Dear Dr. Nordquist,
I had a radical prostatectomy in 2002. My current(March 2008) PSA is 0.15. I started to experience bone pain a year and half ago, when my PSA was 0.08. It started in my hip joint area, where the right leg connects to the pelvis. A full body bone scan was performed. The radiologist thought there could be metastatic disease in two ribs, a neck vertabrae and greater trochanter, plus arthritis. A series of follow up CT scans and X-rays were done, but no tumors were found, and I was told I did not have cancer anywhere. Three months ago I had another follow up bone scan. It showed no change from the first one. A CT scan of the chest last month, done my pulmonologist for a different reason, also showed no tumors in the bones of my chest. However, since that last CT scan, my bone pain is getting worse and seems to be spreading. My ribs are definitely more sore - I can't comfortably sleep on them - and now both upper leg bones have occasional pain. I have also been to an orhopedic specialist who has not found any explanation. I would like to know if there could be a cancer in my bones not detectable by CT scan - for example, small cell carcinoma or some other form. Since the PSA is still low, is it likely there is a primary cancer of a different type somewhere else causing this bone problem? And finally, if it is unlikely to be cancer, what else can cause these bone scan results and my pain?
ANSWER: To find metastases in bones it would be better with MRI scans in combination with x-rays & PET scans and other bone isotope scans. A low PSA does not support the suspicion of bone metastases of your prostate cancer. But nor does it guarantee against it either unfortunately. And of course another spreading cancer can not be excluded a priori either.
In this situation I can only recommend a new series of scans and pictures as mentioned above in order to find out if there are any signs that support your suspicion!
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One more follow up question:
Do you know of any other condition besides cancer that could produce a bone scan like metastatic cancer? In other words, what else could produce such a bone scan?
ANSWER: That is really a question for a diagnostic radiologist which I'm not. However inflammatory bone conditions may mimic - to some extent - cancer growths in bone.
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Dear Dr Nordquist,
There is another piece to this puzzle that may bear on my medical condition: I have been taking Tegretol XR(carbamazepine), 400mg, 2X/day, for many years for a neuropathy. Four months ago, I was diagnosed with Osteopenia. My physician at the time did not make the connection to my Tegretol usage, but last night I learned from the medical literature that this drug often causes osteopenia as well as general bone mineralization depletion. One study I read found that the drug directly attacks the osteoblasts. Also reported in the literature are cases in which tegretol patients report bone pain. Indeed, a common recommendation was that in all cases where this drug is proscribed, supplemental vitamin D(minimum 2000 IU/day and calcium(600-1000 mg/day) be administered, especially if the patient gets little vitamin D from sunlight.
Can this be the source of my bone pain and perhaps explain why the bone scans found what looked like metastasis? I live in northern Ohio where for much of the year(except for summer) the sun is too low for significant Vitamin D production. And I am a physicist and so work indoors all year round.
Thank-you for your help. Your thoughts on these matters have been very helpful to me.