How to scan the spreading of prostate cancer?

Once a patient is diagnosed with prostate cancer, there are several tests performed to determine whether the cancer cells have spread around the prostate and to other parts of the body. Here are some of the imaging tests available today:

Isotope Bone Scan or Radionuclide Bone Scan 

Bones are one of the most common places for prostate cancer cells to spread. Hence, bones scans are popularly used to see how far prostate cancers have metastasized.

This type of procedure uses a small amount of radioactive tracer which is injected into the patient’s vein. The radioactive tracer tends to collect in areas of the bone, and a bone scan detects those traces in the bone to create an image. Healthy bones appear grayish while areas that are damaged by cancer appear dark because Abnormal bone absorbs more of the radioactive substance.

After the intravenous injection of the radioactive tracer, patient’s have to wait up to 3 hours for the bones to absorb the material. It is recommended that patients bring along a book or magazine during the wait.

Computerized Tomography Scan (CT Scan) 

This type of scan creates a three-dimensional image of the internal organs using an x-ray machine that takes images from different angles. A computer combines the images taken by the X-ray to create a cross-sectional view of the body. This will help reveal any tumors or other abnormalities. At times, a special dye is injected into the patient’s bloodstream to help show organs and tissues more clearly.

The CT scan makes use a tiny amount of radiation but is perfectly safe for patients. A scan takes about 10 to 30 minutes to complete and is painless, but patients will be asked not to eat or drink anything for about 4 hours before the scan. The injection of dye may make patients feel hot all over. Patients are interviewed before the procedure to make sure they are not allergic to anything in the dye, especially iodine.

Magnetic Resonance Imaging (MRI)

This machine makes use of magnetic fields, radio waves, and a special computer to image a patient’s body. A substance may be injected into the patient’s bloodstream to help create clearer images. An MRI can help show whether cancer has spread throughout the prostate or to the lymph nodes near the prostate.

Before any MRI scan, a checklist is given to patients making sure that they don’t have anything metallic in their bodies such as pacemakers, screws, or minute particles that may have lodged in their bodies. It is because the MRI is a huge and powerful magnet. It can do serious damage if there are metal particles in a patient’s body.

An MRI usually takes about 30 minutes and is painless but may be slightly uncomfortable because patients are asked to lie very still for the entire duration of the procedure.


An x-ray is used to take images of a patient’s chest and bones to check for any cancer cells that may have spread around the body.

Seminal Vesicle Biopsy 

It is a procedure that involves removing fluid from the seminal vesicles, which are the glands that produce semen, using a fine needle to extract the sample.

Pelvic Lymphadenectomy (also known as lymph node biopsy or lymph node dissection) 

It is a procedure performed to remove one or more lymph nodes surgically in the pelvic area. The samples are taken and examined under a microscope to check for the presence of cancer cells. If cancer cells are present in the lymph nodes, then surgery is unlikely to be effective in removing the entire tumor, so other treatment options have to be considered.

There Are Several Ways to Remove Lymph Nodes

Surgical biopsy 

This procedure removes lymph nodes through an incision made in the lower abdomen. It is often performed along with radical prostatectomies, which are operations that remove the entire prostate. If the nodes contain cancer cells, then the surgery ends there because removing the prostate would be unlikely to cure cancer. However, nowadays the prostate is removed even if lymph nodes contain cancer and both are examined under a microscope.

Laparoscopic biopsy 

This procedure is performed using a laparoscope which is a long thin tube with a video camera at the end. It allows surgeons to make only tiny incisions insert instruments into the body to remove the lymph nodes. This procedure is often preferred because it is less invasive than standard surgeries and the recovery period is much faster. This method is used only when patients don’t plan on getting a radical prostatectomy because they are opting for radiation therapy.

Fine needle aspiration (or FNA) 

When imaging results show that lymph nodes are enlarged, then a radiologist may take a sample from the enlarged lymph node using a long thin needle through an incision in the lower abdomen. It is performed during CT scan so that a radiologist can see how to get to the enlarged lymph node.

Local anesthesia is applied to the skin before the procedure and recovery time is quick. The patient can go home only a few hours afterward.

ProstaScint® scan

This procedure makes use of a small amount of radioactive material injected into the bloodstream to locate cancers that have spread past the prostate. The radioactive substance has an affiliation for PSMA (prostate specific membrane antigen), a substance found in both normal and cancerous prostate cells. Thus, the radioactive substance can locate prostate cells (which are cancerous and metastasizing) in other parts of the body.

About half an hour after the substance is injected, patients are asked to lie on a table under a special camera which gets images of your body through the substance that is in your body. This procedure is repeated about 3 to 5 days later.

It is not recommended for men who have just been diagnosed with prostate cancer. However, it may be useful after treatment if PSA levels suddenly rise and the location of cancer cannot be found.

Dr. Adem Gunes
Dr. Abdullah El-Hossami