[NPInfo] that PMR pt

Mon Nov 5 11:58:10 PST 2007

Prostate cancer will almost always go to bone before anywhere else, so a bone scan would have been the most appropriate workup in a pt with back pain and h/o prostate cancer.? PETs pick up metabolically active tumors in the body but are not as good picking up low grade tumors or bone lesions.

James Blackwell, NP (Oncology NP)

-----Original Message-----
From: Diana Galler <galdena at sbcglobal.net>
To: NP Info <npinfo at nurse.net>
Sent: Mon, 5 Nov 2007 2:41 pm
Subject: RE: [NPInfo] that PMR pt

Barabara-- 
  You  mention "new fx in patient with low risk prostate cancer" but this was a 
patient WITH a hx of prostate cancer. If bone scan was positive would you not 
want to do a PET before Bx to see if there was any metabolic activity to 
indicate the possibility of a cancer? Then a bx if the PET scan was positive? 
Would you exhaust all non-invasive procedures before going invasive? If PET was 
negative, would a bx still be necessary?
  Dena Galler

"Rogers, Barbara" <BB_Rogers at fccc.edu> wrote:
  In our internal PET request form, prostate cancer is not listed as an approved 
indication for PET. At a site of recent fracture, would expect the bone scan to 
be positive in that area. Would have probably done MRI to look at the site to 
see if there is a lesion at that site and possible bx if unclear (new fx iin 
patient with low risk prostate cancer). 

Barbara Rogers

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net]On
Behalf Of Dena
Sent: Saturday, November 03, 2007 8:57 AM
To: 'NP Info'
Subject: RE: [NPInfo] that PMR pt

I believe the difference is that PET scans show chemical and metabolic
activity so, whereas a bone scan can spot a lesion that indicates the bone
is breaking down (or repairing itself), a Pet scan can tell if the lesion is
living/breathing/eating and differentiate between active and non-active
disease. By simply showing metabolic activity, Pet scans can pick up cancers
way before x-rays, CTs, and MRIs can pick up anatomical changes. Pet scans
can also see mets in the bone marrow that bone scans can't. I imagine the
cost of a Pet scan is a lot more than a bone scan so it would make sense to
do a bone scan first and if you see something suspicious, then see of it's
alive and eating... so you can get to work on killing it. 
Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Priscilla Merrill
Sent: Saturday, November 03, 2007 3:50 AM
To: 'NP Info'
Subject: RE: [NPInfo] that PMR pt

That link was great Dena.
Question: they say to order a bone scan as follow up but I thought it was
PET scan. I admit to not fully understanding the difference. Can anyone
out there explain to me how these are different?

Thanks Priscilla

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Dena
Sent: Saturday, November 03, 2007 12:39 AM
To: 'NP Info'
Subject: RE: [NPInfo] that PMR pt

Paula--
You wrote "he had prostate ca several years ago and surgey. what is weird i
that he had spine films and chest films-NEGATIVE except his compression
fracture last spring". 

I'm simply trying to point out to you that the compression fx MAY NOT have
been a NEGATIVE finding as you stated-- it could in fact have been a VERY
POSITIVE finding and, with this man's prostate cancer history, someone (his
care provider at the time) should have gotten suspicious and picked up on it
when they read the x-ray report. Sounds like someone (his care provider at
the time) dropped the ball. In patients with breast, lung, or prostate
cancer (as well as thyroid and kidney), a fracture MAY indicate a metastatic
process going on and one should not just dismiss it as a NEGATIVE finding
(as you have mentioned several times) without a full work-up. In this poor
man's case, the compression fx may have been an extremely significant
finding-- nothing NEGATIVE about it at all-- but apparently, according to
your report, no one was putting 2+2 together and now everyone is acting so
surprised at the results. It probably should have been one of the first
things someone thought of at the time of the x-ray. 
Dena Galler

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