Are bone and CT scans required quarterly if PSA and testosterone are basically zero and no symptoms?

[Wildfun44]

I have stage IV prostate cancer with a spot on my lung being the only known spread of my cancer. After my chemo regimen, my CT and bone scans have been clean for a year now. And my blood work is perfect at the moment. I am on Zytiga and getting a Lupron shot quarterly.

My doc still wants to do full bone and CT scans every 3 months even though my PSA and testosterone are zero or very low. And have been for a year now.

Is this normal or a bit overkill? I am worried about the radiation but also my novice perception of wasted resources.

Thoughts?

[Tall_Allen]

It sounds like overkill, but he may have a reason?

[Wildfun44 in reply to Tall_Allen]

I will visit with my oncologist in more detail next appointment. I have had a lot of radiation in my life (multiple full body and targeted radiation treatments, tons of CT and bone scans, xrays, etc), chemo twice, three types of cancer, etc. I am just trying to dial things back a bit if the blood work shows nothing is happening. Thanks for the feedback

[Xavier10]

doctors love ordering scans and there may be a bit of “defensive” medicine going into that so I suggest telling the doctor you just don’t want to unless there is a real good reason. Ultimately we all make our own decisions.

[Wildfun44 in reply to Xavier10]

Yeah, I was thinking the same. I have a friend who has worked in hospitals for years and said there is a lot of "defensive" testing done that is unlikely needed. But he also said there is a lot of money to be made with CT and other scans. He said they opened up a new wing just to fit in more CT type machines because they were such cash cows. I have a feeling that if I was in Europe they wouldn't scan me at all until my blood work showed that I might have a reoccurrence.

[Nusch]

I’m not a doctor, so I would ask him

for the reason(s). My testo is less 0.1 and my PSA undetectable. We do a PSMA Pet/CT once a year.

[Wildfun44 in reply to Nusch]

Yeah, that is the routine I would rather be on. Thanks for sharing. I will visit in more detail with my Oncologist.

[treedown]

I am in a similar situation and have thought of a couple reasons for getting scans again 3 months after my last one when previous to that it was almost 1 year. My PSA is very low so I suspect they are monitoring for NEPC and also there was a spot on my T6 that showed on the last CT but the bone scan could not corroborate. If these scans, tomorrow and Friday, look clear and they say to do them again in 3 months I'll wany to know why.

[Doctorsceptic]

Sounds absolutely pointless and a waste of money. Never have a test unless you have thought through each potential outcome and know how you will respond to each.

I don’t know your age but the key question, if therapy is suggested, to ask your doctor is what difference treatment will make to overall “all cause” mortality - not just from cancer. And furthermore what is the trade off in terms of quality of life with side effects.

[Wildfun44 in reply to Doctorsceptic]

Agreed. I think extra money/lower risk for hospital is at play

[Ian99]

Some oncologists prefer to manage based on what they can see vs bio markers. That was my situation. I cannot say if that approach would apply given your numbers are so low.

[Wildfun44 in reply to Ian99]

Agreed, I am going to visit with my oncologist in more detail

[turkeyjoe1]

This is your 3rd trip around the block. He may just want to keep a close watch on it. Compromise at 6 months if he doesn't have a good reason in your mind but ask him.

[Wildfun44 in reply to turkeyjoe1]

Yep. 3 different cancers and 3rd time on prostate cancer. I've had my share! I'll see if that is part of why my oncologist is so overly aggressive here.

[kiteND]

I get a PSMA or Choline 11 scan every three months, but that might be because I have a history of always having very low or undetectable PSA. My regular MO would not recommend such frequent scans, but my other doc, Dr. Kwon, recommends it.

And, it has paid off. I had no tumors at one point and the scans revealed new tumors.

[Wildfun44 in reply to kiteND]

Thanks for the feedback. And sorry to hear about your reoccurrence.

[Wildfun44]

Yep, they biopsied me through my chest to get to the spot/growth on my lung. But chemo (Aug 22 to Jan 23) and ADT seems to have knocked it back. All my scans have been clean for over a year along with my very low PSA scores. I know it is early but curious if others had experiences like mine with testing.

[SteveTheJ]

This is not advice, just my experience. I was diagnosed in April 2020 and my scans went from quarterly to semi-annually to annually now based on good scans and low testosterone and PSA. YMMV.

[Wildfun44 in reply to SteveTheJ]

I hope to get to that same schedule. Thanks for the feedback and continued good luck on your tests.

[j-o-h-n]

Remember.... doctors have mortgage payments too.........(free lunch only for illegals)...

Good Luck, Good Health and Good Humor.

j-o-h-n

[Wildfun44 in reply to j-o-h-n]

Yep...that is what I am worried about a bit.

[j-o-h-n in reply to Wildfun44]

Not to worry, he/she will probably give you a ride in his/her new S-CLASS MAYBACH S680 4MATIC MERCEDES-BENZ...

Good Luck, Good Health and Good Humor.

j-o-h-n

[RoseDoc]

It is a bit aggressive but I would rather have an aggressive oncologist than not. Ask him his reasoning on your next visit. Kwon does choline scan every 6 months and a PSMA scan every 6 months. There is a 3 month gap between choline and PSMA.

[Wildfun44 in reply to RoseDoc]

I'm not familiar with a choline scan. Can you fill me in?

[Professorgary]

my doctor usually won’t do scans when labs are stable unless a symptom such as pain shows up.

[Wildfun44 in reply to Professorgary]

I hope to get to your testing protocol. Thanks for your feedback

[Wildfun44]

Thanks for the feedback Agreed