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/
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