Should you get a bone test if only on ADT for 6 months

You want a bone density scan (DEXA). You should’ve had it before going on Orgovyx, but it is a good idea to have it now to see what’s going on with your bone density. ADT can really deteriorate the bones so you want to make sure your bones are in good shape and you don’t need bone strengthening drugs.

If for some reason, your PSA starts rising and you need to go back on ADT it’s good to know where you stand.

We usually recommend people get that scan before starting ADT.

Thanks Jeff
I will request a Dexa when I go in.

Timmy, yes. it's an easy test. Radiation, also, can negatively affect bone marrow where the cells that build bone originate.

We did a baseline DEXA scan in March 2021 (at 65y) prior to starting a 6-month regimen of Eligard; then repeated the DEXA scan in April 2023, and again in June 2025. We don’t plan on doing another one. (These were all part of my treatment plan, not something we happened to discuss later.)

As with any other numbers, we wanted to stay ahead of whatever might have happened. It’s always good to know what’s going on and that it’s going well.

I am 77 years old, diagnosed with Adenocarcinoma prostate cancer in Feb 2025 with 3 tumors (Gleason scores 7,8,9) contained within prostate. Took ADT hormone treatment with 3 Leuprolide and Denosubmeb at 6-month intervals along with 27 Radiation treatments in July-August 2025. No initial bone density test offered. Found out height dropped 1.5 inches in May 2026. Bone Density completed with normal results. After third Hormone shot, experienced higher than normal hip pain, small sores all over body which itched and some developed into sores. Not much diagnosis and treatment for hip pain from Cancer team, resorted to dermatology & Orthopedic specialists for support. Have 1 year Radiation Oncology follow-up in September with only a PSA test to support. Previous PSA scores good, 1 testosterone test in Jan 2026. Should I push for PET Scan to ensure cancer cells have not become immune or spread?

A 2024 study was done to see if patients were being monitored according to accepted guidelines:

"To reduce the complications of ADT, the American, Canadian, and European Urologic Associations have developed monitoring guidelines specifying that all patients on ADT should undergo routine measurement of plasma glucose levels, lipid profiles, calcium/vitamin D levels, and bone mineral density measurement at the initiation of therapy and at regular intervals thereafter (every 6–12 months for laboratory investigations, every 1–3 years for bone mineral density."
https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.35606

@monte09
You don’t mention your current PSA level. If it’s undetectable Or real low, then insurance may not pay for a PSMA pet test. That is what you want however, if you have hip pain. They could do a bone scan just to see if they can find a metastasis with that, The PET scan is better, but they can do the bone scan with a low PSA. They can also do a CT scan to see if there’s any changes from a previous scan. That is sort of standard to do every six months for somebody that has had prostate cancer treatment.

If you are going to continue to get Lupron shots, you should ask to switch to Orgovyx, A daily daily pill you take, and it may not have the same side effects.

@climateguy

I know of no one who had the tests you listed. Everyone I know got radiation or surgery with only a biopsy and PET scan. All also got ADT for 18 or more months.

@pesquallie At Fred Hutch in Seattle, an NCI designated cancer center, they are doing blood work prior to each appointment that includes most of that list if not all. I noticed and appreciated that they did a DEXA scan for baseline data prior to initiating ADT for me, as per the guideline. Since my biopsy was not originally interpreted by their own in house pathologist, a review by their pathologist was the first thing they ordered.

@monte09
Hi,
If your PSA is starting to climb after several readings I would say a PET scan would be the next step. Since you did have radiation you will have some live Prostate tissue so your PSA test score could bounce around a little the settle down to a average level.

Dave 3+4