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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2006ProstaScint Poll
A buddy of mine who did not heed my advice 5 years ago when I went through DX, RP, etc. has just been diagnosed w/ PCa. He was having a routine colonoscopy and his prostate felt abnormal to the dr. PSA 7. I told him at that time that unless he had prostatitis or BPH, he had PCa. He had his Bx a couple of weekd ago and the uro told him he had the "slow-growing" kind of PCa or something to that effect. I told him to ask for/demand a copy of the path report. 1/2 samples affected, G.S. 3+4. Not insignificant PCa. Anyway, the uro has ordered a bone scan, CT, and ProstaScint. That's - what - well over $5000 worth of tests? As we know, Strum thinks even a bone scan is a waste, as is a CT w/o endorectal coil, much less a ProstaScint. I had a ProstaScint when I recurred after an initial PSA of 33 and it showed nothing. What is the likelihood w/ a PSA of 7 that this expensive test will have any Dx value? So, the poll is: WHO HAD A PROSTASCINT AND DID IT SHOW ANYTHING OR HAVE ANY DIAGNOSTIC VALUE? Bill Denton RP 2/12/02 PSA 1.10 Memphis My Onc. would not order a ProstaScint saying that "in order for anything to show up conclusively, it would need to be very significant (my PSA was low at the time). This was after my Uro. recommended I get one. Rich > (snip) > [quoted text clipped - 5 lines] > PSA 1.10 > Memphis > So, the poll is: WHO HAD A PROSTASCINT AND DID IT SHOW ANYTHING OR HAVE > ANY DIAGNOSTIC VALUE? I had a prostascint at Johns Hopkins 2 years after rad treatment. It didn't show a thing. This is in addition to a PET-scan, MRI, and 2 bone scans this year. I suspect it's good to help stage but maybe isn't so good for checking mets. -kh > So, the poll is: WHO HAD A PROSTASCINT AND DID IT SHOW ANYTHING OR HAVE > ANY DIAGNOSTIC VALUE? I had one at .75 (May 2002). Showed nothing.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum I had a Prostscint in Non 2002. It showed the cancer was contained to the prostate. I had surgery the next month and the pathology agreed with the prostascint. Rich, were you at risk for extra-prostatic extension and/or mets? In the vast majority of routine cases a ProstaScint is going to show just that - organ-confined disease - because that is all there is. Congrats BTW. The question at hand is whether a ProstaScint will show advanced disease in marginal cases. The tide of opinion these days seems to be that it will not. There are several men here (myself included) who most likely had non-organ-confined disease at the time they had ProstaScints that did not show anything. In my buddy's case w/ a PSA of 7 I think a ProstaScint is a huge waste of money. And we all pay for it in ins. premiums. Bill Denton RP 2/12/02 PSA 1.10 Memphis Nope, no ProstaScint - my rad/onc would not do one. My psa was .3 and he reported nothing would show and it would be a waste of time. I did get a bone scan and CT against my better judgement. My wife and other hospital staff convinced my that it would give a proper baseline for later years. Dave P > A buddy of mine who did not heed my advice 5 years ago when I went > through DX, RP, etc. has just been diagnosed w/ PCa. He was having a [quoted text clipped - 19 lines] > PSA 1.10 > Memphis > Anyway, the uro has ordered a bone scan, CT, and ProstaScint. The bone scan is useful because one can assume there is currently no significant metastasis to the bones and a scan done now provides a good baseline against which to check for future changes. The other two tests are, in my view, a waste of money and time. On the other hand, it will be very worthwhile getting the biopsy specimens reviewed by a specialist laboratory (can someone provide the list, please). In any case, you friend needs to be reading, educating himself and deciding on treatment options. With Gleason 3+4 this is not something he can ignore. The very limited information you have presented does not give me much confidence in your friend's current urologist. I strongly suggest shopping around for an expert on PCa and getting a second opinion. SignaturePeter Headland > On the other hand, it will be very worthwhile getting the biopsy > specimens reviewed by a specialist laboratory (can someone provide the > list, please). Here ya go: Bostwick Laboratories, David Bostwick [800] 214-6628 Dianon Laboratories 1 [800] 328-2666 (select 5 for client services) Jon Epstein (Hopkins) [410] 955-5043 or [410] 955-2162 (Dr. Epstein does not do ploidy analysis) David Grignon (Michigan) 313-745-2520 Jon Oppenheimer (Tennessee) [888] 868-7522 UroCor, Inc. 1 [800] 411-1839 > In any case, you friend needs to be reading, educating himself and > deciding on treatment options. With Gleason 3+4 this is not something [quoted text clipped - 3 lines] > confidence in your friend's current urologist. I strongly suggest > shopping around for an expert on PCa and getting a second opinion. I second that motion.. Regards, Steve J "The most bothersome aspect of what goes on in the world of PC today is that few (less than 5%) of physicians (mostly urologists) bother to spend the 10-15 minutes to use the literature published in urologic journals and oncology journals to calculate the individual's risk for OCD (organ confined disease) vs non-organ confined disease. This is like going to sea on the open ocean and not checking out your ship or the weather but just "doing it". Physicians are not behaving as scientists and moreover, they are not translating what we know into what is done with the patient. Unfortunately, we appear to be living in a time when physician income is more important than patient outcome." --Stephen B. Strum, MD on p2p, June 12, 2004 > Anyway, the uro has ordered a bone scan, CT, and ProstaScint. That's - > what - well over $5000 worth of tests? As we know, Strum thinks even a > bone scan is a waste, as is a CT w/o endorectal coil, much less a > ProstaScint. Two of my uros ordered CTs. They were a waste because I have so much bone damage from 30+ years of ankylosing spondylitis.
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