now available if you pay out of pocket ? No?

Schwah

[Tall_Allen in reply to Schwah]

PSMA scans are only in clinical trials in the US - there are restrictions. Some are free if you meet their qualifications, some are available for pay. Anyone can pay for Axumin off label, but it costs a lot

[Break60]

Bone scans are no where near as sensitive as ct pet scans and are generally not recommended until PSA is 20or above. They are obsolete but cheap. At some point when approved by FDA as is axumin for recurrence then ct pet scans with the new tracers will be standard of care.