Bone scan/CT sensitivity?

[Proflac]

My husband has only ever had regular nuclear bone scan and CT. PSA is now rising over 6 months from .45 to.9. At what PSA level would repeat scans be likely to image progression? I am aware of PSMA and this might come down the line but currently from what I read from TA and others is that we need comparable scans? These are rationed for us so can't simply repeat at will. So would such 'basic' scans be likely to provide any useful info at this PSA level? Next PSA test 10th July. Should we wait? Thanks.

[GP24]

Without ADT a bone scan will detect mets at a PSA value of 10.0 ng/ml or more. With ADT it is difficult to decide. I would wait until the PSA value gets above 2.0 ng/ml. This value can be used to determine castration resistance.

[Mascouche in reply to GP24]

That is not what I've experienced. I had been off ADT for 13 months, just restarted ADT a week and a half ago now.

When I had my bone scan on May 10, my PSA was 0.90 ng/ml and it still detected a metastasis on my right shoulder blade. I'll admit I was surprised about that discovery but the bone scan did pick it up. even though my PSA was ten times lower than the 10.0 ng/ml you mention.

[GP24 in reply to Mascouche]

As I wrote, it is difficult to predict with or after ADT. The value I mentioned is used when a patient is first diagnosed with PCa. Then a bone scan will rarly detect bone mets at a PSA value below 10.0 ng/ml.

[Proflac in reply to GP24]

That's helpful. Thanks.

[Ian99]

I am Stage 4 mCRPC. DX Dec 2014. T3b M0 N0 Gleason 9 (4+5) psa=8.9.

During my time on ADT and Zytiga I have been on NM bone and CT scan compares for almost 3 years.. since 2021. Despite a PSA which has gradually risen to 53, the scans show no radiographic progression. So your husband may have a way to go on that front. Personally I fear these scans do not show the level of granularity needed. Something is feeding the PSA.

I have since tested BRCA2+ so I am trying Lynparza. Fatigue even more an issue. Only seems to go away when I play golf or go to the gym, which I think raises some adrenaline. Physical activity is important and could help your husband. Good luck.

[Proflac in reply to Ian99]

Thanks for replying. Hoping the parp helps. Great that you are persevering with the exercise.

[Tall_Allen]

There is no reason to give up on your current drug regimen until your PSA goes above 2.0. You can check for radiographic progression then.

[Proflac in reply to Tall_Allen]

Thanks. I will be asking to stay on Abi a while longer if next PSA is below 2. Might have to self fund but it's not expensive these days. I will also ask about the dexa switch but I anticipate a negative response from the NHS consultant. They are finally doing genetic test on original biopsy sample. This is from 2017. From what I read I think that's OK (they will only look for BRCA) though it's old tissue? I got germline done few years back - nothing of value for tx.

[Proflac in reply to Tall_Allen]

Thanks

[MateoBeach]

PSMA PET scan can detect mets at PSA levels as low as 0.25 to 0.50. With a PSA doubling time of 6 months this is very worrisome. I would insist on a PSMA PET scan NOW.