Bone scan with PSA 13?

User

Posted 16 Apr 2016 at 17:51

Saturday 16th April

Hi all,

I've suddenly got a bit worried by the fact that my probable surgeon, out of County, asked if I had had a bone scan, at my local hospital, based on my PSA being 13. I said No, so I am now going to have one. Reminder my Stage is T1/2, Gleason 3+4, tumour in one side, so symptoms. No-one has actually told me why, with all this, my PSA is 13, which I know isn't that high in the scheme of things. Also, the PSA has stayed within the 13 point something between the first I ever had done in February, and 10 days ago.

The MRI states M0 but I think MRI's dont show M anyway, do they? The surgeon said it will 'come back clear'.....but of course I now have a doubt, as I know there's this micro spread thing, even with the tumour fully contained.

Any knowledge most welcome, thank you.

David

User

Posted 16 Apr 2016 at 19:31

Hi, David.
I had a bone scan around the same time as my MRI and trus biopsy. I think they are 'routine', so I don't know why you didn't have one initially. My PSA was 9.0 the 8.3. (Great that yours is steady.)
It involves an injection of a marker that will bind to inflamed bone marrow, as I understand it, so it shows up spread to the bones. It is more sensitive than the MRI, which is the equivalent of eye-balling so won't see anything 'micro'.
You may know that you have to get the radioactive 'dye' injected, then go off and wander for a couple of hours while it gets into your system. The actual scan is much quicker and quieter than the MRI.
Of course your surgeon shouldn't really promise you that it will be clear, but it is good to know their strong hunch is that you won't have met.s that they actually said that!
You are bound to worry until you have it and hear it is clear, though.
Best of luck!
Henry

User

Posted 16 Apr 2016 at 20:31

Hi David,

Some hospitals carry out bone scans as normal routine regardless of staging and PSA level............others don't.

My staging pre op was PSA 9.86 T2b N0 Mx G6 ( 3+3 )..... I never had a bone scan even though I was referred out of area for my da Vinci op.
I can only presume my surgeon was quite happy to perform the procedure without one....even though my subsequent histology was upgraded to pT2c N0 Mx G7 ( 3+4 )

I wouldn't read too much into it in your case, especially as the 'main man' is confident that it will come back clear...probably just routine practice for him.

Luther

User

Posted 16 Apr 2016 at 21:51

Originally Posted by: Online Community Member

Hi, David.
I had a bone scan around the same time as my MRI and trus biopsy. I think they are 'routine', so I don't know why you didn't have one initially.

MRI scans are routine for men that have had a positive biopsy, unless they had the scan beforehand. Bone scans are not routine - some hospitals would only offer a bone scan to men in the high risk / aggressive groups. Even when dealing with chemical recurrence, a bone scan isn't always done; I had to fight (and in the end, pay) to get one for John before his salvage RT/HT

Some hospitals seem to do them at the drop of a hat though!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Apr 2016 at 23:12

Not necessarily.

In PCa, aggressive can be used to describe any one or combo of:
- Gleason 8 or above
- PSA over 10
- T3 or above
- some of the rarer forms

I imagine a bone scan would always be offered to a man dx with a rare PCa - perhaps I am naive.

But some hospitals would only offer a bone scan if there is a reason to believe there may be bone mets. As you have been staged (so far) as T1/T2 you perhaps didn't meet your local hospital's criteria.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Apr 2016 at 23:16

By the way, M isn't just about bones so M0 denotes 'no mets' rather than 'no bone mets'

M1a would be distant lymph nodes, M1b is bone mets and M1c is 'other mets' or 'bone and other'

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Apr 2016 at 23:42

I was told that for men with a PSA at diagnosis of sub 20 the risk of the cancer having gone to bone was low but this certainly does not rule it out as cases reported by Lyn illustrate. It shows how PSA on it's own is not a reliable indicator. Perhaps the optimism of the consultant here for a clear bone scan is boosted by the T1/2 staging arrived at through Gleason and most probably MRI scan. There are no certainties with this disease and sometimes the unexpected happens. Hope your surgeon is proved right.

Barry

User

Posted 16 Apr 2016 at 23:58

I was Gleason 4+3 PSA 7.7. Think it was routine for our hospital but I had MRI post biopsy, bone scan and also CT scan.

Thanks Chris

User

Posted 17 Apr 2016 at 09:37

Originally Posted by: Online Community Member

Not necessarily.

In PCa, aggressive can be used to describe any one or combo of:
- Gleason 8 or above
- PSA over 10
- T3 or above
- some of the rarer forms

I imagine a bone scan would always be offered to a man dx with a rare PCa - perhaps I am naive.

Im not sure the term aggresive applies to those categories...certainly high risk.

To me the term aggresive is sometimes used when the doubling time is very short and PSA is rising at a fast rate...

I had a bone scan but i had a PSA around 20

Bri

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User

Posted 16 Apr 2016 at 19:31

User

Posted 16 Apr 2016 at 20:31

Hi David,

User

Posted 16 Apr 2016 at 21:01

Very useful replies, thank you.

Does anyone have any knowledge about 'general' PSA levels/Gleasons that tend to suggest mets, or does it vary just like everything else? I have read that PSA 100 would suggest mets quite likely, while, say, 40 probably not but could....

Thank you
David

User

Posted 16 Apr 2016 at 21:43

It doesn't work like that. We have had men with PSA of 140 or so with no apparent mets while Si_ness had a PSA of around 3 and mets throughout his skeleton.

John had a PSA of 3.1 and the scan suggested whatever tumour was in there was too tiny to even show. Once the surgeon got in there it was clear the tumour was in every bit of the gland and had already gone to the bladder.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Apr 2016 at 21:51

Originally Posted by: Online Community Member

Hi, David.
I had a bone scan around the same time as my MRI and trus biopsy. I think they are 'routine', so I don't know why you didn't have one initially.

Some hospitals seem to do them at the drop of a hat though!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Apr 2016 at 22:12

And Lyn, by high risk/aggressive groups,you are referring to the higher Gleason scores?

David

User

Posted 16 Apr 2016 at 23:12

Not necessarily.

In PCa, aggressive can be used to describe any one or combo of:
- Gleason 8 or above
- PSA over 10
- T3 or above
- some of the rarer forms

I imagine a bone scan would always be offered to a man dx with a rare PCa - perhaps I am naive.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Apr 2016 at 23:16

By the way, M isn't just about bones so M0 denotes 'no mets' rather than 'no bone mets'

M1a would be distant lymph nodes, M1b is bone mets and M1c is 'other mets' or 'bone and other'

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Apr 2016 at 23:42

Barry

User

Posted 16 Apr 2016 at 23:58

I was Gleason 4+3 PSA 7.7. Think it was routine for our hospital but I had MRI post biopsy, bone scan and also CT scan.

Thanks Chris

User

Posted 17 Apr 2016 at 07:56

I would have liked my OH to have a bone scan as he is in a lot of pain with his lower back. He takes anti inflammatory tablets every day. But was told with a psa of 4.9 and Gleason of 6 that it was completely unnecessary. It is always in the back of our minds. But I am assuming that as the psa is 0.6 now after brachy that there can't be any spread. Also assuming that over a year after treatment his back would have got worse if there was a problem. But it does still play on ones mind. At least after a bone scan you can rest your mind.

User

Posted 17 Apr 2016 at 08:32

I had a bone scan - PSA6, Gleeson 4+3. In my case MRI was done before the biopsy (transperennial). Fairly straightforward, only issue was I had to go to Harefield which was quite a drive from here.
So I don't think you can say they only do bone scans if the PSA is very high, they do seem pretty routine.

User

Posted 17 Apr 2016 at 09:04

Davews...

Not sure it is correct to say that bone scans are routine.

I had original PSA of 4.7.. had an RDE followed by an MRI which showed something near apex. So... Biopsy done which resulted in diagnosis of T1c Gleason 3+3.

There has never been a suggestion that a bone scan was needed.

I have since had open RP ... post ops show pT2c Gleason 3+4.

User

Posted 17 Apr 2016 at 09:37

Originally Posted by: Online Community Member

Not necessarily.

In PCa, aggressive can be used to describe any one or combo of:
- Gleason 8 or above
- PSA over 10
- T3 or above
- some of the rarer forms

I imagine a bone scan would always be offered to a man dx with a rare PCa - perhaps I am naive.

Im not sure the term aggresive applies to those categories...certainly high risk.

To me the term aggresive is sometimes used when the doubling time is very short and PSA is rising at a fast rate...

I had a bone scan but i had a PSA around 20

Bri

User

Posted 06 May 2016 at 09:41

Friday 26th May 2016

Well my bone scan came back normal, thank goodness. All set for the RALP with pathology during, this coming Tuesday. Gulp.

I just hope and pray they get it all.

David

User

Posted 06 May 2016 at 14:12

Excellent.
Good luck!

User

Posted 06 May 2016 at 15:21

Hi David

I just wanted to wish you well for Tuesday.

Just remember afterwards to take things easy and not overdo it as in the long run you will recover quicker.

All the best.

Kevan

User

Posted 08 May 2016 at 18:55

Good luck David, I had rrp with lymph nodes onthursday 4th May. Home next day and doing well. Similar to you psa 12.9, Gleason 3+4 and stage t1c-2. Looking forward to catheter out on Thursday, all being well. Taking it easy but on the up.

User

Posted 27 May 2016 at 18:54

So Mazdad, how are you doing? I had catheter out and didnt leak at all, though I seem to squeeze out a teaspoon amount during the day. Very lucky tho not sure how I stop this amount....gradually I guess!

User

Posted 27 May 2016 at 20:13

Pleased to hear your bone scan has come back normal David 👍🏼
My dad has a PSA of 14 with a T2/T3 cancer with suspicion of invasion of capsule, A Gleason score of 4+3=7 and 3+3=6, His consultant has said he doesn't think it has spread elsewhere (don't think he should have said that as I am now holding on to those words for dear life !!) He is having a bone scan on Wednesday of next week, I'm now feeling worried that people are saying this isn't usually routine, fingers crossed for good results
Viv
X

The only time you should look back is to see how far you have come

User

Posted 27 May 2016 at 20:24

Hi David, Still going well, only a few drips when I practice PFEs. Getting back to normal, external wounds disappearing. Still very tender underneath, so take a cushion to some venues. When is your team meeting equivalent, mine is 24th June - Addenbrokes said they would phone the week before with summary of findings.

Good luck for future!

User

Posted 02 Jun 2016 at 20:36

Mazdad, my meeting is dated for June 21st. No planned phone call first, Lister, Stevenage.
It's the lymph node worry for me. They took them all out, so I am hoping that IF anything had got there (nothing showed on MRI), then it has been removed, but that may be wishful thinking. 'Live' pathology during the RP showed negative margins everywhere hence they spared both nerves. It's the microscopic spread possibility......however unlikely!
Belly button wound still a bit open, being looked at every 2 days locally, but it's ok.

Vivienne, thanks for your comments and good luck to your dad.

User

Posted 03 Jun 2016 at 09:12

Hi David. Good about tHe live pathology, I don't know if I had any nerve sparing, but I did have the lymph nodes done on the surgeon's advice. I'm expecting a call next week - it's not necessarily something to dread if there is a bit of positive margin, it can often be managed. I've had an allergic reaction around the 2 main wounds, possibly the glue, very rashy and itchy. I'm still bearing the cushion of shame most days, worst in the car, the sports suspension seemed a good idea at the time.

Good luck on the 21st.

User

Posted 03 Jun 2016 at 17:24

Just a warning note about side effects: surgeons don't always tell you about lymphodoema associated with lymph node removal. In my case, my left leg is appreciably fuller than my right. The lymph fluid doesn't drain so well with part of the system removed and gathers in one or both legs. You may be offered support stockings (which I found useless, dropping like Nora Batty's) and massage, which can give some relief, but is of course temporary. My answer is to prop up my feet on a footstool when sitting down or try to sprawl with my feel on the sofa arm (when the dog gets off and lets me!).

I was very glad to learn that my lymph nodes were clear, but how I wish they could have been left in situ and scanned somehow to tell me that! No doubt one day that will be possible.

User

Posted 03 Jun 2016 at 18:08

Hi, my legs were very swollen in the hospital overnight, but since have been Ok. They kept telling me I was dehydrated and getting me to drink more. I wore the stockings for nearly 4 weeks and was very relieved to finish that. I've not had my feedback yet, so time will tell if I' m clear or not.

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