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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2004Feasibility of Prostascint Scan
Greetings, I had an RP in '99 (Gleason 7, PSA 9.5), PSA post-op was .4. Had immediate RT+ hormonal therapy for 12 mos. PSA stayed at <.01 until 6/03 then went from .12 03 to .17(Sept.03) to .33(Dec.03). I am getting ready to go back on HT with extras. One Dr. recommends a Prostascint to see if we can still catch and radiate the Ca in nodes that were missed during RT(e.g.iliac nodes). This sounds attractive to me(who wouldn't want to catch it if possible) but also expensive($4800) since I believe it is a long shot. My other Dr. does not support this approach. I would be interested in hearing from anyone out there who may have tried this approach so late in the game. "I had an RP in '99 (Gleason 7, PSA 9.5), PSA post-op was .4. Had immediate RT+ hormonal therapy for 12 mos. PSA stayed at <.01 until 6/03 then went from .12 03 to .17(Sept.03) to .33(Dec.03). I am getting ready to go back on HT with extras. One Dr. recommends a Prostascint to see if we can still catch and radiate the Ca in nodes that were missed during RT(e.g.iliac nodes). This sounds attractive to me(who wouldn't want to catch it if possible) but also expensive($4800) since I believe it is a long shot. My other Dr. does not support this approach. I would be interested in hearing from anyone out there who may have tried this approach so late in the game." Coincidentally. Phil, I just finished a ProstaScint this morning. I had no idea it was that expensive; that is apalling, especially considering the high false-negative rate for it. My uro ordered both a bone scan and ProstaScint and the latter was done after the former w/o any re-evaluation. It may well be that a positive bone scan would have confirmed systemic disease, making the expensive ProstaScint unnecessary - another example of the waste in American healthcare. Don't think for a minute that doesn't drive up ins. costs. I am not aware of a protocol for a second round of RT; I think they figure they get it all the first time and that any residual PCa is not down there. I would not get the ProstaScint unless a radiation oncologist (not your plumber/ carpenter uro) says that more RT is a real possibilty. Bill Denton RP 2/12/02 Memphis > One Dr. recommends a > Prostascint to see if we can still catch and radiate the Ca in nodes > that were missed during RT(e.g.iliac nodes). This sounds attractive to > me(who wouldn't want to catch it if possible) but also > expensive($4800) since I believe it is a long shot. I had a prostatscint before salvage RT. My PSA at the time was .34 - .75 (somewhere in there). The prostascint scan showed nothing. It was explained to me that they were just making sure there weren't any mets anywhere, that with the low about of PSA, it was very likely they would see nothing. In your case, I'd imagine there is a likely chance they'd see nothing. And, if they see nothing, it doesn't help you at all. Re RT of the iliac nodes, I never heard of it and I've been here for a couple of years. I am not in favor of the Prostascint Scan. I had one shortly after my RRP because I had positive margins. The scan showed activity at the iliac node, but I was told by my radiation oncologist that Prostascint "almost always" shows a hot spot there. After looking at the statistics published about the false alarms and the false negatives, I concluded that you had about a 50% chance of getting the correct answer, so ignored the results. I did have a course of radiation, but the decision was not guided by the Prostascint results. Uncertainly, Tom Northern Virginia Diagnosed 12/99 at age 64 PSA 2.37, Positive DRE; Gleason 3 + 4 = 7 RRP 7/00, 1 nerve spared, microscopic capsular penetration, positive surgical margin EBRT 4-5/01 37 treatments, 66 Grays Transient side effects from both treatments 1/04 PSA 0.013 > Greetings, > I had an RP in '99 (Gleason 7, PSA 9.5), PSA post-op was .4. Had [quoted text clipped - 7 lines] > not support this approach. I would be interested in hearing from > anyone out there who may have tried this approach so late in the game. That is absolutely fantastic!  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 > I am not in favor of the Prostascint Scan. > [quoted text clipped - 38 lines] > > not support this approach. I would be interested in hearing from > > anyone out there who may have tried this approach so late in the game. Paging Dr. C. Paul Williams --- I would love to hear from you on the matter of Prostascint, if you have anything to share with us. Larry > I am not in favor of the Prostascint Scan. > [quoted text clipped - 38 lines] > > not support this approach. I would be interested in hearing from > > anyone out there who may have tried this approach so late in the game. Oh, I'm so excited...something I know something about. The Prostascint scan involves labelling a monoclonal antibody specific for a glycoprotein found in the cell membrane of prostate cells and tissue with a radioactive tracer called Indium-111. The antibody attaches to the cell membrane of ANY prostate tissue in the body...metastases, local recurrence, normal prostate, BPH, etc. By then scanning the patient in a machine called a SPECT scanner (single photon emission computerized tomography), the "hot spot" should show up in an anatomically specific way, i.e. prostate bed, pelvic lymph node, spine. Sounds marvelous, no? The problem comes in the analysis of the results of the scans when compared with surgical pathology and post op PSAs. (I had to look these up, I don't carry them around in my head) Positive predictive value 62%-77% Negative predictive value 72%-41% first number when compared to surgical pathology, second with post op PSA In my opinion, these numbers do not inspire confidence in the results of the scan. If a positive scan is obtained, there's only a roughly 3 in 4 chance that is really is positive. If a negative scan is obtained, it's even worse. Leonard could perhaps shed more light on what the statistical numbers mean in real life...to me, it indicates the study is "OK" but far from foolproof with either a positive or negative way. Hope this helps. By the way...the absurd charges mentioned in previous posts are probably correct. Every radiology study is divided into technical charges (which the hospital charges for equipment and personnel) and professional charges (by the interpreting radiologist). I can tell you that our professional charges for an average nuclear study is around $100... Good luck. CPW > Oh, I'm so excited...something I know something about. > The Prostascint scan involves labelling a monoclonal antibody specific [quoted text clipped - 14 lines] > first number when compared to surgical pathology, second with post op > PSA I'm reminded of a Farside Cartoon. What humans hear: "Come on Skip. Come on. Skip! Don't you want to taste this? Come on Skip." What dogs hear: "------------------ Skip -------------- Skip ----------------Skip" Just kidding, doc. Having had one, I almost understood everything you said until you got to predictive values. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 |
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