Still true that using same scan type is preferable to changing scan type?

[spouse21]

Mr. Spouse 21, ten years since dx with Gleason 9 in 80% of cores, has only had bone and CT scans to track progression. That's how it was done in 2014. He's been stable since chemo with his current Eligard & Xgeva treatment--see full Profile for his record of Lupron, radiation, Zytiga (failed), Docetaxel at year five, followed by lifelong Eligard and quarterly Xgeva.

While looking for something else, I came across the following advice in my notes--best to stick with same scan type just as it's best to stick with same lab for testing PSA. Tall Allen gave the following advice in October, 2022. With most guys now getting PSMA scans, does this advice still hold?

healthunlocked.com/advanced...

Tall Allen: You've put your finger on why patients should always track progression using the same scan. No one can answer your questions. I suggest you ask your MO why he ordered it.

I recommend having a new scan done using the same scan you had before. If you had NaF before, it's twice as good at finding bone metastases as the PSMA PET scans. Newer isn't always better.

[Tall_Allen]

It will always be true that if you are trying to figure out if a therapy has been effective, you have to have the same scan that you had pre-therapy.

But that isn't always the goal. If the purpose is to figure out the site of a recurrence, or whether a PSMA-based therapy will be effective, there may be other scans worth getting.

[spouse21 in reply to Tall_Allen]

Thanks for making that distinction. We'll see what scans are needed if things move in the wrong direction.

[GrantB47]

I'm sorry. I have been on Eligard for less than two months. I'm not even remotely qualified to offer an opinion. I do wish you well.

[Shorttimer]

Sorry I don't have experience with your situation. I pray you can have many good days while dealing with cancer

[dhccpa]

Good question. Did he fail Lupron before adding Zytiga?

[spouse21]

Hard to say if Lupron "failed" since the protocol for someone having radiation was Lupron for 18 or 24 or 36 months. He went 34 months before PSA began to rise rapidly. Zytiga was added a year after Lupron ended, but it failed within months. So new treatment was docetaxel, Eligard (ADT again) and Xgeva. Was told new round of ADT still has effect on some cancer cells .