Scanxiety today 3/9

sounds like you are doing exceptionally well. but I know the feeling- I am having PSA draw later this month...I have been undetectable for 6 months but prob will never get over the surprise of PC diagnosis last JUne...never know what scans are gonna find in us older guys...but all we can do is take our meds, eat good food and exercise...worry doesnt help at all. SO I try to not go down the "what if" rabbit holes..

Ahh... Spring. Used to be new life and nature's rejuvenation. Now it's scans and blood tests. 🤣

DXA scan and fasting blood tomorrow for me. Good luck! 👍👍👍

RO wants a scan to check a met on L5 next month but didn't tell me what kind of scan yet.

(Layperson writing)

As I understand, with your PSA suppressed to undetectable levels, any tumours would be dormant and have little/no PSMA uptake, effectively blinding that type of scan.

Even though they're lower-resolution, CT+contrast, MRI+contrast, and/or bone scans can see the actual structure of your body, including lesions or damage from lesions, even when the metastases are dormant, so — again, as far as I understand — they make more sense for you.

In my case, with PSA < 0.01 for over 4 years, I had all three of those alternative scans last year, as well as blood tests every 3 months including not only PSA but ALP (which can point to damage from bone metastases), LDH (a non-specific damage indicator), and tests for the health of my kidneys and liver. While no one of these in definitive, together, they allow a skilled oncologist to synthesise a fairly good picture of what (if anything) us happening

Are cells still dying? Yes, continues up to 18 months after radiation.

I am not well versed about RT but just want to wish you the best of luck with your scan < 3. I am sure that they want to double check everything "just in case" and really do not expect to see any new findings. : ) You had amazing result with your 2 therapies (RP and RT) and I am sure that all will come back squeaky clean : ))) - but it is always better to check and address any issue on time if it ever arises.

My husband is having PSA test today and results will be tomorrow and I did not have much sleep for 3 nights in a row and my nerves are totally frayed @@, so I understand you completely.

Sending you "good vibes" and the best wishes : ))) Let us know how it went ASAP !

@surftohealth88 Hi Surfer !
I hope everything turns out good for you and your husband:)

I feel you. I have my PSA test tomorrow.

Why would you want another scan if your PSA is undetectable? Are you on ADT?

@chippydoo oncologist ordered these scans because I am very high risk. First scan after radiation and being on Firmagon and abiraterone. This scan is making me nervous because it will tell me how effective (or not) my treatments have been. PSA is < .02 but I have read about varieties of PCa that spread without expressing PSA.

@johndavis60 I have found some mentions in the literature of the rare neuroendocrine type of prostate cancer (NEPC) advancing with PSA < 1.0, and there may be a handful of cases (out of hundreds of thousands) of NEPC advancing with PSA < 0.1, but I have yet to find a mention of progression when PSA is undetectable on the ultrasensitive test (< 0.02 or 0.01). That test wasn't common until recently.

When there's something slightly concerning on a scan, my radiation oncologist does follow up, but as he told me, even NEPC expresses *some* PSA (just a very small amount that older PSA tests couldn't detect, hence the "varieties of PCa that spread without expressing PSA" thing you still read online).

It's normal to be nervous — I am too, before any scan — but you've been a good responder to doublet therapy and your PSA is still undetectable on an ultrasensitive test, so I think it's a pretty-safe bet (as safe as anything is in this world) that if any lucencies do show up in your scan, they will be non-cancer "noise" rather than cancer "signal," as happened to me with an MRI last fall. That's especially common places like the ribs, where scans can't easily distinguish between a cancerous lesion and a bruised rib healing, for example. Radiologists and oncologists have to use their subject-matter expertise, your medical history, and other test results to make a judgement call.

Best of luck!

Caveat: Non-expert layperson writing here. Discuss what I wrote with your onco.