Does anyone have any information or opinion about the respective strengths and weaknesses of Axumin Pet Scan vs Ga68 PSMA Pet Scans for Metastatic Prostate Cancer?
Axumin Pet Scan vs Ga68 PSMA Pet Scan - Advanced Prostate...
Axumin Pet Scan vs Ga68 PSMA Pet Scan
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cesanon
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Hi:
Iti is a complex subject. In a nutshell the Ga 68 PSMA is the most sensitive, detecting metastasis with PSA =/> 0.2.
The problems of GA 68 are: - Cancer may be PSMA negative (very lo % of cancers), they do not have PSMA so GA 68 will give a false negative. Gallium 68 is eliminated by the kidneys and the accumulation of the radio tracer during the study in the bladder may obscure some metastasis.
11 C acetate may follow Ga 68 PSMA in sensitivity and then 11 C choline.
Here they explain:
sciencedirect.com/science/a...
"Review of the current literature generally favors PSMA-based imaging in the setting of biochemical recurrence; nevertheless, more comparative studies are needed to further clarify which pcPET radiotracer is most appropriate in each of a variety of clinical presentations. "
if you are getting an Aximun with a low PSA it may give you false negatives, so a 11 C acetate or Ga 68 PSMA may be indicated.
Anything, please let me know.
Raul
Break60 in reply to
If scan efficiency increases with higher Psa , why isn’t it good to wait til Psa is 2 or more ?
It seems best to wait, unless you have an aggressive form of prostate cancer.
It does appear that my docs are pushing to do it earlier, than later.
I do have aggressive PCa but I waited for Psa of 2.3 for last axumin scan in May 17. I only had one met which I treated with sbrt and started xgeva and went back on ADT3. It’s not clear to me why there’s a need to fear Psa rising to at least 2.0 to get a good scan result.
Bob
cesanon in reply to
Nice summary Raul
Braunyny in reply to
Great post. Thanks. Need to follow up with Oncologist . Brauny
Thanks Raul
Here are some more questions
1. What is the relative radiation load for PET vs PET & CT vs PET & MRI vs Axumin
2. Are PET vs PET & CT vs PET & MRI even options?
3. Might it be generally best to just wait until you hit 3.0 PSA for any of these tests? If you have a high doubling rate, that is not a lot of time and trade-off may be a much more accurate test.
4. Axumin vs Galium 68
What is the relative difference of load on my kidneys?
false positives vs false negatives (advantages and disadvantages of either)
side effects
in reply to cesanon
Very good questions. I am not a nuclear medicine person, so I give you my understanding for what I have read in the past and what I talked with some experts.
A MRI has not radiation. A PET/MRI has a better definition of the anatomy and less radiation than a PET/CT. I think the limitation is the availability and cost of the equipment for PET/MRI. They could be an option if the institution have both types of machines. When I went to Germany for Lu 177 treatment they offered me one or the other. I went with the PET/CT because I do not like confined spaces.
The amount of radiation with these tracers is very low since the dose is small and they have a short half life. I think the Gallium has the longest half life around 2-4 hours meanwhile the others I believe have a smaller half life.
In general I was told no to worry at all for the radiation of the tracer they use. I think one should be worry of receiving frequent Ct scans even when they try to use techniques to decrease the amount of radiation. The CT in PET/CT is not exactly the same (less radiation) than a regular CT with contrast.
They recommend to do the Ga 68 PSMA when the PSA is over 0.2-0.4. The higher the PSA the higher the sensitivity. For the Gallium 68 PSMA this is true up to a PSA of 2, then it does not make too much of a difference. This may not be true of the other tracers which are less sensitive than Ga 68 PSMA.
I believe there are not false positives with Ga 68 PSMA and I believe there are few false negatives with PSA between 1 and 2. The Germans do not do GA 68 PSMA if the PSA is less than 0.4 because of false negatives. I do not have info for for the other techniques.
If I were to have a PET/CT I will select the Ga 68 PSMA. In my case I am waiting to have a PSA around 0.5-0.6 to get the study done (actual PSA 0.09). If with the higher PSA the study is + for metastasis I will go to Germany for other Lu 177 treatment.
As far as I know there are not side effects with these tests, except for the IV and the liquid one has to drink with the Ga 68 PSMA.
I'll look for more info and I;ll let you know. Very good questions and they should be researched.
Best wishes
Raul
cesanon in reply to
1. Wow, what an answer!
2. May I ask where in Germany you went. I am going to be doing an Axumin or a Gallium 68 but I have already had far too much radiation. I want to do the PET with MRI, but I think that is going to be hard to get in the US.
in reply to cesanon
I went to Technical University of Munich. Do not worry to much about the radioactivity of the tracer. UCSF (Ubiversity California San Diego) I believe has a PET/MRI machine. You coul call nuclear medicine at UCLA, UCSF, Stanford, Mayo Clinic etc and find out.
If the PSA is low I will have a Ga 69 PSMA study. The other advantage of this study is that you will know that the PC is PSMA positive, so you will be a candidate for Lu 177 is ever needed. There are a % of cancers which are PSMA negative.
cesanon in reply to
"Do not worry to much about the radioactivity of the tracer."
I am not. I am more concerned about the CT part of the PET/CT.
in reply to cesanon
I agree. In 2016 I had one CT with contrast and 3 PET/CT with Ga 60 PSMA and during 2017 I needed because of other medical problems 2 CTs with contrast and a bone survey.
I believe you could get a PET/MRI. I think Phoenix Molecular Imaging has a PET/MRI and they do 11 C acetate which is a good test.
Wife32 in reply to
We are considering Germany at the suggestion of my husband’s oncologist. My husband is Gleason 9, had sx, one shot of lupron, and radiation. A year of no psa and normal testosterone followed by now rising psa.
Hoping Germany will do LU-177 prior to widespread metastasis on a still hormone sensitive patient. Hubby hasn’t been on any HDT in over a year. Never had chemo or anything else.
in reply to cesanon
This is an article with more information about the different tracers or compounds they use for PET studies of PC. It confirms that the Ga 68 PSMA is more sensitive than others and has a very good specificity (very few false negatives).
Kind of dense, but it is the only article I found so far where all techniques are mentioned.
ncbi.nlm.nih.gov/pmc/articl...
Anything, please let me know
Best wishes
Raul
cesanon in reply to
Raul,
I called Pheonix, they don't do the PET/MRI. They say it is not so common in the US. Do you have some contact information for the German place that you used?
in reply to cesanon
This is the international office of the TUM Klinikum
mri.tum.de/office-foreign-p...
cesanon in reply to
Thanks
carcinoid.org/2017/04/06/ga...
Above is a link with a list of locations state by state in the USA from last year.
I thought I had read that it is not covered by insurance though. I am not sure about that. I did the Auximen scan and it found things that were not picked up by reading the MRI taken a month before. We found 3 lesions in my bones. 2 in the pelvis and 1 on my vertebrae at T11. I believe it saved a lot of time in deciding on a strategy for fighting the systemic nature of the disease. 90 days after RP my PSA was .58. 120 days after PSA was 1.14.
I would try my best to fave the test that is most sensitive for Pca. At the moment all of the things I have read indicate that is GA 68 PET scan. If I need to do some additional testing, I will try to get the gallium test.
Many doctors working at places who don't have the test seem reluctant to use it in my anecdotal experience. I talk to a lot of people in the "club". Here in Philadelphia Doctors at Jefferson tried to prevent a friend from going to the University of Pennsylvania to get the Auximen test. The test was productive in refining a strategic response to disease progression,
Could you be please put the whole reference of how to find the article you are quoting?. My understanding is that except for NEPC all the other PC express PSMA and NEPC is rare.
cesanon in reply to
"My understanding is that except for NEPC all the other PC express PSMA and NEPC is rare." Raul80
I don't understand. What is "NEPC" and "PC express PSMA "
nepc=neuroendocrine prostate cancer,
pc=prostate cancer
cesanon in reply to
LOL still don't understand what you said
who is joel?
Thanks!!
Joel's quote I think it comes from this article:
ncbi.nlm.nih.gov/pmc/articl...
where the authors said that between 5 to 10% of patients with PC, the PC does not express PSMA. However in this article no reference to any study is made. In my opinion this type of statements is worthless. I'll keep looking.....
From the literature below seems that GA-68 is head and shoulders above comparables in sensitivity and the opportunity for your oncology professional to identify the most appropriate response strategy.
pctrf.org/pca-commentary-11...
sciencedaily.com/releases/2...
I had PSMA PET-CTscans done at Charite in Berlin, very helpful people who all all spoke good english (thankfully) and had a good hour same day with Director of Oncology to review the scans in detail.
Unfortunately when I brought the scans back to Canada they had never had such early and detailed information on pelvic tumor progression and fumbled on how to respond in terms of therapy response. What I got was the 'standard' radiation treatment which I am hopeful will be successful.
Peter
I have had 2 Axumin PET scan (July ‘17 and February ‘18) and one high contrast MRI (August) but all had been negative despite rising PSA from 09 to 4.2 during that period. So I’d say that Axumin dit not helped me in isolating the met (wherever that is).
To: Raul80
Sir, Again I take my hat off to you!
Good Luck and Good Health.
j-o-h-n Sunday 02/18/2018 3:46 PM EST
Has Axumin Pet scan after mets post radical prostectomy and chemo. Showed nothing even though PSA 0.5. Had Ga68 PSMA Pet showed lymph node in pelvic area.
The previous solution using Axumin was wait now atleast know where it is. Seeing oncologist next week to decide next option, considering Lu177 PSMA.
Unfortunately had a pay privately at London Clinic for PSMA PET cost £2588 not available on NHS in UK.
Hmmm
It seems that a a pelvic lymph node invasion is not that big of a deal.
Lu177 PSMA is a big deal.
Everything you take or do has risks. Lu177 PSMA can do damage to salivary glands (a much bigger deal it sounds) and kidneys.
I would get a few independent second opinions on Lu177 PSMA before pulling the trigger. There may be a case for waiting and monitoring before using the Lu177 PSMA. Waiting until it spreads outside the pelvis, or goes to the bone, or you get a rapid PSA doubling rate.
Your body will take only so many Lu177 PSMA treatments (I believe most places stop at around 8). Maybe you should save those bullets for when you really need them.
I'm new and late to this discussion - hope it's not over yet 4 mos after the last post. My history: diagnosed 2008; 4 HIFU procedures in Germany and France (2008, 2010, 2013, 2015); last HIFU in 2015; PSA consistently 0.6 - 0.9 since then except for a couple of blips over 1.0 that retreated back to below that immediately (lab error?) (My history might differ from most of the guys here; HIFU is the only treatment I've ever had. I started with HIFU because I had no insurance at the time of diagnosis, and besides having fewer side effects than RP, HIFU was far cheaper, incl. airfare, hotels, cars, meals, doctors, hospitals; I couldn't afford RP at all. I've had so many HIFUs because the tumor is stuffed into a tiny corner of the apex of the gland, hard to reach even with the most advanced HIFU technology.)
BUT - Nov. 2018 PSA was 0.9, April 2019 doubled to 1.8; this May it was 2.27. Alarming. My HIFU doctor in France thinks that level of PSA isn't necessarily indicative of metastasis, and if there is it's probably local. But from what I read here about low PSAs with metastasis, I think he might be wrong, and I'm scared.
My doctor ordered the Axumin scan, which I'd never heard of - scheduled for June 4 - insurance pays. The results will determine what I do. My new doc says radiation if local, hormone if systemic - and I desperately do not want the hormone treatment if at all possible. When I read about its effectiveness lasting only 18-24 months...well, it seems so ominous to me, and then there are the side effects.
But now there's this new (to me) PSMA scan. Seems Axumin and PSMA each have strong and weak points - Axumin might find no metastasis, but then I should get the PSMA to be sure? Get both scans with the idea of reconciling different results?
My mind is reeling.
i am no expert but had both Axumin & 68-GA PSMA a year apart. It seems like you may not have a choice right now, as I've recently been told by my docs is that presently PSMA is not available (for sure in SF but I believe also nationwide US) while the FDA evaluates the data from recently completed clinical trials to determine whether to approve it as a diagnostic (that would then be covered by insurance). You could still try to track it down, but as of last week that is the information i was given. Good Luck
1. I think your analysis is good. Start with auximin.
2. Don't be so scared of androgen deprivation. I tolerated it well. I did concurrently with radiation treatment. Just make sure you get estrogen patches. Make sure to do light weight type of exercise.
3. Check out the cost of Sbrt radiation treatment. It is more focused, with fewer rounds, and at least as effective as traditional imrt.
If you choose sbrt, ask if the LINAC they will treat you on is a Varien Rapid-Arc or newer. If it's an older machine, find someone else.
4. You really should be taking hormone treatment in conjunction with any radiation treatment. You should at least try it to see how you tolerate it.
5. The pmsa scans I understand are very inexpensive in Australia.
Thanks for your suggestions. But...estrogen patches? My WIFE uses those! I'd never heard of them for men with PC - in fact I think I've read estrogen promotes PC. When we got married 12 years ago, we'd each been alone for years, and we were just getting to really enjoy intimacy again, had a great couple of years, then PC - after the 4th HIFU it's gone (damage to nerve bundles) but I think it was starting to return, and having to face androgen deprivation is just...
I'll ask my doc about Sbrt vs Imrt - I can't remember which one he talked about - that meeting is kind of a blur - what really stuck in my mind was "cancer is back" and "possible metastasis." And I'll ask about the machines too.
Had an interesting discussion about PSMA with the tech who gave me the Axumin scan the other day. He said the gallium in this region (Pacific NW) is made in Seattle, they can make only 3 doses a day, and its half-life is only 70 minutes, so it's hard to get it to any imaging center outside the Seattle area. When I searched for PSMA scans in Oregon, the 5 that turned up were all in the Portland area, and the tech said that at best they're on the list to get the gallium if it ever becomes available to them - IOW they're not really doing those scans now, and if they were I'd be on a waiting list. I haven't checked out his info yet - still waiting the Axumin results. He did say that while PSMA is much talked about as having greater accuracy, the consensus that he's aware of is that both scans are virtually equal that way.
One of the most vexing things about PC for me has always been the kind of pinball ricocheting from one bit of info to another to another, some of them kind of matching, some contradictory, some from another planet, one guy's hope to another's success to another's disappointment. I've had a nearly 4-year break from that and kind of forgot about it, and now I'm immersed in it again. Thank god for my wife - only 2 years of marriage and I come down with this, and she's been unfailingly positive and hopeful and loving, and it hasn't been easy for her but she never gets down, don't know how she does it but I'm a lucky man.
The more experienced prostate cancer specialists will give you vivelle estrogen patches. If you ask for them, and the Doc doesn't know why, you have the wrong doc.
They block a lot of the androgen deprivation side effects, including the hot flashes.
Also ask for metformin. It blocks the push that adt can give you toward type 2 diabetes. This is not so common, but the famous Dr. Myers gave it to most of his prostate cancer patients. He believed there were multiple prostate cancer reasons for doing so. But not too many oncologists would likely prescribe it.
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