Ambiguous sclerotic spine lesion post radiation/ Taking HDT.

[Spagnoli12]

Has anyone after proton beam radiation treatment and on hormone deprivation therapy gotten ambiguous sclerotic lesion(s)on the spine? If so, what recommendations did the Dr's give you. My friend has a new sclerotic lesion on the T2 and the diagnosis was left uncertain. Follow up in 3 months with another CT but, can't it get worse without knowing for sure?

[Tall_Allen]

Radiation can induce sclerosis in bone metastases. It is a known reaction. What is the problem? Pain? Cortisone and NSAIDs can help - it is temporary.

[Spagnoli12 in reply to Tall_Allen]

He's got a focal sclerotic lesion o]f the T2 vertebra, indeterminate for blastic mets or a bone island. He's out almost two yrs from proton beam radiation treatments and is on hormone deprivation therapy: aberaterone. Can mets occur this soon? His psa is <.03. His stage 4 Gleason9 status is concerning. He has had insufficient fractures of the pelvic ala, both sides, but this vertebra sclerosis wasn't identified as any sort of fracture. The recommendation of the radiologist was for scintography, but oncologist didn't confirm, instead he implied watch/wait, which is like saying, 'See if it turns into something...'

[Spagnoli12 in reply to Spagnoli12]

Before this, he had no evidence of any metastatic spread.

[Tall_Allen in reply to Spagnoli12]

So it may be an insufficiency fracture that caused sclerosis or it may be a metastasis. What is his DEXA scan saying? NaF18 can possibly distinguish if it is too small to biopsy.

[Spagnoli12 in reply to Tall_Allen]

He hasn't had one. This T2 just showed up on a CT three days ago. He didn't have any bone mets til this ambiguous lesion presented on the scan.

[Spagnoli12 in reply to Tall_Allen]

I just sent a message to CClinic requesting an NaF. Thanks, Tall_Allen. Will see what the RO says, he's been very proactive so far.

[SeosamhM in reply to Spagnoli12]

NaF is great at picking out bone anomaly details in comparison with other scans, but note that a biopsy is the only way to absolutely confirm PCa ("confirmation" without biopsy is scan + other data like PSA, ALP, and comparison to older scans).

Medicare/Medicaid took NaF PET out of the approved PCa scan formulary years ago and most private insurance companies followed suit (I am hoping this changes, see: ncbi.nlm.nih.gov/pmc/articl.... Since my PCa has manifest almost exclusively as bone metastases, I've paid out of pocket for an annual scan for the last few years at about ~$2K. - Joe M.

[Spagnoli12 in reply to SeosamhM]

Wow....thanks, Joe.

[Spagnoli12]

Thanks, Nalakrats. Didnt think of a spine specialist. Good idea. Waiting worries me.

[Puckcancer]

I had radiation on both T2 and T3 because the nerves that went all the way the fingers on left side were being pinched by tumors.