Bone Scan
If prostate cancer has spread, the most common place for it to go to is your bones. Because of this, your doctor may ask you to have a bone scan to show if cancer has reached your bones. However, you may not need a bone scan if your PSA reading is low and your prostate cancer cells look very like normal prostate cells. In this situation, the prostate cancer is very unlikely to have spread to the bone.
For a bone scan, a small amount of low-level radioactive material is injected into a vein intravenously (through an IV). The substance settles in damaged areas of bone throughout the body over the course of a couple of hours. Areas of repair to damaged bone show up on the bone scan as hot spots. They are a sign of active bone cells. Having hot spots does not necessarily mean you have cancer in that area. They may be due to old fractures or arthritis. Your doctor will look at the pattern of hot spots to see whether they are likely to be due to cancer cells in the bone or whether they could be caused by other conditions. To make an accurate diagnosis, other tests such as plain x-rays, CT or MRI scans, or even a bone biopsy might be needed.
X-rays
You may have a chest X-ray to check your general health, especially if you are going to have surgery.
You may have X-rays of any hot spots that have shown up on your bone scan. This is to try to see if the hot spots have been caused by cancer or by arthritis, old fractures or other bone conditions.
MRI scans and CT scans
MRI scans can produce a very clear picture of the prostate and show whether the cancer has spread into the area surrounding the prostate and/or nearby lymph nodes. This information can be very important for your doctors in planning your treatment. But like CT scans, if your cancer is newly diagnosed and likely to be confined to the prostate, your doctor may decide that an MRI scan is not needed.
MRI scans use radio waves and strong magnets to create pictures. Like a CT scan, a contrast material might be injected, but this is not as common. Because the scanners use magnets, people with pacemakers, certain heart valves, or other medical implants may not be able to get an MRI.
MRI scans can take up to an hour. During the scan, you need to lie still inside a narrow tube, which some people who don’t like enclosed spaces can find difficult. The machine also makes clicking and buzzing noises. You can ask your healthcare team about headphones to block out the noise.
To improve the accuracy of the MRI, you might have a probe, called an endorectal coil, placed inside your rectum for the scan. This must stay in place for 30 to 45 minutes and can be uncomfortable. These are not available everywhere in Ireland as yet. If needed, your doctor may give you a sedative, which is medicine that will make you feel sleepy, before the scan.
MRI scans and CT scans can show whether the cancer has spread to the area around the prostate gland or to nearby lymph nodes. You will need these tests if you are going to have surgery to remove the prostate or radiotherapy to try to cure your prostate cancer.
Abdominal ultrasound
An abdominal ultrasound uses sound waves to build up a picture of the inside of the body. It is completely painless. You may have a scan of your tummy (abdomen) to look at your kidneys and see how well your bladder is emptying.
Waiting for results
You will be asked to go back to the hospital when your test results have come through, which can take some time, and may be up to 2 weeks. You may feel very anxious during this time. It may help to talk to a close friend or relative about how you feel. Or you may want to contact a cancer support group to talk to someone who has been through a similar experience. Your GP may also be able to put you in touch with a local counsellor. You may have contact details for a specialist nurse and you can contact them for information if you need to. You can also contact the Marie Keating Foundation nurses.
