Follow-up scans during treatment?
Posted , 4 users are following.
Hello
Age 75, I was diagnosed with PCa in February this year (T3a, NO, Gleason score 8, PSA 3.3), despite my PSA being in the normal range, and my testosterone levels very low. Apparently this implies that my cancer is probably an 'aggressive' one. I have been on hormone therapy (Zoladex) since March, and my PSA, as expected, has gone down to 0.3. I start 37 sessions of radical radiotherapy next week, and have to continue with Zoladaex for the next two and a half years.
I am concerned to find out whether the tumour has broken out of the prostate capsule during the last 6 months, and whether there is any evidence of spread to lymph nodes or bone marrow (the bone scan I had in February was normal). Is there any point in my asking my GP or the oncologist to refer me for a follow up bone scan, and for a MRI scan to check for spread of the tumour (or maybe this will be picked up during the EBRT)? Or is it too soon for any spread or metastases to have occurred since diagnosis?
I gather that even if there has been a 'breakout' and bone metastases, my 'gold standard' treatment plan would be the same, anyway. But I would like to know, all the same - although I can see that the cost to the NHS for the two follow-up checks may not be justifiable. Any views from anyone who has been in a similar situation?
Best wishes
Tony Kaye
0 likes, 14 replies
Davey22 anthony37993
Posted
Hi Anthony,
You need to get an Axumin PET scan to check for cancer that might have spread, or a PSMA PET scan.
You don't need a bone scan, ct scan or mri.
Let us know the results after the test.
Look up about these test online.
Davey22
anthony37993 Davey22
Posted
Many thanks for this suggestion - I will look into the possibility of asking for a PSMA PET scan, but am not sure whether this is available locally for me.
barney34567 anthony37993
Posted
You don't need a bone scan. What you want is a PSMA PET CT scan which is a great detector of any spread of the PCa.
The fact that you have a Gleason 8 means you have "High Risk" disease and a likelihood of spreading.
If the NHS pays for the scan, then good for you. If it doesn't pay, then establish the cost. It is the best (or equal best) imaging tool for this wretched illness.
anthony37993 barney34567
Posted
Thanks for this advice, Barney. So far, I have found out that the PSMA / PET scan is available at the London Clinic (cost £2588 !). However, I get the impression that it is generally only used in cases where the PSA level has increased / doubled rapidly, and my oncologist has pointed out that my PSA is now very low (0.3) and I don't yet need to worry.
However, what DOES worry me is that the tumour I have does not signal its presence through increased PSA levels - for years my PSA readings have been normal for my age, yet I have an aggressive cancer with a high G score. So, I deduce that the now very low level of 0.3 does not necessarily mean that there has been no spread to lymph nodes or bone marrow. Or am I barking up a wrong tree? It seems difficult to get a clear answer on the correlation between PSA levels and tumour spread / presence...
anthony37993
Posted
On further checking, I've found out that a PET scan using Choline C-11 as a tracer is available at the Northampton General Hospital, fairly close to where I live (cost £2430 if I have it as a private patient, assuming my oncologist thinks it necessary or appropriate, as it would still require his referral). How does this compare with the PSMA PET scan in terms of suitability for my case? Any views?
Davey22 anthony37993
Posted
Click on his link for comparison test between the 2 types of PET scans
https://prostatecancerinfolink.net/2016/09/02/comparison-of-gallium-68-and-choline-c11-based-petct-scanning-in-high-risk-and-progressive-prostate-cancers/
Davey22 anthony37993
Posted
With a tumor grade of T3a, and a Gleason score 8, in my opinion, it's important to know if any cancerous cells have spread. That's another question that you should ask your doctors.
The Zoladex is keeping your psa number down.
Davey22 anthony37993
Posted
Wow, that's an expensive test at $3045 U.S.Dollars
Davey22 anthony37993
Posted
anthony37993 Davey22
Posted
Thanks
Davey22 anthony37993
Posted
I tried to put in a link but this website blocked it.
Try this: prostate cancer info link.net but without the spaces. There's some information on the latest chemicals used in the PET scans and more.
richard98806 anthony37993
Posted
The questions you bring up should be the discussion you have with your doctor.
I am post RARP 6 months ago. I still have a PSA reading .15 & .19. Therefore putting me in the recurrent PC category. I had a PET SCAN with Axumen last week which came out negative. I am now on the wait and watch agenda with 3 month PSA testing hoping the PSA doesn't increase.
The Scan with Axumen is prostate cell sensitive which is relatively new (approved in the US about a year and a half ago). Fortunately I pay out my a-- for insurance and don't concern myself with costs. The Axumen scan has only been approved for recurrent cancer and I am not sure your ADT treatment falls in the category of 'treated cancer'.
My other question is regarding the 37 treatments of radiotherapy. What or where is the radiation being directed at? I would assume a scan or MRI would be necessary to properly direct the radiation.
anthony37993 richard98806
Posted
Hi Richard
Indeed, I will be discussing this with my doctor; but I find it's so useful to get feedback and advice from people like yourself on this site, it helps me to get better informed.
As for the 37 radiotherapy treatments, yes, the sessions are very carefully targeted on the tumour, using state of the art techniques (combined image guided radiotherapy (IGRT) and intensity modulated radiotherapy (IMRT). Hopefully, this will destroy the cancer cells in the prostate, whilst minimising any side effects on the bladder or colon.
richard98806 anthony37993
Posted
if they are targeting the prostate gland/tumor then I would assume they believe the cancer has not spread. I went the surgery route mainly because I have a distrust of the results of radiation therapy. Hang in there. Keep asking questions. you need to let them know it is YOUR body, YOUR health.
Ask about the side effects. You want to make sure that treatment doesn't get in the way of YOUR quality of life versus the impact of the progression of the cancer.