More on Axumin, a question

[alephnull]

I have had a prostatectomy (5 years ago)

I have also had radiation to prostate bed AND lymph nodes in that area. (3 1/2 years ago)

But, I have a rising PSA, theoretically it should no longer be in either of those two places.

Scans are negative, so wouldn't it make sense to have the Axumin scan when my PSA reaches about 1.5?

I'd really like Tall to chime in.

[Darryl Partner]

Hi Alephnull There have been 61 posts on Azumin You might find help by reading through these: healthunlocked.com/advanced...

[Tall_Allen]

How high is your PSA now and how quickly is it rising?

[alephnull in reply to Tall_Allen]

Not very, 0.09

But based on the last time I was on an HT vacation it has a doubling time of about 2 months. Last time it nearly quadrupled in 4 months.

My next test is next month and it likely will be in the range of 0.2 to 0.25

So in about 6 more months it will be about 1.4ish.....

I know this is speculation but last it went from undetectable to 0.71 in months

[Tall_Allen in reply to alephnull]

Sure, if you want to get an Axumin scan before you start your next HT cycle, why not? As long as you do not put off HT, I don't see any downside.

[Break60 in reply to Tall_Allen]

TA

The “ problem “ with starting ADT is that Psa will stop increasing and the magic 1.5 Psa level won’t be reached until you become castrate resistant! So it could take quite a while before the scan can be done.

There’s the catch 22!

Bob

[Tall_Allen in reply to Break60]

It's not a "problem" if you live longer. He's on iADT anyway with a rapid PSADT.

[tango65]

I am in a similar situation but with a cancer that is becoming castration resistant. My PSADT is about 2 months. The advice I got from 4 different oncologists, one of them from the MSKCC and other from Munich was to get a Ga 68 PSMA when the PSA is around 0.4. My PSA was 0.25 last week of December 2018.

The Ga 68 PSMA or the 18 F DCFPyl PET/CT are more sensitive than the Axumin PET/CT and they have a lower incidence of false positives.

If there are metastases in the Ga 68 PSMA PET/CT I would try to get treatment with Lu 177 PSMA or spot radiation with SBRT (if possible) and see what happens with the PSA. If the response is not adequate then there are the possibilities of starting therapy with the new anti androgen or chemo.

UCLA does the Ga68 PSMA PET/CT if the PSA is 0.2 or higher (they charged $ 2675) and NIH does the DCFPyl for free if the PSA is 0.5 or higher. With a PSADT of 2 months I agree with the oncologists I consulted, in having a sensitive PET/CT done sooner than later.

I do not think there are data showing that doing a very sensitive PET/CT with a PSA around 0.4 is better than waiting to have a PSA of 1.5.

We both do not have a prostate so the PSA is coming from metastases and I believe most oncologists agree in starting therapy if metastases are detected. With the new PSMA scans it is possible to identified metastases with a very low PSA and if necessary start therapy with a smaller tumor load.

[j-o-h-n in reply to tango65]

Who's the Oncologist that you saw at MSKcc?

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 01/05/2019 5:27 PM EST

[elvismlv123]

Is this like a blue laser scan? Its not unusual for PSA to rise after your procedures and 5 years later. radiationis precautionary but it always assumes an organ confines disease.

That is purely wishful thinking. Too many failures suggest PCa is always where its not supposed to be. Yes the treatments address the bulk of it but it s five years to reveal it elsewhere. If you are hormone sensitive I would look at ADT to control whats left.

[elvismlv123]

You could do IADT and go on and off as long as its safe to prevent CRPC.