When is a Bone Scan Necessary for High-Risk Prostate Cancer?

By Dr. David Samadi

Bone scans play a crucial role in managing high-risk prostate cancer, mainly when there is concern that the disease may have spread to the bones. While men with low- and intermediate-risk prostate cancer often do not require this scan, those at high risk are generally advised to undergo the procedure to assess for potential metastasis.

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Understanding Bone Scans

A bone scan is a specialized imaging test that detects abnormal bone activity, including cancer spread, fractures, or conditions such as infections and arthritis. The process involves injecting a small amount of radioactive material into a vein, circulating through the bloodstream, and accumulating in the bones. A scanner then uses nuclear imaging technology to detect the radioactive material and evaluate the condition of the bones, providing detailed insights into cell activity and bone function.

In the context of prostate cancer, a bone scan can reveal whether the cancer has spread from the prostate to the bones—a common site for prostate cancer metastasis. It is also sometimes used to assess overall bone health before initiating treatment.

Who Needs a Bone Scan?

For men with high-risk prostate cancer, a bone scan is an essential diagnostic tool. High-risk patients typically include those with a Gleason score of 8 to 10, or those in prognostic grade groups 4 and 5. Men with advanced disease may not experience immediate symptoms of bone metastasis, but signs such as persistent bone pain or elevated calcium levels in the blood may suggest that the cancer has spread.

Bone scans are typically recommended when a man’s prostate-specific antigen (PSA) level reaches 20 ng/dl or higher or when cancer has become extensive enough to be felt on both sides of the prostate or beyond. In contrast, men with PSA levels below ten ng/dl generally do not need a bone scan, as the likelihood of metastasis is relatively low. If there is concern about cancer spreading to lymph nodes or other areas, additional imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) may be necessary to evaluate the pelvis for enlarged lymph nodes.

Additional Imaging for Detecting Prostate Cancer Metastasis

Beyond bone scans, doctors may use several other imaging methods to determine whether prostate cancer has spread:

• CT Scan: Often used to examine the abdomen and pelvis, a CT scan can detect any spread of prostate cancer beyond the gland such as to the liver, intestines, or bones in these areas. It may also reveal lymph nodes affected by cancer, significantly if they are enlarged.
• MRI: This test is beneficial for evaluating whether cancer has invaded tissues near the prostate or to check for residual tissue following prostate surgery. MRI offers a highly detailed image of soft tissues and can clarify uncertainties from other scans.
• PET Scan: A positron emission tomography (PET) scan is a more advanced imaging test that looks at the anatomy and the body’s function. Cancer cells, which tend to increase, absorb radioactive sugar that is injected during the test. This makes them “light up” on the scan, helping doctors pinpoint where the cancer has spread. PET scans are sometimes paired with CT scans for even greater accuracy and can provide insights that other tests might miss.
• PSMA PET Scan:  PSMA is short for prostate-specific membrane antigen, is a protein predominantly found in prostate cancer cells. PET (positron emission tomography) is a nuclear imaging test employing a radioactive tracer to scan for cancerous activity. PSMA PET-CT combines PET with CT (computed tomography), comprehensively visualizing the affected areas. Traditionally, conventional imaging methods such as CT scans, MRI, and bone scans have been used to detect metastatic prostate cancer. However, these techniques have limitations, often missing small tumors. This technology can identify cancer that is frequently overlooked by standard imaging techniques.

Conclusion

For men with high-risk prostate cancer, bone scans and other imaging techniques are vital in detecting whether the cancer has metastasized. Early detection of cancer spread can significantly influence treatment decisions and improve outcomes. If you have concerns about your prostate cancer diagnosis or whether you need a bone scan, speak with your primary doctor taking care of your prostate cancer to ensure you receive the most appropriate care.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board-certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.