sclerotic rib lesion

[_knowledgeiskey00]

my dad age 73 has been diagnosed with Gleason 9 (4+5) prostate cancer. He did a bone scan with spect Nov 2 2022 and it was clear. On Nov 28 2022 he did a ct scan that showed a sclerotic lesion posterior rib concerning for mets. His oncologist says it’s an inconclusive result for him and he’s having another bone scan and ct scan in a few weeks. He wants to see if it shows up on bone scan and if it decreased in size now that my dad is on Lupron on the ct scan. Is it possible that someone with prostate cancer can have 1 single Mets all the way at the rib with nothing elsewhere? Has this happened to anyone? No known injury that we are aware of. But I guess even coughing can cause injury especially at the ribs. This lesion was seen on ct chest july 2021 but the report said nothing. Apparently it grew in size now. his treatment plan is external radiation. He had turp for urinary retention in December. my dad has no other symptoms. No pain nothing

[6357axbz]

yes it’s possible and not uncommon. If it decreases is size after Lupron it’s probable cancer.

[GP24]

It depends how sensitive the scan is. If your father would get a PSMA PET/CT it will probably show additional mets. This scan could also verify whether the met is cancer.

If it turns out to be a bone met, your father should add Abiraterone or a similar drug to Lupron. He may also get the prostate radiated to slow cancer progression.

[_knowledgeiskey00 in reply to GP24]

Thank you! regardless what it is I know radiation on prostate is definitely happening.

Just weird how bone scan with spect didn’t pick it up. Based on my reading bone islands generally don’t have hot spot on a bone scan. I know SPECT was used on his chest area

[tango65]

Request a PSMA PET/CT before proceeding to any therapy. This test has a higher detection rate than any other test and it may change the course of therapy and be useful to plan radiation to the prostate and pelvis.

[Hidden]

Your oncologist is correct. He needs a FCH PET as it is better than a whole body SPECT for detecting bone metastasis. This FCH PET is tried and true. Let his oncologist do his job in ruling out the bad stuff.

Best wishes,

Gourd Dancer

[Concerned-wife]

I recall reading in UroToday that reading the rib reports can be tricky ..sounds like his doctor has a good plan.

[_knowledgeiskey00 in reply to Concerned-wife]

tricky? Do you recall why?

[Concerned-wife in reply to _knowledgeiskey00]

this isn't the article i remembered but it talks about it ncbi.nlm.nih.gov/pmc/articl...

[Tony666]

I had a similar situation.

3 years ago with all signs showing cancer confined to prostate including clear bone and ct scans. But a psma pet scan pointed to a small uptake in a rib. I was being treated at NIH under a top docs care. They said sometimes there is a small uptake on a rib that is benign. They then ordered a sodium fluoride (NaFl) scan which apparently is better than psma pet at determining if ribs are cancerous or benign. When the NaFl came back negative I started ADT. After two months they did another psma pet scan and there was the same small uptake on the rib. They concluded that given the negative NaFl scan and the no change in uptake in response to ADT that it wasn’t cancerous but a benign lesion. I asked them if it would help to biopsy the rib but they said no - this would likely be both risky and inconclusive. So I went through a treatment protocol just focusing on the prostate. 3 years later, psa is undetectable. So though it was uncertain, this would seem to confirm it was benign and they were right to ignore the small uptake in the rib.

In conclusion, it could be benign and you might ask for a NaFl scan as a first check. Hope this story helps. Best of luck.

[FormulaRob in reply to Tony666]

fantastic information thanks Tony

[Ducttape]

Good Day ! I am 72, - had MRI, CT scans etc back in Nov 21 prior after s jump in PSA in early 21. The CT spotted three small blips - one at T-12 vertebrae, one at 8th posterior rib and one on hip. Started Lupron Nov 21 just as a baseline to so if there was any change in the boney critte after three months ; follow up in Jan. - no real change so the RO/MO and tumor team all agreed it was none conclusive. Had Fusion Biopsy in begin of 22, Gleason 9 in Seminal Vesicle and some scattered 7's in prostate. Surgical Uroligist and RO decided Radiation was the best route. High Does (HDR) Brachytherapy and followed by 24 sessions of External Beam. still on Lupron [ the Devils Love Potion #9 . No pains all around except old athletic injuries and can remember shots to the back and hips for sure. I am starting to get active again with bike riding (although I am banned from Mt Biking by my sweetheart. My head and body tends to find rocks and gravel . Hair on Fire biking at 72 sounds good, till you're doing a header over the handlebars). I have to start some walking (boring) and some light weight work as recommended by the M.O. Probably a good thing for me and your Dad in general.

I met with my Med Oncologist a few days ago and she says I am responding very well to the ADT-Lupron path and the Radiation Treatments including whole pelvis. She wants me to just keep track of any pains that I get that are no the norm in those areas; I asked about PET or the newish PSMA scans and she felt it would be OK to hold off, the size of the spots and no change in PSA as well as good results on Lupron give her a cautiously but good optimistic view. Plan is to watch PSA (which is now almost undetectable) every three months and to continuous Lupron for another three rounds for a total of two years. Potentially have a PET or PSMA later this year to get a base line. She DID set me up with a bone density test also to get a baseline. She is with MD Anderson and a lung and Prostate centric M.O.

i feel comfortable with her plan. So does my Wife - which is the tie breaker

So stay positive -

My mantra is Screw '22 - just be me in '23! (AND look for the day that I can drop Lupron and the Male Mental Pause side show that comes with........ I now have a very sympathetic nod to lady's that have to go through Menopause)

Party On

Ducttape Jake

[j-o-h-n in reply to Ducttape]

Hey Jake,

I suggest that next time you go bike riding I think you should tie yourself to the bike using Duct tape....... and think about this, if you do crash it will all be caught on tape....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/23/2023 7:40 PM EST

[Ducttape in reply to j-o-h-n]

No Kidding! My sweetheart would probably write "Do Not Return to Sender" or "IF found, call a Vet for this horse's As.....uh rear end" on the DuctTape on my helmet.......

Party On

DT Jake

[j-o-h-n in reply to Ducttape]

Just make sure your sweetheart knows which side is your rear end...........🤡🤡🤡

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/23/2023 11:21 PM EST

[_knowledgeiskey00]

hi thank u for your reply. What does bone density show? Is it for Cancer or because you’re on ADT?

MD Anderson is the place to go if you have Cancer. So I agree you are in good hands, as you should be.

Stay strong warrior

[Ducttape in reply to _knowledgeiskey00]

In my effort to do my research and get up on Prostate Caner and using ADT, I often saw info that folks may get some bone thining or some depletion of calcium. So easy to over-research and become a "google-Doc" with this dang stuff. So I asked and the M.O. who said it would be a good idea to get bone density tested (I have never had that done....been called a Bone Head, but never really tested) to see where I stand. She also asked me to start taking about 1200mg of Calcium and 1000mu of vitamen D. Easy to do and what the hec, the gummies are tasty

Party On

DT Jake

[Ducttape in reply to _knowledgeiskey00]

sorry K.I.K-00, I Should have answered your question a bit better - the bone density wasn't cancer centric. It was more from potential lupron side effects.

[j-o-h-n]

True🔑 ..... e.g. the first words Adam said to Eve "Stand back I don't know how big this thing gets".

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/23/2023 7:50 PM EST