I am wondering, is it standard to further confirm suspected spinal bone mets (found via bone scan and MRI follow-up) through use of needle biopsy?
Are bone biopsies subject to false positives and negatives, and do they add useful information beside simply helping confirm what is detected via scans as actual PC (as opposed to being a different kind of cancer or other abnormality)?
They could sometimes study the genome and do immunohistochemical studies of the cancer. It depends in how much cancer tissue they could get. The genome of the cancer is important since it could have specific mutations which could be treated with drugs such as Olaparib, Keytruda or similars.
Thanks.
Once a needle biopsy of the prostate is done, can/do those core samples get used for genomic testing? I can't remember getting a clear answer from my Uro (something like, "how much do you want to spend, and to what end?" may have been the gist). Would those cores differ from the bone biopsy in usefulness?
I believe if it is possible to do genetic studies from needle biopsies of the prostate. You could consider to call Foundation One and ask them.
foundationmedicine.com/contact
However the most important genome in your situation is the genome of the metastases. Metastases could be genetically different from the primary tumor.
One sure way to diagnose spinal metastases is to see if they shrink with hormone therapy. A biopsy may seldom be useful for identifying targeted genomic therapies are rare types of prostate cancer. Sometimes spinal biopsies are difficult to collect.
Completely agree with this advice, Allen! I was in terrible pain in my spine. I had to take oxycodone. Within a week of starting Lupron the pain was greatly improved and I was off all pain meds.
Why risk pain and spreading? I had Mets at t3 and L2. No bone biopsy. Marked via nuclear bone scan and soft tissue CT scan. Mine resolved with treatment.... Lupron and Chemotherapy.
GD
I agree with the others that it's not necessary.
My first doctor delayed the start of my treatment by almost 3 weeks so they could do a bone biopsy despite the fact I was in severe pain. They told me it was important because without knowing if I had Small Cell PCa, they wouldn't be able to give me the right treatment. My PSA was around 350 at that point.
Unfortunately, I didn't know any better at time. They could have sent me home with a bottle of Bicalutamide and I would have started getting better. Not to mention the fact that a bone biopsy isn't exactly an enjoyable way to spend the day or the next week.
If one has mets in the hips, shoulder and ribs as well as the spine, I was told that it would be easier to collect he biopsy samples from the hips or shoulder thus sparing the spinal column. Please correct me if I am wrong.
On December 1, 2015 MRI's confirmed the presence of multiple lesions on my spine, pelvis and ribs. After receiving a Treatment Plan from an excellent MO, I was invited to visit the Phoenix branch of Cancer Treatment Centers of America to receive a second opinion on treating my Stage IV Gleason 9 prostate cancer. After the requisite intake procedures of questions, imaging, and testing (a very thorough three days) the MO refused to give me my Treatment Plan! He asked if I'd be okay with them drilling a hole in my back! I said, "Sounds like fun! When can we get started?"
They said they wanted to take a sample from my T11 (for some reason, their tumor of greatest concern, maybe because growth here could compromise my spine) to grow in a petri dish. They wanted to confirm that it was, in fact, metastasis from my prostate and not an entirely different type of cancer (I think multiple myeloma was mentioned). If my cancer was metastatic it would rule out Radiotherapy, since the cancer would now be systemic.
As I was on my stomach on the CT guidance table waiting for propofol to be administered, the following exchange occurred:
Nurse to Doctor: Are we using the drill?
Doctor to Nurse: Yes, the big one.
Patient to Self: Hey! I'm still awake here!
Symptoms of beginning met to bones
PCa with Bone mets in femur 
Alk Phos and bone mets? 
Mets to Bones and Lymph nodes
