Bone Scan question

[inthefight]

Hello fellow warriors, my latest CT and bone scan is showing no new lesions, hoping for Zytiga to lower PSA further, asked oncologist if bone scan would show decrease of mets in the future and he responded that the tracer used will still be taken up by the repaired areas as well so that we would not be able to see which mets are dissolving. He was going to check with his radiologist and get back to us. We are hoping to see areas dissolve to lower the mets burden and to have the option to add radiation in the future to further fight this beast. Is his answer correct about bone scans?

[Shooter1]

Mine (bone lesions) after 4 years no longer show up on regular scans, but then my new lesions (2) didn't show up either, Na-F18 scan found them. Radiation took care of them. Life Is Good, especially when you feel good.

[inthefight in reply to Shooter1]

We have only done conventional bone scans, no PET scan yet. We are feeling positive about results.

[dhccpa in reply to Shooter1]

Did your Na-F18 scan see your old lesions? The ones that had disappeared from the bone scan? If so, were they distinguishable from the new lesions? Were they "dead", for lack of a better word, or simply inactive?

[Shooter1 in reply to dhccpa]

No uptake of the F18, so they didn't show... No PSMA exhibited by them and they are well healed.

[dhccpa in reply to Shooter1]

Thanks. I've heard very different answers about whether bone mets can ever be cured.

[dhccpa in reply to Shooter1]

Here's a Healthline article by an MD that states unequivocally that bone mets cannot be cured.

healthline.com/health/cance...

[Seasid in reply to dhccpa]

I don't believe in this article. I have 15 bone mats and I should be dead already according to the article. It was not written by the doctor. It was just fact checked.

[dhccpa in reply to Seasid]

By now, I've heard (from doctors) and read so many things that I hardly know what to believe.

[tango65]

I would request PET/CTs ( PSMA PET/CT or Na F 18 PET/CT) to detect which bone mets are still active and if there are new bone mets which could be irradiated, Bone scans are notorious for the low detection of mets when compared with PET/CTs and for possible false positives.

IMO we should recognize that bone scans and CT scans should not longer be used to stage patients when we have much more sensitive and precise techniques approved by the FDA and paid by insurance including Medicare.

[inthefight in reply to tango65]

When our journey started we did not know the difference in scans. They have continued with the conventional scans to be able to compare "apples to apples". We are thinking of letting the Zytiga hopefully do its job and beat this beast further into submission before asking for a PET scan next time.

[tango65 in reply to inthefight]

It all depends if you want to know the extension of the cancer lesions which are 4 mm or larger. Using bone scans , they will miss many of these lesions.

One can have a PSMA PET/CT in any moment and start a new apple to apple comparison with a more precise test, which will allow to make decisions about treatment earlier in the disease process than using bone and CT scans.

[inthefight in reply to tango65]

Our next appointment is in about three weeks with the oncologist. Will mention it again to him. We are trying to stay on top of all the information out there so that we can make our own informed choices. Thus far he has followed standard of care for our situation. We did see an oncologist at Dana Farber in August for a second opinion and she has outlined the same tx we are on. Her suggestion was to wait for nadir and then repeat scans to see if radiation would be an option. Would prefer a PSMA PET scan but VA insurance only covers once in 12 months.

[tango65 in reply to inthefight]

Medicare is paying for PSMA PET/CT. Many places in the USA are doing the Pylarify PET/CT.

[Shooter1 in reply to inthefight]

We changed mine because my PSADT was fast---12 days. New stuff was going nuts..

[Magnus1964 in reply to inthefight]

As long as PSA is low and no real increases show in Ct or bone scans keep going on the present course.

[hansjd in reply to inthefight]

A PSMA PET scan will show which mets are avid. A bone scan will not. It’s time to switch. Have a PSMA PET scan before starting Zytiga as a baseline. Then have another in 12 months and you will have a valuable comparison.

[dhccpa in reply to tango65]

Intetestingly, practicing docs give very mixed answers about the usefulness of bone and CT scans; many say they are still useful but are vague when I've tried to pin them down.

[Muffin2019]

I have been on the genetic since last December, PSA was 15.6, after a couple of months it dropped to .7 and over the year it us now a 1.0, the oncologist says it is stable at this point. Having another bone and CT scan at the end of January, last one was 8 months ago.

[bean1008]

I have been on Lupron and Zytiga for one year now. I asked about getting a new scan (I’ve had two g68’s since 2018) to see if I had any new bone mets (have one on my hip). I believe I was told it wasn’t necessary as long as my PSA remains undetectable as the previous met would be inactive and no new ones will have formed.