I'm looking for some research regarding how often DEXA scans should be scheduled to track bone health. My husband is 61, and 4.5 years from diagnosis. His treatments: Lupron, Taxotere (6 rounds when first diagnosed), Zytiga and prednisone, Provenge. PSA has remained at <.1. No pain, he's still working full time. He has the usual side effects from the treatments, fatigue, weight gain, but nothing serious. He gets a CT scan once a year.
Today, the oncologist scheduled his CT scan for July but did not schedule a DEXA. He told my husband that it's only needed every 2 years. This is the same oncologist that wanted him to start Xgeva as soon as he was diagnosed. I think a DEXA once a year should be scheduled. He has had two scans since diagnosis and has been diagnosed with osteopenia. I think his T was -1.6 in 2020. Previously it was -1.7. He did not have a baseline DEXA.
Thanks in advance.
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Union98
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It doesn't seem to be changing much. If you feel comfortable getting it every year, get it every year. It's such a cheap and easy test to do. He may find that an estrogen patch and increased weight-bearing exercise are all he needs.
Good idea. Ive inquired about this as its also useful to locate bone mets. Problem is medicare wont pay for it inside the 2 years without a special letter from MD.
Ideally a DEXA scan for Bone density should be done every 6 months to track any changes in bone density and effectiveness of current treatment. The rules made by health insurance companies dictate doctors to do DEXA scan every 2 to 3 years. But, that's due to financial reasons.
In US, Dexa scan costs in the range of $60-$80. And private imaging centers are happy to do it for you if you pay out of pocket.
Under what circumstances are dexa scans generally called for? When are they not?
What do they pick up and what do they not?
To what extent and what circumstances can and/or should they be in used to monitor metastatic prostate cancer that has spread to the bone but is currently in apparent remission?
Under what circumstances do you jump to the more expensive pet / ct / mri scans?
DEXA scan is a simple 5 to7 minute scan which ONLY measures Bone Density. This scan provides scores like T score and Z scores of Vertibrae, neck of femur etc.. Bone Density is only one component of overall risk of fracture. There is a formula called "FRAX Score Calculator" You need to answer like "did you ever had a fracture?" "Do you have family history of fractures?" "Do you take steroids such as Prednisone?" and them you have to put your T score in this calculator and this provides you a final composite score indicating your risk of having a fracture at the given time. Just bone density alone is not enough for accurate assessment of fracture risk.PET CT and DEXA are two different things. DEXA has only limited ability and that is to tell you how dense your bones are.
None of my husband's oncologists (three of them, over five years) have ever ordered a DEXA scan. Not one (well, a PA once ordered one by mistake when he meant to order a nuclear bone scan).
Never had a baseline scan, never had a scan to see if there's going to be issues. They just pump in the Zometa every three months and call it good.
My PCP handles the dexa scans. Roughly a year after starting ADT +Zytiga/pred. Due for my second this July. The Dr's wanted to pump me with the bone strengthening meds but I said only after a dexa scan. Dexa scan was normal so no bone meds.
From my experience, it's not a well established protocol for when it's given. Given how cheep and readily available, it should be a no brainer.
i had one at start of titan trial....noone mentioned one for 4 yrs ...had one 6 mos. Ago ...good thing had a baseline scan,new scan showed 22 percent bone loss left hip....
I had that my first scan. Now my ribs are breaking . Ouch watch out buddy. We’re going to suffer . I’m trying to stay off is in meds for as long as possible
It's baffling to me that a baseline DEXA test, and regular testing after baseline, isn't SOC for PC patients: it is an easy, cheap test. Yet the start bisphosphonates right away, which have serious long-term risks.
Well actually it's not baffling--medical facilities can bill a lot more for bisphosphonates than dexa scans. This for-profit medical system is so twisted.
Its done and my FRAX is 1. Any idea what the range is? AP Spine is 1.046, Femoral Neck left .731 Femoral Neck right .709. MOF 8.7% Hip Fracture 1.1%. Any idea what it means? .The femoral necks stay Osteopenia but .731 is above -1.0 so why isn't it normal?
Dam! I’m no doctor. I got my scans and the dr didnt explain anything to me. Said prolia is working. Tells me my left# 3 rib is fractured. These docs know that we are all depleted .. post your questions and those in the know will answer? Basically my scans says that all of my joints are going . I feel it in every crack and crevice that’s breaking. I think the small outside bone in my left foot is broken . Crazy pain if I do an ankle rotation. Aye Caramba! I don’t know? 🤷♂️
How much does he exercise? Especially, does he lift weights? It’s so much easier for doctors to prescribe drugs than get involved with anything preventative. Not only is it what they do, who can blame them? In this case, men in particular tend to lie about their fitness habits.
I had a baseline T score of +1.5 at diagnosis which dropped to +1 and stayed there after a year of ADT. Weight bearing exercise almost surely the reason.
I got dexa scans in my own, since none were recommended by my doctors. This is wrong, but I knew and expected that. No matter in my case but if I had a doctor that was advising dexas every 2 years and I was a -1.7, wow. I might keep him as my onc, but I wouldn’t bother discussing bone scans with him anymore.
Weight bearing exercise in sufficient quantity usually eliminates or at least significantly delays the need for Prolia etc.
Which is nice but the best reasons to do it are well documented, proven, and make life on ADT FAR easier.
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At what point for scan ?
Dexa scan report showing osteoporosis 
Mike’s update 
CT or PET scan
