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Inconclusive bone scan - please help?

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User
Posted 09 Apr 2023 at 20:49

Hi everyone,

Following my dad's prostate cancer diagnosis about 18 months ago I've been following posts on these forums and have found everyone to be so encouraging, helpful and well informed.

I should probably get round to updating my profile with his stats etc but a bit of a run down -

- Diagnosed October 2021 with a PSA of 10, sorry I can't quite remember the Gleason score etc. The cancer was stage 2 and thought to be very slow growing and he has had no symptoms.

- Due to having no symptoms and his worries about side effects from treatment (he was 63 when diagnosed and is very active and healthy) he opted for Active Surveillance.

- Active Surveillance was all going well with his PSA bobbing around between 8 - 12 or so, then at his last check up they found it had risen to 18 which prompted a new load of tests.

- A new MRI re-graded the cancer as T3a with it touching the edge of the prostate, PSA of 18 with no lymph node involvement.

- These updates prompted a bone scan...which highlighted 2 small areas on his ribs. They described them as 'focal points' and said that the results were inconclusive, requiring a Choline PET scan and further investigation.

He is absolutely gutted by this news and is now very concerned the cancer has spread. I wondered if anyone had any further knowledge/ information about an inconclusive bone scan and what this means? Does this definitely mean bone mets, and if so what impact does that have on treatment etc? He will be starting some form of treatment as soon as possible!

Sorry for a lot of info, please ask away and I look forward to connecting with people here - albeit in difficult circumstances.

Roz xxx

User
Posted 10 Apr 2023 at 10:36

Hello 

If you read my profile you will see my journey has been very similar to your dads.I was on active surveillance for 4 years until a sudden rise in my PSA .I had to have a prostectomy that wasnt fully successful so I had to have RT and hormone therapy.I also have had an inconclusive bone scan it proved to be what is called an insufficency fracture but it took a bone scan , CT and MRI scans to conclude that is what it was.Many different bone problems show up on a bone scan not just cancer ,old injuries ,arthritis,degeneration  etc full diagnosis can be complex.

I have been very lucky for three years since commencing treatment my PSA is undetectable  and all  my scans are clear so hopefully with good timely treatment your Dad will be doing as well as I am .I know how worrying and frightening this disease is but there are so many new treatments available now that can cure Prostate cancer or if not cure extend life for years  so dont be too despondent a positive mindset is very important .

User
Posted 10 Apr 2023 at 15:49

I had bone scan in the build up to the op. Showed spots on my ribs and spine which was in total conflict to biopsy, which said no spread. I researched private PET psma scan near me, £3200, I was just about to do it when hospital called and said as bone scan conflicted , they would do pet scan. Had it and it was clear.  3 months ago I had the op. 1st psa shows 0.01. So if bone scan was right, I would not expect this psa result. 

 

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User
Posted 09 Apr 2023 at 23:49

The bone scan images are very poor resolution. If there's a questionable area, they'll usually X-ray or CT-scan it. It actually works by looking for newly growing bone, which happens around bone mets. That also happens if you've broken the bone in the last 6-12 months.

The PET scan is a way to look for mets anywhere including bone. It includes a CT scan, which should give them a better quality picture of the ribs. (Bone scan will only find mets in bone).

User
Posted 10 Apr 2023 at 00:14

Originally Posted by: Online Community Member

The bone scan images are very poor resolution. If there's a questionable area, they'll usually X-ray or CT-scan it. It actually works by looking for newly growing bone, which happens around bone mets. That also happens if you've broken the bone in the last 6-12 months.

The PET scan is a way to look for mets anywhere including bone. It includes a CT scan, which should give them a better quality picture of the ribs. (Bone scan will only find mets in bone).

 

Thanks for this further information - I was looking to find out a bit more about what 'inconclusive' specifically means here in the case of a bone scan. Based on your comment, it would simply pick up areas of newly growing bone which could be mets/ injury repair?

I don't know of him sustaining any rib injuries in the past year which makes me more concerned it's mets, which he's very worried and upset about.

User
Posted 10 Apr 2023 at 09:46

My mother-in-law cracked her ribs without realising, probably during an episode of a very bad cough.

Edited by member 10 Apr 2023 at 19:31  | Reason: Typo

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

User
Posted 10 Apr 2023 at 10:36

Hello 

If you read my profile you will see my journey has been very similar to your dads.I was on active surveillance for 4 years until a sudden rise in my PSA .I had to have a prostectomy that wasnt fully successful so I had to have RT and hormone therapy.I also have had an inconclusive bone scan it proved to be what is called an insufficency fracture but it took a bone scan , CT and MRI scans to conclude that is what it was.Many different bone problems show up on a bone scan not just cancer ,old injuries ,arthritis,degeneration  etc full diagnosis can be complex.

I have been very lucky for three years since commencing treatment my PSA is undetectable  and all  my scans are clear so hopefully with good timely treatment your Dad will be doing as well as I am .I know how worrying and frightening this disease is but there are so many new treatments available now that can cure Prostate cancer or if not cure extend life for years  so dont be too despondent a positive mindset is very important .

User
Posted 10 Apr 2023 at 15:49

I had bone scan in the build up to the op. Showed spots on my ribs and spine which was in total conflict to biopsy, which said no spread. I researched private PET psma scan near me, £3200, I was just about to do it when hospital called and said as bone scan conflicted , they would do pet scan. Had it and it was clear.  3 months ago I had the op. 1st psa shows 0.01. So if bone scan was right, I would not expect this psa result. 

 

User
Posted 10 Apr 2023 at 19:31
Steve, I think you mean the results conflicted with the MRI rather than the biopsy? A biopsy can’t tell whether there is any spread (mets) to bones, lymph nodes or soft organs. It can sometimes identify that the cancer has moved into the seminal vesicles or escaped from the covering of the prostate. Cancer can spread to bones or lymph while still contained in the gland.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 10 Apr 2023 at 20:28

Hello, My biopsy result did state M0, ..when I asked the nurse what it meant  she said ...no mets. So I just assumed that it meant no spread. Anyway, I will check with my dedicated nurse re the cycling but if there is any doubt, I'll wait the 6 months. Thank you for taking the time to give a detailed reply.

User
Posted 10 Apr 2023 at 22:21

Originally Posted by: Online Community Member

Hello 

If you read my profile you will see my journey has been very similar to your dads.I was on active surveillance for 4 years until a sudden rise in my PSA .I had to have a prostectomy that wasnt fully successful so I had to have RT and hormone therapy.I also have had an inconclusive bone scan it proved to be what is called an insufficency fracture but it took a bone scan , CT and MRI scans to conclude that is what it was.Many different bone problems show up on a bone scan not just cancer ,old injuries ,arthritis,degeneration  etc full diagnosis can be complex.

I have been very lucky for three years since commencing treatment my PSA is undetectable  and all  my scans are clear so hopefully with good timely treatment your Dad will be doing as well as I am .I know how worrying and frightening this disease is but there are so many new treatments available now that can cure Prostate cancer or if not cure extend life for years  so dont be too despondent a positive mindset is very important .

Thanks so much for this response, and it does seem like your story has definite similarities to my dad. It sounds like things are going really well for you!

He's feeling really negative and down at the moment because he was more than happy with active surveillance, so having the goalposts changed has been quite a shock. He's definitely not in a positive mindset place currently.

I know nobody on here can offer particular medical advice/ diagnoses, but the impression I'm getting is that this bone scan currently is not the 'be all and end all' - this isn't a death sentence. There are other things the scan could highlight rather than bone mets - he's not aware of any recent rib injuries, though he did have an unsuccessful stint playing rugby about 40 years ago when several bones were broken!

He's due a Choline PET scan in the near future, so is there anything in particular we should be aware of with this? I'm mostly wondering the chances of finding mets via the PET scan when the initial scan was inconclusive, but obviously I know this will vary person to person 🤷🏼‍♀️

User
Posted 10 Apr 2023 at 22:25

Originally Posted by: Online Community Member

I had bone scan in the build up to the op. Showed spots on my ribs and spine which was in total conflict to biopsy, which said no spread. I researched private PET psma scan near me, £3200, I was just about to do it when hospital called and said as bone scan conflicted , they would do pet scan. Had it and it was clear.  3 months ago I had the op. 1st psa shows 0.01. So if bone scan was right, I would not expect this psa result. 

 

This sounds similar to my dad - no lymph node involvement seen on the MRI and the cancer was touching the edges of the prostate capsule but didn't appear to have been breached yet so there was no indication of any spread.

Following this, hearing the news that there could be bone mets came as a real shock and not what we were anticipating at all. He is awaiting a Choline PET scan but this could take a while so he is considering a private referral. Is this the right sort of scan or is PSMA considered the 'gold standard'?

User
Posted 10 Apr 2023 at 23:20

Hi Roz,

My husbands MRI showed something on his pelvis, he had a bone scan and the local MDT (multi disciplinary team) confirmed it was prostate cancer spread to his bone. We got a second MDT opinion and they disagreed. He then had a PSMA pet scan to confirm and this also said no cancer. He did have cancer in one lymph node but went on to have the operation to remove it along with his prostate.

These things are often based on opinions and how someone reads the scan. We continue hoping that the second mdt and PSMA were correct 🤞🏼his psa has started to rise again slightly.

So I would say it’s far from conclusive that it is anything on the bone, hopefully you will get more answers with the further scan x

User
Posted 11 Apr 2023 at 00:16

Originally Posted by: Online Community Member
a) no lymph node involvement seen on the MRI and the cancer was touching the edges of the prostate capsule but didn't appear to have been breached yet so there was no indication of any spread. Following this, hearing the news that there could be bone mets came as a real shock and not what we were anticipating at all.

b) He is awaiting a Choline PET scan but this could take a while so he is considering a private referral. Is this the right sort of scan or is PSMA considered the 'gold standard'?

 

a) Cancer doesn't spread to bones or lymph nodes by bursting out of the prostate and invading the pelvis until it reaches some bone. Cancer spreads to bones through the blood and to lymph nodes through the lymphatic fluid. It is entirely possible for cancer to be fully contained within the prostate and still be metastised to bones, nodes or soft organs. The cancer can burst out of the prostate and invade structures nearby such as the bundles of nerves that cause erections, the bladder, bowel or pelvic muscles - what your dad's MRI was suggesting was that this does not appear to apply in his case. 

b) as I said to one of your other posts, choline, PSMA G68, PSMA F18 and axumin are all very similar tracers used in PET scans but each has its own strengths and drawbacks. Choline seems to be the right next step for your dad's situation.

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

 
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