Anyone done a PET-PSMA scan with Galium-68?

[Ian2017]

I am due a PET-PSMA scan this week. I have a persistent pain in my lower back and have consulted both my oncologist and a neurosurgeon. We are trying to determine what part of the pain may be coming from an osteo-type effect (I have a degree of spinal stenosis also narrowing of the gaps between some vertebrae) and what part may be coming from the tumour effect. Basically, the outcome will decide the next course of action. I am interested to hear from anyone who has been through the same scan .. how effective was it, etc?

[whatsinaname]

I have done the PSMA 68 Gallium PET/CT scan twice, once in January and later in October of this year. It is one of the most advanced scans being done, I am told.

It detects where all in ones body the prostate cancer has spread. My cancer is majorly metastatic, with tumours in the skull, neck, collar bone, ribs, lungs, spine, thighs, etc.

Of all the tests that I have had to undertake thus far (not even a year as yet), this test has proven to be the most useful, by far.

[dress2544 in reply to whatsinaname]

I am interested to know the name of the hospital where you had undergone gallium 68 psma pet scan. I had gone through your posts in this site. I wish to know where you had done your chemo also. Hopefully waiting for your reply.

[whatsinaname in reply to dress2544]

Are you based in India ? If yes, which city ?

[dress2544 in reply to whatsinaname]

Yes, I am from India, Kochi - Kerala. Which City you are from.

[whatsinaname in reply to dress2544]

I am from Bombay. Born & brought up in Bombay. Have traveled quite a bit all over India and the world. Love Kerala for a holiday Places like Kumarkom, Kovalam, Thekaddy, Munar, simply amazing, God's own country

So, obviously, I had my biopsies (prostate & L4 vertebrae), PSMA 68 G PET/CT, radiation therapy and chemo in Bombay. The hospitals were Kokilaben (biopsy), PSMA (one at Lilawati, the other at Tata Memorial), radiation at Hinduja and chemo now at Breach Candy.

Nice meeting you here, Ajith. My name is Carlos de Souza. My forefathers were from Goa, hence the Portuguese name. Cheers and all the very best.

[dress2544 in reply to whatsinaname]

Thank you Carlos for your reply. As a result of various treatments I underwent for my advanced Pca, I am totally incontinent. So my travel is limited because of this urinary incontinence. Anyway I will be happy to meet you when you visit Kerala next time. We will spend some time together.

I am treated at Aster medcity, Kochi. You may refer my posts for my treatment history. How much did you pay for the psma pet scan in Mumbai? I had undergone chemo therapy in 2016. But I couldn't tolerate the toxicity and discontinued the treatment with the first infusion itself. But when I read the protocol you had for your chemo therapy I suspect that I suffered the severe side effects because of a bad protocol. They didn't give me any precautionary medicines or hydrations as you described. If it is required I will follow the protocol you had.

If you can give me your contact telephone number I will keep in touch with you.

Regards and best wishes for very happy Christmas.

[whatsinaname in reply to dress2544]

Thank you very much for the Christmas greetings, Ajith. I heartily reciprocate the festive wishes. I know in Kerala, you guys celebrate everything Great secular traditions down in Kerala.

Sad to hear about your incontinence. It is really a curse of this disease. I am extremely fortunate in that respect. Travel is something I just cannot give up on, come what may.

I will go through your posts in more detail over the next few days. I found out your name (Ajith) from one of your previous posts.

As regards the cost of the PSMA 68Ga PET/CT scan, it cost approx Rs. 24000/- for the complete job. The entire procedure took about 3 hours, start to finish.

Yes, the protocol that I have been going through for chemo, is really the most stringent that I have noticed. Not a single person on this board seems to have been accorded so much care and precaution. Lots of hydration, plenty of precautionary medicines, even the chemo being delivered slower to prevent problems. Breach Candy Hospital is justifiably regarded as one of India's top hospitals. And, as a result, thus far, I have faced minimal side effects Touch wood

Here is my e-mail address :- [e-mail] Please write to me there and we will take it from there.

Cheers, Ajith, all the very best.

[GP24]

It will probably detect more cancer lesions than you did expect to see. It will not only show bone mets but usually several lymph node mets. Or maybe visceral mets in the lung or liver too.

If possible, make an appointment with the RO who analysed the scan and have him explain the report to you in person. This makes me more confident to fully understand the results.

I had three PSMA PET/CTs.

[Ian2017 in reply to GP24]

Did they use the "68Ga-PSMA" tracer or something else?

[GP24 in reply to Ian2017]

Two Ga68-PSMA and one F18-DCFPyL.

[Ian2017 in reply to GP24]

Very interesting. Was there any noticeable difference in what the scans revealed?

[GP24 in reply to Ian2017]

No, I could not detect a difference and the RO did not expect it. He said they sometimes do a second PET/CT with F18-DCFPyL if they are unsure, so they can compare the two results. In my opinion the experience of the analysing RO makes a bigger difference than the tracer used.

[Ahk1 in reply to GP24]

Hello,

I just did the DCFPL and it did not find anything and at the same day, did MRI which found a 10 mm lesions where the bladder meets the urethra where the surgery RP happened and another pelvic 4 mm lesion in the hip bone. I thought the psma was supposed to be. More accurate, now the RO like to biopsy the first one and then decide on radiating both if it is positive for pc.

Any thoughts that these might not be pc canser since I already had SRT to the prostate bed 2 years ago. Thanks

[GP24 in reply to Ahk1]

There are patients that are PSMA negative, i.e. they express not enough PSMA for a successful PSMA PET/CT. Or, in your case, the RO analysing the scan did have no experience. Also, the PSA value of 0.51 is a low value for a PSMA PET/CT. Studies report that about 58% of the patients show mets at that value.

However, maybe it turns out that it is no met after the biopsy result.

[Ahk1 in reply to GP24]

Thank you, gp24. I appreciate your thoughts

[whatsinaname]

Started on docetaxel almost immediately. Finished 3 cycles, 4th coming up. The results will be known in a while.

The second scan showed that the mets had spread (despite ADT and radiotherapy) and the best treatment would be chemo for distant mets.

[whatsinaname]

No, I have not yet been gene mapped, but I am checking out the possibilities of getting that done. Good point, Nalakrats.

I am also going to have a chat with the MO and PSMA test technicians as regards the possibilities of radio treatments. Another excellent point. Kudos, Nalakrats.

The thing is I have been just 8 months (or slightly longer) on cancer treatment having being detected only in February, 2018. At that time, my MO's were of the view that Casodex, Eligard and Radiation therapy would comfortably pull me through at least 3 years. How wrong they turned out to be

No real point in looking back. One has to move forward and your suggestions, Nalakrats, are excellent. I will be looking into them asap. Thank you very much indeed. Much obliged.

[whatsinaname]

Thank you very much, Nalakrats, for the advice. I'll take up the matter immediately.

[whatsinaname]

Absolutely, thanks, Nalakrats, much obliged.

[boness]

My husband had the Gallium 68 in June of this year which didn't show anything. With a rising PSA, he had the Aximum scan in November. This scan showed cancer had advanced into the pelvic lymph nodes. What we don't know is if the cancer was too small to detect in June with the Gallium 68 or if he had the 10% type of cancer that the Gallium 68 does not pick up or if the Gallium 68 just missed it. We are two years into this. Previous MRI's and CT scans showed nothing. Initial treatment was Brachytherapy and 25 radiation treatments.

[Ahk1 in reply to boness]

What was the psa numbers please when you did these scans?

Thank you

[boness in reply to Ahk1]

Sorry for the delay in responding, Ahk1. PSA in May was 9.9. Went up to 28.15 in October.

[Bethpage in reply to boness]

Interesting, boness. My husband had the Axumin in December of 2016. It showed nothing. In January 2017, he had a C11-acetate at Phoenix Molecular Imaging. It also showed nothing. Earlier this month, he had the DCFPyL (PSMA like 68 Ga) and 68 Ga RM2 at Stanford. The PSMA shows uptake in the left prostate bed. We don't know the results of the 68 Ga RM2 because Stanford won't release a written report for that scan. We have the CD, but no radiologist will re-read it without a written report from Stanford. So now, like you, we're wondering whether the Axumin and C11-acetate didn't pick the cancer up because it was too small or if the two tests missed it entirely while the PSMA was able to pick it up. We are five years in, PSA has actually decreased a couple of times since last December. Treatment has been a simple prostatectomy in August of 2014 (simple because biopsies from 2003 to 2014 were always negative) and a salvage surgery to remove seminal vesicles in July 2017.

[boness in reply to Bethpage]

I would be fuming at Stanford. We're with Memorial Sloan Kettering. Pretty good for the most part.

[Bethpage in reply to boness]

Fuming doesn't adequately describe the sentiment. He's not having treatment at Stanford, though. I have husband booked for an appt. with Dr. Kwon, Mayo Rochester, on 1/28 and 1/29. I have heard that MSKCC is one of the best. I have yet to get a call back from them, though.

[MichaelDD]

I had it this past October '18 at UCSF. Persistent PSA since DaVinci in 2016. I've had a very low PSA but doubling time every 3 to 5 months. My oncologist has given me three body scans up to mid 2018 looking for anything. No detection. Was considering Axiumin scan then my MO got me enrolled into clinical trial at UCSF. My PSA going into the scan was 1.77. The scan was very successful. It found metastases only to my lungs both. No place else. Measurable we're 10 plus nodules with the biggest being 10mm. Now I have my own oncologist plus one at UCSF. They decided to get me on Zytiga / Lupron. My oncologist feels that this scan probably is a year before what we may have seen with "normal" scans. Plus with the lungs they always question is it prostate cancer?? This scan is used to look for JUST prostate cancer.

[paulparry]

I have the same problem. Lower back in the sciatic region. Makes walking a bit difficult as well.

Sacroiliac hip joint is 1 problem and I think L1/2 vertebrae also causing a problem.

MRI scan not showed anything for cord compression either.

[CYR7]

I had the G-68 PSMA scan twice in two years, both on a rising PSA but both under 2. I live in HK and the G-68 PSMA is readily available at slight less than US$2k each pop at local hospitals. The first time was in 2017 when my PSA went from a low of 0.01 during an ADT holiday to 1.8 within a matter of four months. I did the scan and it showed two in-gland hot spots. This was followed by a whole-gland HIFU. Then this year four months after the HIFU, I found my PSA rising again from 0.03 and doubling fast. I did the second scan at PSA 1.8. One spot lit up on my lumbar and my oncologist treated it with radiation plus ADT. Now my PSA has gone down to 0.02. If I ever have the misfortune of finding my PSA rising again, I will definitely use GA-68 PSMA as a diagnostic tool. Though some say it works best when PSA hits 2 at least, I found it to be effective as low as 1.5.

Good luck with your test!

[drsridhar53]

I agree with the comments of Whatsinansme. It is the most useful diagnostic tool for PCa today. I have had it done thricr. Finds metastases over 5 mm size. The picture usually

looks frightening, like a well lit Christmas tree. . My Inc said " don't be too frightened by all those green_ yellow bright spots . Most

will 20 years to start bothering you" . But he did find three other lesions worrisome enough to start me on Taxotere.

[E2-Guy]

When my PSA had risen to 1.1 in May of 2017, I wanted to go to UCLA for the 68Ga PSMA scan and was told that my Medicare insurance would not cover the $2650 charge since it was not yet approved in the US. Had the scan done in Melbourne, AU for $600 US and it only identified three sacra LN's. I had those three along with five other suspicious looking LN's removed via robotic surgery at UCI (8/2017) which reduced my PSA immediately from 1.3 to 0.54. I was told that the 68Ga PSMA scan had poor validity at PSAs below 0.7. Tall_Allen does not think that it will identify lesions smaller than 4 mm. Since my PSA in April of 2018 was at 0.71, it was obvious that the scan didn't pick up everything. In retrospect, had I known what I know now, I would have tried the transdermal estradiol gel (tE2) route as per Dr. Richard Wassersug PhD's suggestion prior to having the scan and subsequent surgery. My last PSA reading was 0.046 applying only the gel. I do however believe that the surgery bought me some extra time.

[Break60]

I had this scan in mid October when PSA was 1.7 at UCSF in China Basin. It was the longest scan I ever had but very effective. Found two small bone mets (right scapula and left third rib) which I treated in early December with SBRT in three fractions to each met. I’ve had low volume disease albeit Gleason 9 since day 1. This is the third time since 2015 that I’ve had scans when Psa rose to find mets. The first was MRI with contrast when Psa was 1.2 to find pelvic lymph node mets; the second was axumin in 2017 when Psa was 2.4 to find a femur met; and the third I just mentioned above.

The rapidly changing scan technologies are a wonderful advancement in the tx of cancer!

Bob

[monte1111]

Sounds like I should also get this gene mapping done. Don't even know my testosterone level. Thanks for all your great advice. Time to get pushy.

[Hidden]

After Da Vinci surgery had persistent PSA.

Went to UCSF for PSMA 68 Gallium PET/CT scan and found uptake on a few lymph nodes.

Had SRT completed 12/2016 and waiting to find out if radiation was successful as I am still at castrate level.

If PSMA scan found distant Mets then SRT would have been fruitless!

Best wishes!