Opinion on a scan

[Scootman]

I had a bone scan in July 19 and was told mets in hips. Since then have had 2 rounds of SBRT to hips and ischium in sept and 2 weeks ago. Just had another Bone scan and cat scan last week. My one oncologolist read scan and said the spots were larger since July . My question is they could of grown before the sbrt and even with the sbrt is the area still going to show as a met. I know the sbrt helps with pain but does it also not kill the cancer in the spots which were targeted. If so would they still show the size of the mets. Plus my understanding is it can take a while for sbrt to work. One other question was told there was a spot on my femur. Doctor order x-rays of hip and femur to check for any fractures . The report can back ok and stated there was no indication of presumed met on femur. Would an x-ray not pick a spot that supposedly bone scan did?

[Tall_Allen]

SBRT should provide good local control of bone metastases. Sometimes a single large zap will do it; sometimes it takes two. It is an ablative dose, so it should work within a couple of weeks. You can try again - maybe with a larger dose.

prostatecancer.news/2019/08...

Bone scans show areas of bone overgrowth which may arise because of metastases but may also be due to fractures, arthritis or infection. Other imaging can help resolve what it really is.

[Scootman in reply to Tall_Allen]

Thank you

[Scootman in reply to Tall_Allen]

Spoke with the radiology oncologist today and he told me that the other radiologists did not look at all of my scans . He also said not enough time had past for results to show (2 weeks) and the met had grown since 7-19 scans and the sbrt would not shrink the met. He also stated that he thinks the bone scan showing something on the femur was just someone reading what could have been bone changes from the different radiation and he said he prefers using X-ray which he feels is more accurate. But he also told me that he feels that I should have chemo because xtandi and zytiga both did not work. Not happy about that I am pretty apprehensive about the chemo and side effects and the fact that the pills did not work will the chemo work with potential side effects.

[Tall_Allen in reply to Scootman]

Chemo has different side effects indeed. But in degree, the side effects are as bad with the pills.

Both docetaxel and Zytiga increase toxicity over ADT alone. In the LATITUDE trial, physicians reported grade 3-5 (serious to death) events among 68% taking Zytiga vs 52% on ADT only. Higher rates of grade 3 hypertension and hyperkalemia were observed. In the STAMPEDE trial, physicians reported grade 3-5 events among 47% of those taking Zytiga vs. 33% of those taking ADT only. Higher rates of hypertension and liver enzyme elevation were observed. In the TITAN trial (Erleada), where almost two-thirds had high-volume metastases, Grade 3 (serious) and Grade 4 (life-threatening) toxicities were similar (41-42%) for those who got apalutamide or placebo. In the ENZAMET trial, serious side effects were experienced by 42% of those taking Xtandi vs 34% of those taking an early antiandrogen. The rate of serious side effects is remarkably similar.

In the docetaxel trials, STAMPEDE reported grade 3-5 events among 52% taking docetaxel vs 32% taking ADT only. Neutropenia, lethargy and GI disorders were especially elevated. CHAARTED reported grade 3-5 events among 30% taking docetaxel. Neutropenia, fatigue, gastrointestinal and allergic reactions were elevated.

One might expect that the increase in toxic events would have been worse with docetaxel, but while they were different in kind, the incidence of all events requiring medical attention was similar for both treatments. All medicines seem to have lower incidence of side effects when they are used earlier, while patients are healthier.