my husband had an nuclear medicine bone scan and CT on 1/27/22 which did not show metastasis in lymph nodes, only prostate cancer, on March 11/2022 we had the PSMA PET scan which did show the Mets to lymph nodes. He got an Eligard shot and Prolia shot 4/13 and started Zytiga on 4/21. His PSA has dropped. The Urologist ordered another MRI for August 16th to see cancer. But if the Mets didn’t show up before on this test, is there a need to get this? The Urologist is thinking we are going to do surgery in September or October but with metastasized cancer I don’t feel good about this! We have a second opinion coming up at MD Anderson on August 31st.
Thank you for your suggestions.
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NNPwife
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I honestly have no idea. I asked the reason and the Dr said he wanted to see it before surgery. But I was so confused since it didn’t show the Mets before, what is the purpose except to radiate him. I don’t want him to have surgery since it’s already metastasized but his dr said, oh yes, it needs to come out. 🤦🏽♀️ Second opinion at that point!!
If they are located in the pelvis radiation therapy to the prostate plus whole pelvis radiation with booster to the known lymph nodes mets and 18 months of ADT could be curative.
If the lymph nodes are outside the pelvis but below the bifurcation of the aorta the same treatment extending the whole pelvis radiation along the whole iliac arteries may be indicated.
More than a MRI they could do another PSMA PET/CT to be sure there are not distant metastases and the test may help with the radiotherapy planning.
He should be taking Prolia only if a DEXA scan showed a T score of -2.5 or less. Bone agents do no t help with the control of bone metastases in hormone sensitive cancer.
Lymph nodes in the right iliac crest were noted to have cancer. I will check about the T score on his DEXA scan, I was unaware of that information. Thank you so much for all this info!! Blessings!
Prolia is indicated if the T scores are -2.5 or less (-2.6, -3.0 etc.). He has T scores greater than -2.5. He does not have osteoporosis, just osteopenia Osteopenia is not treated in castration sensitive PC. He does not need Prolia, They could repeat the DEXA scan every 2 years.
Stage 4 here 8/1/16. Time to forget your urologist and find a good oncologist. I get a set of scans every 6 months to compare against the last one. That tells the doctor if the treatment is going right. If you cancer has left the prostate it will do no good to remove the host ( prostate ). Just saying. Fight a good war warrior
The PSMA-PET scan is about 92% accurate in detecting metastatic tumors or the lack of tumors. In some cases the accuracy could be higher. The results depend wholly on the knowledge and skill of the person reading the scan.
Starting in 2003, I have had 26 sets of nuclear bones scans with soft tissue CT scans. The first five only as a baseline and to rule out metastatic lesions. It doesn’t mean that there were no metastatic lesions taking place; only that it was not seen on the scans. The first was by the Urologist.the next four were by two different Radiation Oncologists. Once I determined not to have surgery, I stopped seeing the Urologist and moved on to the ROs - one for Brachytherapy and the other for IMRT; my primary treatment path for prostate cancer treatment.
When metastatic lesions were detected 11 months later, I moved on to a Medical Oncologist in 2004.
A good discussion to have with your physician is the possibility of micro-metastasis and their treatment path to nip in the bud. Case in point, my Medical Oncologist told me that it mattered not which primary treatment I selected. So don’t second guess yourself. You already had micro-metastasis before your original Prostate Cancer treatment. Micro-metastasis explains BioChemical Rate on failures of primary treatment.
The most accurate test for detecting prostate cancer is still the prostate biopsy. This biopsy involves taking a tissue sample from the prostate and examining it under a microscope, which can help your doctor determine whether there is an uncontrolled growth of cells in the prostate gland. What is the Gleason score for your husband? Generally, it can tell one which risk group there are in: Low, Intermittent, or High.
Today, if your husband decides on surgery, then the Urologist is your person. If he decides on Radiation, then the Radiation Oncologist is the person. If and When confirmed metastatic lesions are detected, then a Medical Oncologist is your person. Only one person should be charged with the current treatment of your husband’s cancer, in my opinion. Too many chiefs translates to confusion......
With this written, not everyone, medically trained or patient will agree. I say, use logic in the decision making process as it will change over time. With this I wish the best.
One final suggestion. On the day that Mets were diagnosed and after I received my first Lupron injection and a script for Casodex, I asked my RO a question that went some thing like this, Doc, if you were in my shoes, newly diagnosed with Stage 4 prostate cancer, what would you do? He thought for a moment and replied that he find the best damn medical oncologist available who is on top of their game. Probably in academia doing research and teaching other oncologists their craft. Do you know one, I asked, the top reply was that he did not. ...... I asked my second RO the same question. He thought and sausages that Brad (the other RO 200 miles away had called and said that I would be asking.... his reply was the same; however he did know such a Medical Oncologist and would call on my behalf.... the rest is history for me....
Tall has pretty good advice. If I'm not mistaken about what you wrote above, just so you'll know, an MRI is not the same thing a CT scan. Your urologist is probably wanting to do a Multiparametric MRI, cheaper, and which can depict lesions in the prostate and sometimes in the surrounding lymph nodes, the neurovascular bundle and seminal vesicles. Another PSMA PET Scan should depict all of those areas plus any metastasis to other areas. If it is already outside of the prostate capsule, surgery may not be of much benefit. Radiation therapy like Tall mentioned is most likely a better approach. You need to find a good radiation oncologist to confer with before letting a urologist run with this.
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Can't treat what we can't see
Huge increase in psa
Question about IMRT on multiple targets simultaneously
