Imaging sites that offer PSMA PET

[Velohomme]

I am post surgery/radiation with a rapidly rising PSA. We are hunting for the location of the remaining cancer and need a PET using PSMA. I have found a few places that offer it (UCSF in SF offers it but has long queue), Mayo in Rochester (not online yet...expected in mid-Sepember). I can fly to Australia and get it done for about $800 but would prefer a US site. Does anybody know of other sites offering PSMA PET?

[tango65]

Here is a list of some of the clinical trials for Ga68 PSMA in the USA:

clinicaltrials.gov/ct2/resu...

[Tall_Allen]

NIH offers the DCFPyL for free. It's the best so far:

clinicaltrials.gov/ct2/show...

UCLA offers the Ga-68-PSMA-11 for $2650, which is their cost. (Others may offer it at the same price)

clinicaltrials.gov/ct2/show...

With a rapidly rising PSA you may be able to detect metastases with the Axumin PET, which is available almost everywhere.

[Velohomme in reply to Tall_Allen]

Thanks. I had a PET choline a week ago but couldn't see anything. Even at higher PSAs the PSMA seems better:

sciencedirect.com/science/a...

[Tall_Allen in reply to Velohomme]

Not all mets are detectable

[Velohomme in reply to Tall_Allen]

Yes and I am struggling with the debate about immediate ADT (TOAD study) vs. treatment potential during this "ogliometastatic stage".

[Tall_Allen in reply to Velohomme]

What is your PSA and psadt?

[Velohomme in reply to Tall_Allen]

PSA: 1.0

Doubling time: 1 month

[Tall_Allen in reply to Velohomme]

There is no question that with a doubling time of 1 mo you should be on ADT

[Velohomme in reply to Tall_Allen]

If I go on ADT now the cancer will be invisible to imaging and I lose the ability to zap/incise

[Tall_Allen in reply to Velohomme]

There is no evidence that is zapping metastases accomplishes anything. However if you wait you will be sure of incurring progression.

[mklc in reply to Tall_Allen]

Hi Allen,

How are you?

Does pc go to the lower leg bone area?

I don't have any bone mets that I know of.

My PSA is 2.3 and has doubled in 6 weeks.

I have had some pain in that lower leg area that comes and goes.

I do have arthiritis in my hips and elsewhere.

Appreciate your opinion. Thanks. Mike

[Tall_Allen in reply to mklc]

Not usually. It usually spreads from the pelvic area, very rarely to limbs.

[mklc in reply to Tall_Allen]

Such a relief. thank you so much.

Good health to you and yours.

[cesanon in reply to Velohomme]

"If I go on ADT now the cancer will be invisible to imaging and I lose the ability to zap/incise"

Exactly

[Hidden in reply to Velohomme]

Exactly

[Hazard in reply to Velohomme]

Post salvage radiation I had rapidly rising PSA. I had PSMA scan when PSA was 0.5 and nothing showed up. 3 months later PSA was 2.5 and I had another PSMA scan and there was one PSMA-avid rectal node. I wanted radiologist to zap the lone met but he wouldn't and put me on ADT immediately. 6 months later I had PSA of 47, 5 lesions in liver and multiple spots in mysentry. So radiologist had been correct - it would have been pointless to zap the lone rectal node when that was all that was showing.

So, if your PSA is 1 and hopefully dropping with ADT, it is likely that scan will not detect anything. Even if it does show something it is highly likely that there other mets which are too small for the scan. Hence there is not much value in zapping the visible nets. There is a lot of discussion about curative treatment for oligometastatic cancer (say less than 5 mets) and while doctors can be certain that scans show less than 5 mets I don't know how they can be certain that there are no micro mets not yet showing.

But I hope that ADT works well for you.

[Kimmilemo in reply to Tall_Allen]

Really? I didn’t know that, How do you know then? Maybe that’s why my husband has so much pain in his hips and buttock area. Maybe they never detected them.

[Tall_Allen in reply to Kimmilemo]

If they cause pain, they are probably big enough to show up on a scan.

[Kimmilemo in reply to Tall_Allen]

Nothing did, just the prostrate area so far but the surgeon said he saw streaks during surgery , what ever that means ?

[Kimmilemo in reply to Tall_Allen]

Where is the NIH located Allen? I think my husband better see if he has small mets since his OC said they didn’t see any Mets. But so much pain . What would his Oc do different bu knowing he has small Mets? I have a feeling they are going to have him do some form of hormone therapy anyways soon since they saw streaks either during his selvedge PR surgery or pathology report he said I don’t know which one. Appreciate all you help .

[Tall_Allen in reply to Kimmilemo]

NIH is in Washington DC. There are many other causes of bone pain, particularly arthritis or osteoporosis/osteopenia and the long-term fracture risk from those. If no mets are visible the pain is probably not due to mets from normal prostate cancer. There are rare kinds of prostate cancer where bone mets are not detectable by bone scans or PET scans, and hormone therapy doesn't help much.

[Kimmilemo in reply to Tall_Allen]

Thank you so much, you’re always so knowledgeable. I will see if we can get pain management to see what we might give him for that.

[larry_dammit]

Might check Saint Luke’s Hospital in Kansas City ,Mo. they seem to be ahead of the curve on some of this stuff.

[Kimmilemo in reply to larry_dammit]

Anything in Saint Louis MO?

[Blueslover]

What is PSMA?

I had a PET scan with Axumin

[Velohomme in reply to Blueslover]

PSMA (prostate-specific membrane antigen) is similar to PSA: it presents itself in prostate cells but particularly prostate cancer cells. Like PSA it can be used to measure cancer. The PSMA PET scan uses a radiotracer (Ga-68-PSMA-11 most often but DCFPyL is now being tested as well) which binds to the PSMA so it can be imaged. This test is more sensitive than a PET with Axumin (aka Fluciclovine, aka FACBC) so the cancer can be seen at lower levels. Here is a graph of a review of various PET radiotracer studies showing sensitivity at different PSA levels: ars.els-cdn.com/content/ima...

[Blueslover in reply to Velohomme]

Thanks.

Good luck guy

[larry_dammit in reply to Velohomme]

My father has been having PSA that rise and fall for several years. Had a Auxium Pet scan Friday, he has been failing very fast and having trouble walking. He is 86. Just got the scan results back on line .he had a bone scan and a ct with contrast, very faint issue is prostate area. The Auxium scan found Mets in his hip and in a lymph node next to his prostate. I’m 2 years into stage 4 now this is on dads plate, he has said he would not get chemo or other treatment . Worried about him .

[AlanMeyer in reply to larry_dammit]

I understand your father's reluctance to get chemotherapy. Besides the side effects, he may also feel that his quality of life is deteriorating now and he doesn't want to "artificially" prolong it.

However, if your Dad has not yet tried ADT, it may be worth his while to try it. The side effects will probably be much less than for chemo and, if the deterioration in his QOL is due to the cancer, e.g., in his hip, it's possible that the ADT will, at least for a while, resolve that problem for him and his QOL may significantly improve. Some men with hormone sensitive cancers have lived for many years on ADT without any PCa symptoms.

He can try ADT with a short duration dose, for example, a 30 day Lupron injection. If he hates it worse than the cancer, or if it does nothing for him, he can stop there and get no more ADT. However, there's a chance it will provide noticeable help in just one month of treatment and he'll want to go on to get additional injections.

Best of luck to you and your Dad.

Alan

[cesanon in reply to Blueslover]

PSMA is allegedly better than Axumin, but you need to get into a clinical trial or travel to get it. And there are apparently some versions of prostate cancer that PSMA can't see.

Auxmin scans are covered by Medicare, PSMA scans are not.

[Blueslover in reply to cesanon]

Just started on Lupron 2 months ago after Axumin scan. There is cancer in 5 abdominal and one pelvic lymph nodes. Failed surgery in 2008 and prostate bed irradiation 5 years ago. PSA had been undetectable in periods in between until last Fall.

At recheck last week PSA went from 5 to undetectable, and testosterone is at castrate level. Feel good about these results. Next CT due in 4 months

[petercraig2]

Premier Diagnostic Center has been performing PET/CT scans on an immediate basis in Burnaby, British Columbia since 2010. In 2000, they began scanning with the first PET machine in Canada, and obtained the first license to produce FDG.

Premier provides Ga68 PSMA imaging for Prostate Cancer.

petscan.ca/about-us/

Pricing on website suggests something like C$3,500. Must get a Report and CD of images for your oncology team.

I'll probably be going there in a month as GA-68 PET/CT PSMA scan doesn't seem to be available in Canadian hospitals.

Peter

[cesanon in reply to petercraig2]

Peter, please report back on the experience when you return from the GA-68 PET/CT PSMA scan at the Premier Diagnostic Center.

Let them know you have a bunch of prospective fellow patients waiting for your report on the quality of their services. LOL

[petercraig2 in reply to cesanon]

Certainly will do.

My trip date however is somewhat dependent on results of my blood work this week.

If PSA remains sub 1.0 I will probably hold off on GA-68 PSMA PET/CT.

Peter

[cesanon in reply to petercraig2]

"PSA remains sub 1.0 I will probably hold off on GA-68 PSMA PET/CT"

That is a real problem. Tall_Allen has a posting on his private blog with a lot of good data on this.

Here it is. You will have to do a search, but about 2 years ago he did a highly informative posting.

Seemed like 2.0 PSA was best, but you can do it with less.

pcnrv.blogspot.com/

Dr. Almeida told me that the doubling rate was an important factor as well.

[Velohomme in reply to petercraig2]

Here is the response from Premier Diagnostic Center (Aug 14, 2018) to my request for a PSMA scan:

"Premier is joining a clinical trial with the Vancouver Prostate Group to perform PSMA prostate scans and are waiting for regulatory issues to complete.

PSMA scans are available at the UCLA David Geffen School of Medicine, but there may be a wait list."

[petercraig2 in reply to Velohomme]

Hmm, thanks for that.

That may be for government funded scans?

Wondering if Premier Diagnostic Center are still taking private fee paying clients for GA-68 PET/CT scan.

Peter

[petercraig2 in reply to petercraig2]

You are absolutely correct, they do not have approval for PSMA GA-68 PET/CT scans and hoping for approval by end of the year.

I may have to fly to Berlin and Charite again.

Peter

[Velohomme in reply to petercraig2]

There are many places in Australia that are doing the PSMA PET. The cost in $US is about $500-600. Example: prpimaging.com.au/

Do you have a link to the place in Berlin?

[petercraig2 in reply to Velohomme]

Yes address below and was 3.495,00 Euro

I had a referral from my Radiation oncologist at PMH in Toronto Canada

CHS Charité – Healthcare Services GmbH

Charité International Healthcare

T: [phone]

F: [phone]

Visiting Address / Besucheranschrift

Bundesallee 39-40

10717 Berlin

Anything else let me know.

Peter

[Velohomme in reply to petercraig2]

Awesome. Thanks

[Flydoggy]

I had a GA 68 PSMA scan at UCLA on July 26th. It identified a small amount of PC in one lymph node near the prostate bed. I am now on ADT and scheduled for surgical removal of nodes mid September. Doc says 33% chance of getting it all. I'll take it.

[Flydoggy in reply to Flydoggy]

Oh, PSA prior to test was 2.5, doubling monthly.

[jimk_mb in reply to Flydoggy]

Just curious as to how many LNs the surgeon plans on removing and whether just taking ones in near the suspect LN from PET scan or bilaterally from a broader field.

Reason for asking is that I had the Ga-68 PET scan at UCLA in May. Like you, it showed small amount of PC in just one LN. I realize there are probably micro mets in other LN. Having some difficulty deciding between 1) surgery at UCI Med, 2) IMRT radiation + Casodex for 2 years, 3) doing nothing and having my med onc in Marina Del Rey continue to watch.

Thanks info on my questions.

[Spaceman210 in reply to jimk_mb]

Have you consulted with Dr. Ahlering at UCI? He did my original surgery, and given some slight PSA rises since, wish in hindsight I had node removal as well, but he hadn't thought it advisable at the time. He did tell me last year he had done theraputic node removal on some other patients. One thing to look up and discuss as a possible SE is lymphedema. Then the very thorough MO I consulted with at M.D. Anderson, John Araujo, dismissed the feasibility/effectiveness of subsequent node removal in my case.

[jimk_mb in reply to Spaceman210]

Yes, Dr. Ahlering did my original RP and is the one that would do the LN removal if I proceed in that direction. He is a great surgeon. When I last talked to him he indicated that he had done 13 of these based on the Ga-68 scan results.

My MO, Dr. Lam, did bring up lymphdema risk - both for surgery and radiation. Dr. Ahlering didn't think this would be an issue for me. Note that I had several LNs removed back in 2012 as part of the RP and have had no issues.

Yes, it is hard to tell what the effectiveness of LN removal is and this whole business of how to proceed in treating what's picked up in the newer PET scans with higher sensitivity seems a little murky to me. My goal is to delay ADT and preserve quality of life. Thanks for your thoughts.

[Spaceman210 in reply to jimk_mb]

I just looked up Dr. Lam, and it seems as though you certainly have selected top-tier docs! I wonder what fraction of regional LN removal could be accomplished or if removal would significantly decrease radiation exposure volume (and thus risk to healthy tissue) in case that was also needed later.

In my case I had also asked about excision of adjacent prostatic fossa tissue (prostate bed) as that suspect location would definitely also be a radiation target, but apparently that isn't done (not sure why.)

If you are curious for a potentially more effective radiation method that is used in several facilities overseas (Germany and Japan) but not yet here due to expense, look up carbon ion therapy. There is at least one U.S. facility in the early planning stages, I think in Aurora CO.

Thanks and best wishes for your decisions!

[jimk_mb in reply to Spaceman210]

Thanks, appreciate it. It's interesting how the newly innovative treatments (e.g. carbon ion, Lu-177) are available first in German.

[louschu]

Excel diagnostics in Houston, UCLA and a place in Omaha

[sammamish]

So I was DX'd in April, had PMSA scan in May. Full prostate involvement and 4 pelvic,& 1abdominal right under Aortic bifurcation.MRI, Pet and bone scan all negative. Biopsy Gleason 9 w 15 PSA. So I got the PMSA at UCLA- it was 2500 appx.. The wait was about 30 days. They said they were doing some kind of study to see if PSMA altered treatment pathways., otherwise the costs would have been more. I have heard UCSF is doing it for about the same price. I have "heard" but can't confirm that waits are longer at NIH due to scheduling demand.

I am also floundering a bit as to which way to go. I took Caso and Lupron for about 60 days(Psa now .9) and just wrapped up a full radical prostatectomy with PND (ouch ouch). So now wondering if I should go off ADT and try and get a decent Nadir baseline, before making any other decisions. I am sure my CO, Radiologist, and surgeon may/will have opinions on this, Still my biggest challenge is the more I look the more I find, and more confusing the decision tree looks( I.e I did the color gene study-and it turns out I have ATM gene-it potentially complicates radiation options and theoretically chemo and parp therapies as well.

Does anyone have personal experience with Provenge before castration resistance?

This seems like a relatively benighn option with a low side effect profile (but unfortunately expensive). If it can generate 4-5 months overall survival for end stage Pca, maybe it could do a lot better if used early?

I know there are posters that are getting really long response times on hormone combos, so I don't want to ignore the obvious, however, I fully understand your concern about missing out on the oligotherapy bus whilst inexorably pushing your cells further along to some other place where they end up being a nasty kind that are refractory.

The clinical based evidence is always a statistic group. A dispersion of responses. For instance, while hormone therapy statistically moves the needle for the group, it can often say very little about the individual. Some will get great effect and duration, others will not. And yes, I understand the significance of the P level., lower level means more likely to be predictive for any individual within the selected group, however...IMO, personalized medicine has a very long way to go. Can we turn the mega data google guys loose on this one?

[geo3]

Upon Dx in Nov 2017, my UCSF urologist was able to get me into the UCSF clinical trial using the PSMA PET fairly quickly, by Jan 2018. Medicare paid for all but the isotope. Had my RP 4/10/2018. Things moved more quickly as I got on waitlists for DX and for procedure.

Stanford also offered a PSMA PET trial, but (when I looked) only for those electing radical prostatectomy.

[Velohomme in reply to geo3]

The Stanford trial is now closed.

[Boywonder56]

Is that like axium pet

[Velohomme in reply to Boywonder56]

PSMA is a different radiotracer than axumin. See my response to Blueslover above.

[DcraigB]

I had my PSMA scan done last March. at the University of Michigan Medical Center. Medicare/Blue Cross pick up almost all the bill. It identified a 5mm lesion in a pelvic lymph node for which I had radiation in June. Waiting to see what happens to the PSA of 1.6 a few months post treatment. No ADT

Reply

[Velohomme]

Thanks for the help guys. I ended up calling all of the places I could find that were doing PSMA PET for recurrent PCa.

As mentioned in the thread PSMA PET is only available via clinical trial in the US so sites are limited. Here are the sites I found in the united states (all doing GA-68 PSMA scans):

UCLA, $2,600

UCSF

Excel Diagnostics, Houston, $4,830

University of Michigan, $6,300

Sloan Kettering, $6,700

Mayo Clinic - available in late September '18

NOTE: Stanford had a trial but it is now closed

The NIH also does PSMA PETs though they are doing a newer variation: 18F-DCFPyL. This is free but the queue is 3-4 months.

I was in a hurry to get my test so I went to Australia. I found sites in Sydney, Melbourne, and Perth.

Here are some Australian sites:

petermac.org/ I found these guys via recommendation from Mayo Clinic.

canberraimaging.com.au/

prpimaging.com.au/

envisionmi.com.au/appointments

I went to PRP Imaging. The cost was ~1,500AUD (about $1,000 US) for PET and CT.