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?
Answer to these questions are already there in yesterday's post by Union 98 ...titled DEXA scan How Often ? Please read there.
Dexa scan measures bone density. After years on ADT drugs your bones loose density and you end up with osteoporosis. You may be placed on xgeva.
They are really just Xrays with some extra processing that shows bone mineral density.
Dexa scan are indicated to measure bone density. They are usually done every 2 years. The T value of this test is used to determine when a patient have osteoporosis (t = -2.5 or greater). Dexa scans are not used to follow bone metastases. These lesions ae usually follow by the obsolete techniques of CT scans and Bone scans. The most sensitive techniques are the PSMA PET/CTs follow by the Axumin scan.
Dexa scans to study bone strength, PET/CTs to study lymph nodes, bone and visceral mets.
DXA [DEXA] will give you the bad news, but there is something you can do to get a better result.
For many on ADT, bone loss starts early, and there is great variation. However, some degree of loss is the norm.
Men with low estradiol [E2[ lose bone rapidly.
Men make most of their E2 by aromatization of testosterone [T]. When T is in the castrate range, E2 may be suboptimal. It should be expected.
If E2 is <12 pg/mL, the lowest-dose E2 patch should be used. Trial-&-error will lead to a target E2 level- say, 20 pg/mL (more is not better.) A daily patch may be required, or less frequent.
Monitor E2 regularly when on androgen-axis targeted drugs.
Remember that vitamin K2 is essential for mineral transport to bone, & that K2-7 is also an anti-PCa vitamin.
Doctors like to treat problems rather than preventing them. In this case the treatments increase the risk for necrosis of the jaw. There are no side-effects with a prophylactic low-dose E2 patch. Even with osteoporosis, the low-dose E2 patch will facilitate restoration - if suboptimal E2 was the cause.
{It has been said that men with PCa & NOT on ADT suffer bone loss too & need the scan. I can't speak to that right now.}
Best, -Patrick
I have several points that I think will add to this thread. 1. My oncologist suggested I begin Xgeva 2 years ago as metastatic lesions multiplied. I took a Dexa Scan prescribed by my GP. Bone Density was above average and the Oncologist then agreed that there was no reason to take it before necessary. The useless nurse practitioner told me that Xgeva for Metastatic cancer had nothing to do with bone density. I did not accept that. At this point, I think it was the right thing for me to do.
2. A fellow warrior I met in the waiting room said he had side effects from Xgeva and wondered if he could have avoided them. I hadn't heard about Xgeva being that unpleasant before. The dental stuff related to necrosis of the jaw was all I was alerted about.
3. I participate in a clinical trial for AMG 509. I am on the same weekly schedule as a clinical trial bro and we now communicate regularly. He told me that he had a rare opposite reaction to Xgeva. It weakened his bones and his femur broke in the fall of 2020. He started a month after me, at triple the dose. His PSA results are much better than mine. 87 to 4 in 8 weeks.
4. I recently asked about Xgeva after learning that I have more Mets and PSA is in the low 90's. I was thinking about getting a DEXA scan after 2 years. My doctor told me I could take the test, but I can't take Xgeva on this trial. I decided to let it go for the time being. I will press the issue if needed after my next nuclear bone scan and CT scan at the beginning of June. Knowing if my bone density has deteriorated is likely an important data point.
I feel good, remain aerobically fit, and have decided to add weight training again. I am going back to the gym tomorrow (Monday, May 3) with a trainer, twice a week. I am fully vaccinated and found a 1 on 1 environment that seems safe. I am hoping that, along with staying active, will help keep my bones strong (enough).
I played golf 3 times in the last 1.5 weeks. I felt fine, though my back gets crampy for about 24 hours after golf. Wednesday's golf was with my uncle who will be 96 on July 1. He is an AMAZING man. I tee it up in the fairway for him and hold his arm as we walk on uneven ground, but he still hits his driver pretty damn far.
I apologize for adding more questions without providing answers. After a several-month break from reading and talking about Pca, I am communicating more about it these days.
It is so important for Doctors to communicate better about what to expect, and what to watch out for. At least for me, it is important. The emotions of having cancer are challenging and we are all so different, but knowing others' experiences can help to mitigate overreaction at times or be a catalyst to responding more quickly to things that we should be concerning.
Philly
I get my first one in June for a baseline and will request a E2 test thanks to this thread.
understanding Ct scans with bone scan reports . 
Scans
Why do Bone Scans and CT Scans if PSMA-Pet are available?
Scans
Questions about types of scans.
