RE: Follow-up Imaging post treatments; HD-Brachytherapy, HD-EBRT

With that low a PSA it is unlikely that a PSMA PET scan will find anything. It would be hard-pressed to find a doctor that would do it with a PSA that low. Your insurance company might not even want to pay for it.

I can’t imagine you are Orgovyx, Zytiga and Nubeqa. I guess you might’ve started with Zytiga And switched to Nubeqa Because of the side effects. Never heard of anybody on all three of those drugs At the same time.

At this point in your treatment, a CT scan and a bone scan are pretty much the standard.

@jeffmarc
YES; started off on Zytiga but stopped due to elevated liver enzymes, switched over to Nubeqa.

AS for CT Scan w/Contrast of the pelvic region, based on current situation ... I am at a loss trying to figure out justification for receiving more radiation.

I am currently at low ALC and concerned about unwarranted and/or inferior imaging.

@jeffmarc
FURTHER, how often would CT scans be ordered?

WOULD this depend on symptoms, PSA levels etc?

@rdmiller
I understand your concern about getting the CT scan too soon. There was a lot of press about CT scans producing radiation and it could Have negative effects.

The thing is, studies have shown that even though your PSA is undetectable (< .1) It is possible for metastasis to still grow. They do these CT scans, maybe every six months to a year, to make sure that nothing is growing. They can’t see everything but they can detect changes when they have previous CT’s to compare it against.

He said low ALC do you mean low A1C? The CT scans won’t affect your A1C, but over time excessive radiation can cause issues.

I have the same sort of issues, They want to do CT scans every six months because of something besides prostate cancer, I have to make sure they do it for a prostate cancer At the same time..

@rdmiller
If your PSA starts rising they will probably do a PSMA PET scan. People really don’t have much in the way of symptoms when they are on the drugs you’re on. More likely, we will see a PSA rise first.

@jeffmarc
ALC; Absolute lymphocyte count

Concern is efficacy of CT-Scan versus PSMA-PET Scan; to establish baseline following treatments.

@rdmiller
As I said before

With that low a PSA it is unlikely that a PSMA PET scan will find anything. It would be hard-pressed to find a doctor that would do it with a PSA that low. Your insurance company might not even want to pay for it.

With your PSA so low you don’t have a choice. The CT scan is the only one that will actually show anything.

While ALC might show aggressiveness of your underlying cancer, with your undetectable PSA. It’s unlikely to be changing.. Ask your doctor to run blood tests.

@jeffmarc
Thank you for your responsiveness and general guidance.
Much appreciated.

Although you are correct that radiation affects your ALC, radiation to the pelvic region has an even greater influence on blood cell counts; the pelvis is a huge bony organ loaded with marrow. So your concern is definitely warranted.
I think you need to speak with your doctors about how much radiation in a CT scan would affect your ALC going forward. There are studies on this - I mean actual nitty gritty ones - not the headlines that scare the crap out of us.
Check the NIH site or simply Google your query and you’ll probably learn more than you will from your docs.
Phil

My PET scan was a combo, PET plus CT. CT over my whole body, and a PET scan to observe where the radioactive material they put into my body had tended to collect.

The American Cancer Society states that a CT scan exposes you to about 10 mSv, and a PET/CT , because its a CT plus the extra dose administered internally, exposes you to 25 mSv. https://www.cancer.org/cancer/diagnosis-staging/tests/imaging-tests/understanding-radiation-risk-from-imaging-tests.html

Consider the bigger picture: your treatment, EBRT plus Brachytherapy boost, tends to result in a higher dose to the cancer and lower to the rest of your body compared to strategies using EBRT alone. Your mileage may vary, but radiation treatments aimed to kill the cancer are by far the biggest source of radiation dose you are going to get over the years as a result of your cancer diagnosis, compared to diagnostic radiation.

And, a lot of data shows patients receiving your combination experience less need for further treatment including any treatment involving radiation as the years go by.

I believe the total EBRT/BT boost treatment dose you've received is thousands of times greater than a single diagnostic CT.