IMAGING TO STAGE

[steinmother]

Finished 44 treatments over 78 days. Hormone Lupron and Casodex. Gleason 6/7 with lymph node found on 3 tesla MRI. CT guided biopsy of node positive. So Stage III. 80 Centigray to prostate external beam and 60 to lymph node. PSA was only 7-8 pre treatment. Had I not had the MRI, I would be Stage IIb. Imaging for nodes is not a routine in staging apparently so how many Stage II are really Stage III since no imaging is done during staging? Routine staging is bone density and bone scan. Should imaging be part of the staging for all patients? Difference between Stage II and III is difference between local disease and metastatic. That's big. What do you think?

[MelbourneDavid]

There is a clinical trial in Australia to see if staging using Ga68 PSMA PET gives a long term benefit. It's not obvious because it's not clear whether extra treatment for the detected nodes affects long term survival - will the cancer have other micrometastises?

Men who have recurrence other than in the prostate bed probably were under-staged.

[steinmother in reply to MelbourneDavid]

Thanks. My point is that either CT or MRI of pelvis and abdomen can show these nodes when bone scan is neg. My small node (1.4x1.8 cm) was needle biopsied. Then the question was what treatment? There have been no trials in this situation. Because nobody is looking for nodes on initial staging routinely. Do you give it a boost? Do you look in the upper abdomen? Even if the treatment is unchanged, which I doubt, wouldn't the patient want to know if he already has mets? Trials are underway to determine at what point chemo is started. Surely the presence of nodal mets would influence that decision. Again, thanks.

[MelbourneDavid in reply to steinmother]

Good move the biopsy on the enlarged node. They can at lest hit that mode with some extra radiation.

I do think Multipatametric MRI to guide treatment is valuable. My surgeon had one done which showed the extracapsular extension so he cut wider and got it all. Likewise radiation can target what is known much.more effectively than when it is not known.

[Hidden]

CT and bone scans seem routine after diagnosis. My urologist didn't hesitate. Remained stage II after those although I wonder if scans were sensitive enough to tell the whole story.

[steinmother in reply to Hidden]

Was the CT for staging or for treatment planning? Gold seed location? Or a true CT for pelvic and abdominal abnormalities? I had a CT during treatment planning but it did not cover the enlarged node. Glad you are Stage II and not III. My MRI was ordered by the radiation oncologist not urologist.

[bobdc6]

CT scanning is routine at Provision Proton (Knoxville). I had both a bone scan and a whole body CT scan showing no mets. My abdominal lymph nodes were treated anyway.

G 4+ 5