@seathink you misunderstood my post. I am fully aware of what stage 4 is. What I meant is that after 10 years since diagnosis, as risk continues to rise (with hormonal cancers) my doctors offer no way to diagnose any spread other than symptoms." The main symptom they mention is focal, persistent new pain. I have arthritis with bone spurs (pressing on nerves) and 7 spinal fractures so that criterion is not particularly helpful.

I recently saw an oncology surgeon to evaluate a small lump and asked about this. She said they used to do annual bone scans but recurrence rates have decreased and they stopped. I asked what other approaches were available and she answered about the focal pain.

Every stage 4 I know or have read about on forums, had their metastasis discovered in imaging for another reason. I can't do contrast and my reports say they cannot detect tumors w/out contrast so that is out too.