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Bonescan necessary?

I am scheduled for RP at the NIH with Dr. Pinto on 6/6. I have a Gleason score of 4+3 ( graded 3+4 at Johns Hopkins)and psa of 6.5 and 9 out 12 cores positive.

Do most people get the bone scans before surgery? I know if there is anything suspicious then no surgery.

Anyone have an idea of long term effects of the bone scans? I already had an MRI of the prostate, pelvis area and lymph nodes that was negative across the board.
I was wondering if the bone scan was not necessary.
Thanks in advance.

Re: Bonescan necessary?

My doctor's have always stated that the scan would be "predictively negative" if the PSA was below 20. I have others say the PSA level would need to be much higher before a bone scan would show hot spots...like most things with this disease, hard to say which study actually confirms anything with high confidence levels. Just my two cents, but based on what I have experienced for 11+years, a scan for you at this juncture would likely not show anything, but could give some degree of peace of mind possibly.

Allen Z

Re: Bonescan necessary?

Allen,
Thank you for the reply.
I was thinking along the same lines that if it shows something it would be worthwhile investigating before surgery. I am guessing it will not show anything because of the psa level but it would be good to know.
I have not had many xrays so I am guessing that one scan will not lead to anything later ( more hoping that since I really don't know).

Good luck to you.

Best regards,
Drew

Re: Bonescan necessary?

Just another question and fear to confront in this world. I am guessing the main reason for a bone scan is to disclaim any cancer spread to make sure a RP is a viable option.. If there is cancer spread, then getting rid of the prostate is too little too late and they will probably by-pass a RP for the next step in treatment. Why would you want to go through a RP if it was not going to give a chance for cancer obliteration? Fear of radiation excess is common in the world of medicine, dentistry, etc. My understanding is that it is all accumulative but relatively minor in dose compared to all the normal sources we are exposed to every day. If you are afraid of something like a bone scan then don't even ask what the dosage is from radiation treatments! The whole thing is a sticky subject that gets more complicated the more you think of it. As with everything concerning this subject of cancer it is just another necessary evil. Throw into the mix that this is very expensive equipment and making use of it keeps the heat on in the building. We all want an accurate diagnosis but that comes at a price, money and risk. Hang in there guys! It gets complicated. Jon R.

Re: Bonescan necessary?

Jon,
Thank you for your comments. You are certainly right that this is complicated.

Best regards,
Drew

Re: Bonescan necessary?

Drew:
The following quote from one of several articles listed from a Google MRI search appears to address two of your primary concern (i. e., risks and radiation):
"An MRI scan is a painless radiology technique that has the advantage of avoiding x-ray radiation exposure. There are no known side effects of an MRI scan. The benefits of an MRI scan relate to its precise accuracy in detecting structural abnormalities of the body."
Regards Don O.

Re: Bonescan necessary?

No test is risk free. But MRi's are least invasive. Then come normal X-Rays. And CT-Scans probably are the worst for you, giving a radiation dose similar to a few years background exposure.

Bone scans are somewhere below a full body CT/PET scan as far as increased cancer risk.

http://www.xrayrisk.com/calculator/calculator-normal-studies.php


While the dose is probably worth the risk, this tests only for bone metastasis... and tells you nothing about lymph or other organs that may be involved. When a urologist does an RP, they usually take a lymph node or three and a pathologist tests for involvement. If the lymph glands are compromised, a bone scan may be a good choice.

Really - it all comes down to trusting the doc. He/she is the expert. If you walk away from a visit and still have questions, you need to be a bit more bold and ask the doc to take the time to explain it to you. If they won't, then find a different doc who will.

And in any case, have a few docs to chat with during this ordeal. Insurance may limit you, but I've found state university hospitals have people doing research that are happy to discuss your case - It's usually as easy as asking your institution to forward the MRI's or scans, or pathology slides, or whatever to the universities medical team for a second opinion. The caveat being you allow them to incude your data in their studies or to keep it on hand for future work.

Re: Bonescan necessary?

ps:

Radiation is often misunderstood. A fire burning in your fireplace gives off radiation. You feel it as heat. But radiation can be pooled into two distinct camps: Non-Ionizing, and Ionizing. IR, what you feel as heat is non-ionizing.

An MRI uses non-ionizing radiation... think radio waves or microwave ovens. These use electromagnetic radiation at Frequencies that can heat things up but lack energy to break apart atoms. The band extends up into visible light and a bit beyond.

An X-Ray or CT Scan uses ionizing radiation. Think UVA and UVB that burn skin and can disrupt chromosomes and thus cause cancer; and then even higher electromagnetic frequencies that do have the energy to break apart or ionize atoms. X-Rays being the most common we hear about, but also include gamma and other types (yes, there is such a thing as delta radiation).

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