Bone scan at low PSA

[fourputt]

I had a prostatectomy in May, 2012 (age 62 ,PSA7, GS 4+3=7) , SRT in June 2018 (PSA.22). My PSA went to undetectable after surgery and my nadir was .05 after SRT. On both occasions my PSA stayed down at those levels for years followed by a slow rise. I'm now apparently working on my third recurrence with a PSA at .22 and slowly rising again. My RO (whom I've seen once and liked very much) is recommending a bone scan and while I'm not questioning him per se I am curious about the effectiveness of a bone scan at this PSA level. Thoughts ?

[6357axbz]

I’m no doc but my understanding is bone scan looks at anomalies in bone structure. It is not affected by by PSA

[Tall_Allen]

Unless the doubling time is very rapid, a bone scan will probably show nothing at your 0.22 PSA. Same for a PET scan. Just monitor PSADT.

[fourputt in reply to Tall_Allen]

Thanks for your reply and I agree. More specifically I guess I'm curious why a bone scan is needed at all if we are waiting for my PSA to reach a level to do a Pylarify pet scan.

[Tall_Allen in reply to fourputt]

It's cheap and easy. Also, it's a sure indication for starting ADT, while PET detection arguably isn't.

[fourputt in reply to Tall_Allen]

Makes sense. Thanks again.

[gsun]

Probably not necessary as you didn’t say you had bone mets. If you do it can be helpful to determine the bone structure and see the damage the mets are doing.

[Hidden]

Out of curiosity with SRT did you have your entire pelvic region treated or just the area where the prostate was?

[fourputt in reply to Hidden]

Prostate bed only.

[tango65]

Bone scans will not show anything with such a low PSA. Bone scans are obsolete when PSMA PET/CTs are available and paid by Medicare. I would wait until the PSA is around 0.5 and get a PSMA PET/CT.

[fourputt in reply to tango65]

This was my thought also but I'm going to follow the doctor's orders.

[Hidden]

The why to me is simple. It’s to track the development and resolution of metastatic lesions. Writing as one who had 27 nuclear bone scans and one PSMA Pet scan since 2003. The first was on original diagnosis of PCa. The at each stage of treatment. In between I was in a clinical trial with bone scan documentation.

If one wanted to track my progress, it’s a simple matter to pull up the scans and compare. One might say it’s overkill, however my record is there to study. I am told that last summer, medical school researchers did exactly that.

I wish you the best in killing the little bastards

GD

[SteveTheJ]

Do you want information or not? Get the bone scan.

[Hidden]

I'm curious. Did you have a bone scan 10 years earlier when you were first diagnosed? Is this to get a baseline scan for future comparisons?

[efsculpt]

A couple of things- I had a similar experience and timing to you. I had prostate bed radiation also (post prostatectomy). The cancer came back. I have since read that even if local lymph nodes are negative, the cancer can "leap frog". I had a G68 PSMA Pet scan and 4 nodes lit up in the illium area where the aorta artery splits to go to each leg. I then had full pelvic radiation (minus the prostate bed area), plus 2 years adt +zytiga/prednizine, plus one chemo). It's been 3 years now, with no movement in PSA.

So, I am wondering if the slow PSA increase is due to one or more lymph nodes in you pelvic region.

I think Tall Alan is right. The bone scan is not a big deal. If one has low testosterone, it is a good idea to keep an eye on bone density.

Craig

[RMontana]

fourputt, see these two articles; from Europe we see that Bone Scans have their place. But the SOC right now is PSMA PET...at a PSA of .20 you have about 50% Sensitivity (finding a PCa tumor) but over 90% Specificity (that is PCa when you do)...I would take the 50-50 shot and do it again as it rises...if you were me I would do this until I found where the bast#rd is growing then treat it while is small...TNX Rick

Bone Scans: healthunlocked.com/active-s...

PSMA PET: two links

1. healthunlocked.com/active-s...

2. healthunlocked.com/active-s...