Prostascint scan vs. Bone scan 
Author Message
 Prostascint scan vs. Bone scan

Age 62,  PSA=6.9  Free/Total PSA=16%.  DRE detected abnormal on the right
side.  12 needle biopsy specimens taken (5/5/99).

Results:  Gleason Grade = 7 (3+4) -- (5/11/99)

Right base: Showed several foci of neoplastic gland formation. These show
much infolding and some distension and some cribriform change. This is an
approximately grade 3 lesion.

Right mid gland and right apex show similarly infiltrative lesions which are
roughly the same grade with some apparent features of grade 4 also.

We do not know yet if the cancer has spread to the lymph nodes or the bones.
To determine this my uro wants a full Chem Panel with an Alkaline
Phosphatase test.  He wants to remove the lymph nodes and check them for
cancer and do a Bone scan.

I had read about the Prostascint scan on the American Cancer Society's web
page and it seemed to be non-invasive way to check both the lymph nodes and
the bones at the same time.  My uro was not aware of this test but said he
would check into it and call me.  He called today and said that it is not
done locally and is not done very much because it has a low selectivity
(60%) and a low specificity (70%).  Whereas, he said, the bone scan has
about an 80% selectivity and a 98% specificity ( he seemed to be quoting
these last two off the top of his head).

If Dr. Casey or someone else knowledgable could answer I would like to know
if he is right about these two tests and is he on the right track for
diagnosis and treatment.  He seems to be heading for a fast RP.

Jack



Sun, 28 Oct 2001 03:00:00 GMT
 Prostascint scan vs. Bone scan

Quote:

> Age 62,  PSA=6.9  Free/Total PSA=16%.  DRE detected abnormal on the right
> side.  12 needle biopsy specimens taken (5/5/99).

> Results:  Gleason Grade = 7 (3+4) -- (5/11/99)

> Right base: Showed several foci of neoplastic gland formation. These show
> much infolding and some distension and some cribriform change. This is an
> approximately grade 3 lesion.

> Right mid gland and right apex show similarly infiltrative lesions which are
> roughly the same grade with some apparent features of grade 4 also.

> We do not know yet if the cancer has spread to the lymph nodes or the bones.
> To determine this my uro wants a full Chem Panel with an Alkaline
> Phosphatase test.  He wants to remove the lymph nodes and check them for
> cancer and do a Bone scan.

> I had read about the Prostascint scan on the American Cancer Society's web
> page and it seemed to be non-invasive way to check both the lymph nodes and
> the bones at the same time.  My uro was not aware of this test but said he
> would check into it and call me.  He called today and said that it is not
> done locally and is not done very much because it has a low selectivity
> (60%) and a low specificity (70%).  Whereas, he said, the bone scan has
> about an 80% selectivity and a 98% specificity ( he seemed to be quoting
> these last two off the top of his head).

> If Dr. Casey or someone else knowledgable could answer I would like to know
> if he is right about these two tests and is he on the right track for
> diagnosis and treatment.  He seems to be heading for a fast RP.

> Jack

Prostascint isn't available everywhere and isn't considered to be a
great test by many experts.  I've found it useful in select cases, but
in your case, I honestly do not think it to be indicated.  Some argue
that lymph node dissection may not even be indicated in your situation,
due to the low likelihood of positivity, but I would do it if a RP were
to be planned.  A bone scan is very unlikely to be positive with your
characteristics, and although I would discuss it with a patient I
diagnosed, it would not be mandatory.  PSA<10 without high grade disease
(G8-10) has a very low likelihood of bone metastases, but of course
there are those who think G7 is a worse actor...

The issue of a lymph node dissection before radiation of whatever flavor
is another controversy, and I do not know which way you're leaning...

My comment would be not to rush.  Learn as much as you can.  Get second
opinions and opinions from a radiation oncologist or a brachytherapist
of whatever stripe if this interests you (though I'm not the biggest fan
of this modality.)

Of course specific treatment recommendations cannot be given to you by
me or anyone else (with good conscience) over the internet, but your age
(if accompanied by good health) probably warrants aggressive treatment
IMHO.

It's a tough call, and finally will be up to you...again take your
time...the cancer's been there a while and a month or two won't likely
make a huge difference, but a therapy you're pushed into and then regret
will make a tremendous difference in how you view the rest of your days.

Take care, and I wish you the utmost of luck.

--
David L. Casey, MD
Denton Urology
Denton, Texas USA
http://www.dentonurology.com/

This communication is intended to provide general information, and in no
way is a substitute for face-to-face medical care.  No implication of a
doctor-patient relationship should be assumed by the reader.

Sorry, but no questions or requests answered by private email.



Sun, 28 Oct 2001 03:00:00 GMT
 Prostascint scan vs. Bone scan
Had prostascint myself. Its not accepted by most doctors because of the
anti-bodies used. Prostascint is basically for soft tissue.
I would go for the bones first. I wouldn't wait too long for treatment since
your a gleason 7.
Good Luck
Ken


Sun, 04 Nov 2001 03:00:00 GMT
 
 [ 3 post ] 

 Relevant Pages 

1. Compression Fracture L4 Bone scan and CT Scan

2. Leading News About pet scan. pet scan,pet scan versus mri,pet scans safe,difference between mri and pet scans,preparation for pet scan

3. Recent News About cat scan. cat scan,teen black cat scans,black cat scans bcat,cat scan of sinuses,cat scan images

4. pet scan : Most Recent News. pet ct scan,understanding your pet scan,mobile pet scan orlando,pet scan brain,ftt uptake pet scan

5. Thallium Scan and EKB vs CT Scan

6. Prostascint scan

7. bone scan vs MRI

8. Bone scan vs. MRI in Post-op osteomyelitis

9. Dexa vs. CAT scan for bone density

10. MRI Scan, MRI Brain Scan, MRI Scan Knee, Cost ,Open MRI Scan, Private MRI Scan.

11. Predictive value: Bruce vs Angiogram vs Fast Scan


 
Powered by phpBB® Forum Software