Value of a ProstaScint in locating PCa after bioFailure

Hawk · New User Joined: 22 Nov 2006 Posts: 9

I have heard that a ProstaScint is specifically designed to take the guess work out of determining whether the PCa is local or a distant metastasis, yet no one on the forums or in medical center websites seem to refer to them.

What is their value and reliability in determining the value a salvage RT after failure from a RP?
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History: PSA 5.2 - 6.7 neg. biopsy - PSA 16.6 (11.2 free)neg. biopsy - PSA 8.2 - 8.1 - 8.7 Biopsy 2 positive cores 4+4 (Gleason 8 )
Lap RP Apri 2004, @age 52 All neg margins, nodes, and structures. (T2a)
Post RP PSA: every 6 mo. <.1 until 46 months
on Feb, 08 (46 mos) PSA .1 - I then got a sensitive test showing .06

Replicant · Moderator Joined: 01 Nov 2006 Posts: 167

Sorry--maybe someone else will join in here.

My understanding is that Prostascint is not as useful as once hoped.

At any rate, scans including Prostascint (soft tissue scan, as I understand) and bone scans will only show distant disease once it has progressed significantly--PSA in the double digits. So you could rule IN distant disease if you see something, but you can't rule OUT distant disease when it is still in its early, microscopic stage.

Salvage radiation is ALWAYS a roll of the dice. Overall, the odds of benefiting are about 50/50, but you can get a better idea by using a nomogram with inputs from your own medical history.

Peter Scardino, in "Dr. Peter Scardino's Prostate Book" (2006), p. 396, says "It's extremely rare for bone scans, CT scans, or plain X-rays to find anything if the PSA is less than 10. In fact, such tests are unlikely to find any signs of metastases until a man's PSA rises over 20." Of Prostascint, he says "[it] has not produced consistently reliable results." By the way, on the next page of Scardino's book he presents an earlier (2004) version of the Stephenson's nomogram that I mentioned.
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 167

Walsh, in his 2007 book, p. 212-213, says "The test has much promise. For now, however, Prostascint scans are difficult to read, and there seems to be a good deal of subjectivity in interpreting them. Because the results are often inscrutable, many physicians are reluctant to rely on this test--which leads to the question, why perform a test if you're not confident in the result."

On p. 384, Walsh says, under the heading "Before you undergo radiation after radical prostatectomy," "Your doctor may want you to undergo some further tests. If there is a slight chance the cancer may have spread beyond the local area, your doctor may suggest a bone scan, chest x-ray, and pelvic CT scan or MRI...The main reason for these tests is *not* because your doctor expects them to be positive, but to establish a baseline of information. (For example, if you have bone pain in years to come the doctor can look at the bone scan and say 'Oh, that's the old football injury; see--it hasn't change d in five years.")
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

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