When to do a CT scan?

[Lavender22]

Hi All,

Could use your feed back on our current status as we move forward. Mainly I am curious as to how often and at what junctures CT scans should occur. Here’s the recent background ( also see profile):

Back in November I posted that my husband had completed 6 rounds of chemo (docetaxel)—concurrently he was receiving Eligard injections every 3 mos. and his PSA #s were coming down incrementally. But surprisingly the ct scan after the chemo showed an uptick in the spinal bone mets (he’d had surgery for spinal compress about a year ago- the same time he was first diagnosed).So we learned that the chemo had failed. A few weeks later he began Abiraterone (1000 mgs daily). And then in February monthly Xgeva shots were added to the mix.

The latest blood work showed that his PSA is now at .07 (that’s with prostate intact) and the alkaline phosphate s now in the normal range.

Scott has his next appointment with MO in June. Should he ask for another CT scan and perhaps a bone density test?

Thanks in advance for your continued feed back on this difficult journey. -E

[LearnAll]

With PSA 0.07 and ALP normal, his CT scan will not tell much and might cause more confusion as scar tissue, arthritis areas, inflammed areas and healed mets..all show up as lesions on CT scan.He certainly needs a bone density scan (DEXA) to assess his fracture risk as T score is needed to put in FRAX calculator to find out his fracture risk.

[Hidden]

Whenever I consider tests of any kind, I think about what I am trying to learn and how it will inform my treatments. That's what I would suggest he discuss with his doctor and then make an informed decision.

[Tall_Allen]

The CT scans are used to see if his therapies are working. There's no need unless there is some question about his therapy. You can discuss a baseline DEXA scan, but with his history of spinal compression, he certainly needs Xgeva.

Xofigo is worth discussing. There is a risk in taking it with Zytiga, Xgeva may mitigate that risk, but, given his history, it may be problematic. His doctor may want to hold off until after he is through with Zytiga. You can read about it here:

prostatecancer.news/2021/02...

Another thing to raise is whether he should add Celebrex along with Xgeva. With Zometa (a similar drug), it increased survival by 22%:

ascopubs.org/doi/full/10.12...

[Lavender22 in reply to Tall_Allen]

Thanks TA,

Yes, they moved my husband to the monthly Xgeva shots because of the mets to the spine and also because they saw a new fracture after the 2nd CT— which was done immediately post chemo and about 6 mos. post surgery. So we’re hoping the Xgeva is bearing some pos results...and we will definitely be asking about pairing it with Celebrex/Zometa.

Thanks for the link about the Xfigio— will review it.

I think I did read it about 6 months ago— but MO went to the Zytiga/Abiraterone. He’s been on this for 6 months and it continues to bring down the PSA. Fingers crossed.

From everyone’s feedback it sounds like a DEXA test is in order.

Appreciate your reply.

-E

[Tall_Allen in reply to Lavender22]

I just wanted to clarify. I think Xgeva is fine, better in fact, than Zometa at preventing fractures and compression. Although the trial paired Zometa and Celebrex, I suspect the results would be equally good with Xgeva and Celebrex.

Also, I'm not sure, but I'm pretty sure they can pull bone mineral density off the CT scan.

[Lavender22 in reply to Tall_Allen]

Got it. didn’t realize that Xgeva and Zometa are both used for bone density.It would be nice to know besides bloodwork if this stuff is working— I’ll find out if bone mineral density can be read off a CT.

Thnx

[Lavender22]

Thanks for your quick reply. Relatively new to this, we didn’t realize that if PSA was below 2 a CT scan would not be useful. Was hoping for a comparative to the one last autumn.

I have learned a lot about advanced pc here- treatments, medications, etc. in less than a year being on this site and while I try not to stress (yeah right— this isn’t stressful) I still find it’s best to be a bit of an informed advocate.

-E

[Cancer2x in reply to Lavender22]

“Might” be useful <2! I had an Axumin PET-CT scan two days ago. My Onco at Dana-Farber in Boston thinks it will help inform treatment, and minimally provide a good baseline for later. My my recurrent PSA is 0.6. The RadTech explained that the CT portion visualizes the body structures, then the PET portion finds the radioactive tracer uptakes (if any), and then the two sets of images are overlaid on each other to locate where in the body they show up. Analysis and results on Monday. Interesting time.

Good luck!

[Lavender22 in reply to Cancer2x]

Thanks for your reply, Cancer 2x. Interesting to hear about the Axumin PET/CT overlay. It sounds like this gives a very good baseline moving forward.

While every case is different, people on the forum supply a wealth of information as per their experience.

Good luck with your results!

Yes, we live in interesting times...

-E

[tango65]

Quantitative CT scan (QCT) can be used to measure bone density and it may be more precise than the regular DEXA scan.

hindawi.com/journals/ije/20...

It is different technique than the regular CT scan. Both use the same type of scanner but radiation and procedure are different.

en.wikipedia.org/wiki/Quant...

[Lavender22 in reply to tango65]

Thanks Tango65. Yes, reading the link, this particular type of CT scan seems to address spinal and pelvic osteoporosis arguably better than a DEXA test. I appreciate your response.

I feel fortunate to have found this informative group.

-E

[tango65 in reply to Lavender22]

Best of luck on the journey

[leo2634]

My Doctor sends me for my CT scan and full body bone scan every six months or so. I'm actually scheduled for both Wednesday the 26th. The tests are fairly tolerable, the anticipation of results not so much. Best of luck. Leo

[Lavender22 in reply to leo2634]

Thanks Leo,We’re just about at that 6 mo. mark since the post chemo scan— so glad to here that it’s often on the to do list for some.

-E

[larry_dammit]

Stage 4 here since August of 16, I get a set of scans every 6 months to make sure the cancer has not grown. So far so good 😁😁

[Lavender22 in reply to larry_dammit]

Hi Larry,My husband is also stage 4. It sounds like what you’re telling me is right in line timing wise with others.

Thanks, E