Testing for Advanced Prostate Cancer

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Patients with prostate cancer that is not localized to the prostate and has spread cannot be cured of their disease; however, many treatments are now available that help prolong overall survival in patients with metastatic disease. Testing for it is one way to be on top of managing and treating this cancer.


Monitoring of advanced prostate cancer

Patients being treated with LHRH antagonists or agonist undergo routine serial PSA testing. A falling PSA or stable PSA implies that the disease is responding to therapy. A rising PSA means that the disease disease has become hormone refractory. Additional testing needs to be done with rising PSA.


When should testing be done?

When patients have rising PSA, onset of new symptoms, bone pain, lower extremity swelling, new development of blood in the urine, and/or changes in the pattern of urination.


What tests may be done?

–CT scan of the abdomen and pelvis.
–Bone scan.
–Sodium Fluoride PET/CT scan.


What is a bone scan?

–Able to detect changes in bones that have metastatic disease.
–Radioactive substance is injected intravenously and areas of tumor in the bone have increased uptake of the substance.
–Appears as a brighter area on the bone scan.


What can a sodium fluoride PET/CT scan do?

–Able to detect increased bone activity.
–Compared to standard bone scan, able to better detect changes in bone metabolism, thus able to detect metastatic disease.
–Improved sensitivity compared to traditional bone scan.


Tests in development

–PSA isoform p2PSA: a more specific indicator of prostate cancer.
–PCA3: higher levels in metastatic disease.