Great awareness about body scanning and prostate scans have been surfacing because of all the excitement of 3T multiparametric MRI prostate scans. There are other scans that evaluate the rest of the body to determine if any cancer has spread outside of the prostate – to the lymph nodes or the bones, or to someplace else. Obviously, this is a critically important question.
One thing needs to be made very clear, there are many types of prostate cancer, the low-grade types in particular, where body scanning is overkill – it’s ridiculous. We know these particular types of cancer never spread, so why would we expose patients to unnecessary radiation, cost, and inconvenience looking for a cancer that we know cannot be outside the prostate. Unfortunately these sorts of well meaning scans – bone scans and CAT scans are often done on a reflex basis at the first sign of anything called cancer. But Grade 6 prostate cancer’s of which there are probably close to 100,000 of these types of newly diagnosed cases every year in the US, don’t need bones scans and they certainly don’t need CAT scans.
At what point do people actually need bones and body scans? The answer to that is, quite clearly, if the Gleason grade on a biopsy is 8 or above, if the PSA is above the 10-15 range, if it’s easy to feel a large tumor on a digital rectal exam, and of course reverting back to the 3T multiparametric MRI prostate scans. If the tumor is noted to be through the capsule, in the seminal vesicles or is particularly large, say over an inch across — a body scan in that situation in conjunction with a bone scan, may be entirely appropriate to be performed.