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Best scans for USA men looking for a few metastases - Dr Snuffy Myers

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At our teleconference yesterday, most of us expressed a great interest in various scans, particularly in looking for early metastasis.

Finding a few metastases early can lead perhaps to a relatively new development - treating these few metastases with radiation with curative intent, or to inclusion in a trial of a new drug to fight the cancer.

An American Medical Oncologist Dr Snuffy Myers has reported on successfully treating five or fewer metastases with high dose radiation to each metastasis. Dr Myers reports that he himself was treated with high dose radiation to metastases of lymph nodes 12 years ago.

I do not know whether either type of imaging he mentioned is currently (24 December 2011) available in Australia, or if there are any plans to bring it here in future.

Your doctor will advise you.

I think the odds are high that you have oligometastatic disease.

[jm: Oligometastatic disease: Only a few metastases (oligo = small, little, a few).]


We would send you to Sand Lake Imaging in Florida for a Fereheme MRI to look for lymph node involvement.

We would also try to get an F18 PET bone scan as it is currently the best way to look for bone metastases.

Our goal would be to try for a cure. You have probably been told that men in your setting have wide spread micrometastatic disease and it impossible to eradicate the cancer. While that might well be true, many men in your setting will enter a durable complete remission with sufficiently aggressive radiation combined with adjuvant hormonal therapy.

CT or CAT: Computed tomography – using X-rays. Best to view hard body tissues like bone, but by introducing contrast agents into the patient can be used on many types of tissues.

PET: Positron emission tomography – using gamma rays from an agent introduced into the patient. Usually done in a CT machine, it can be thought of as a CT scan with a radionuclide tracer injected.

MRI: Magnetic resonance imaging – using magnetism. Best to view soft body tissues, but by introducing contrast agents into the patient can be used on many types of tissues.

Economic issues: A modern 3,0 Tesla MRI scanner costs more than $2 million, and the specially shielded MRI suite around $500,000 on top. Scans to cover this investment may cost more than other scans, though the cost of newer contrast agents may be a factor in these and other scans as well.

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