Bone Scan

On May 26, 2020 I had the Bone Scan. 

It is an easy process that involves an intravenous injection of a small amount of a low-level radioactive substance that is preferentially taken up by damaged bone. (Bone can be damaged by cancer as well as by osteoporosis and other bone diseases.) A special scanner is then used to detect the radioactivity.

The injection was painless. I was then allowed to leave the hospital and return after 3 hours. I went about normal activity including drinking plenty of water. They want you to drink at least 16 oz in that time. When I returned they had me use the washroom first because the scan takes about 45 minutes and they don't really want to interrupt it for anything.

They had me get on the machine bed and put a triangle under my knees and a wedge pillow to hold my neck and head in place. Then they instructed me to hold my big toes together and then they used tape to hold my feet in that position so that my legs were slightly spread. Then they looped a sheet over my lower chest and brought the ends around my arms and tied it so my arms were held away from the bed and supported next to my body with my thumbs touching my hips. One must stay completely motionless during the scan except for normal breathing.

Once I was all comfortable they started the machine. The bed slowly moved into the machine and then the scanner came down to within about an inch of my nose. It starts with the head and that took several minutes then it slowly moved me along so my whole body was scanned in about 25 minutes. I nearly fell asleep! 

After that first trip they checked that I was still comfortable and adjusted me a little. Then it started phase two which was a scan of my spine. For this the machine rotated around my body as the bed adjusted me back and fourth. 

The next day my Doctor called me with the results.

My scan was totally negative which means they found no evidence of cancer in any of my bones. This is good, but only one step. It is clear that I have cancer somewhere or my PSA would NOT be doubling so quickly. All this shows is that there is no clear evidence that it is in the bones. -- As an aside at the bottom are the actual finding. I am glad I am not as bad off as the scan appears. The Doctor reading the scans says I have arthritis and maybe difficulty walking. I walk 3 miles 3 or 4 times a week and do that in about 1 hour up and down the hills where we live. I am happy about that!

That is good because it means that ADT (Androgen Deprivation Therapy) and radiation have a chance to kill off the cancer. It is good news because if they had clearly seen cancer in the bones it would be too late to do radiation and my only choice would be ADT and that by itself will not cure, only prolong life. 

The PET scan is out of the question because the wait is up to 9 months. At the rate my PSA is rising it would be risky to wait that long and the only thing the PET scan might tell is the exact location of the cancer. It would not improve my chance of a cure. Because if it did not show anything more that the other scans I would still need treatment and the wait would maybe give time for the cancer to spread. If it did show cancer away from the prostate area then it would be too late to do radiation and a cure would be very unlikely. Also this scan is considered experimental and there is no clear evidence that having this scan will increase the likelihood of improving the chance for a cure. 

So, I get the CT scan on June 1. I will start ADT then as well. If the CT scan is also negative (good) then after about two months I will start radiation treatments for about a month. 

I really don't look forward to this journey, but the alternatives are worse. So, I hope that the treatments work, but I put all my trust in my Lord and my medical team. 

I trust in my Lord and am willing to accept whatever He has in store for me. "What does not kill me makes me stronger." I am doing what seems to be the best chance for a cure according to my oncology team and all the research I have done. 

I stress again that this type of cancer puts a lot of responsibility on the patient to make choices between various options. The medical team can only advise to the options but not give clear final say on the very best course to take. I am thankful for my wife who supports me and we together consider the options, pray for guidance, make our choice, then accept wherever that choice leads. 

I have always made an effort to live a healthy well balanced life. I am in good health and feel great! I regularly walk about 5 KM (3 miles) several times each week. I do a lot of work around my home on the yard and building things.  I am confident in my eternal well being. So, whatever this life gives me I am prepared to accept. 



Actual Finding with my interpretations in {}:
    Whole-body images and tomographic images from the base of the skull to the proximal femora {thigh bone}obtained using 99mTc MDP {radiotracer used in nuclear medicine especially for bone scans} failed to demonstrate any definite abnormalities suggestive of metastatic bone disease Relatively symmetric increased uptake is seen at the posterior {Posterior is often used as a technical term in biology and medicine to refer to the back side of things}aspect of the left and right temporal bones {base of the skull} Subtle periosteal {outer surface of the bone} uptake is apparent at the right tibia. Increased uptake at the 1st MTP joints {big toe} is consistent with an arthropathy {arthritis, which is joint inflammation.}. The thoracic spine {The section of the spinal column called the thoracic spine begins below the cervical spine (C7, neck), roughly at shoulder level and continues downward until it reaches the first level of the low back (L1, lumbar spine). Twelve vertebrae, numbered T1 through T12 from top to bottom, make up the thoracic spine.}appears quite kyphotic {excessive outward curvature of the spine, causing hunching of the back.}on the SPECT views {For a bone scan with SPECT/CT imaging, a "SPECT" scan is combined with a "CT" scan to help localize an area of abnormal activity that may be present on the planar bone scan image. }.

IMPRESSION from Radiologist MD:

1. No convincing evidence of skeletal metastases.  {no evidence cancer has spread to the bones}

2 Bilateral 1st MTP arthropathy. {arthritis is both big toes}

3. Increased periosteal uptake at the right tibia is a nonspecific finding. not typical for metastases. Periosteal {outer surface of the bone} uptake may relate to altered ambulation. noted history of remote left ankle fracture. {difficulty in walking properly}

    
 

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