Axumin scan results...now onto PSMA scan

[shueswim]

I finally had my Axumin scan on 1/8/19 with my PSA at approximately 1.7 (last blood test on 12/26/18 was 1.5 and it's been rising about 0.1/wk). From what I've read, that would have given me about a 65% chance of detecting the source of my BCR. Well, nothing showed up. On the one hand I saw that as good news, certainly better than too much showing up, but not the "best case" result - perhaps an ogliometastatic situation where spot treatment could be combined with systemic treatment.

With those Axumin results in hand I contacted a PSMA scan clinical study and was accepted immediately - my scan is schedule for 1/24/19. Yesterday I met with my MO and Urologist to discuss the Axumin and future PSMA scans as well as there advised path forward. Both were very supportive of decision to pursue the more sensitive scan but I was surprised by their treatment recommendation after the scan is completed next week. Both have advised that without proof of metastasis that it was premature to begin ADT, let alone any consideration of a more aggressive approach with Zytiga.

I'm confused...having had a RP and adjuvant RP, doesn't BCR by definition mean that I have metastatic PCa? With a PSADT of 1.9 months I'm a little nervous about delaying treatment much longer but I was essentially told to chill out and enjoy the symptom free time period until it becomes necessary. A positive finding on the PSMA scan would presumably change their advice. Absent that, I asked what should trigger the decision to begin ADT and I didn't get a clear response. I came away from my visit to Johns Hopkins last October with a recommendation to not start ADT until my PSA hit 10 (at my current rate that would be in May). That seemed like too long to wait and Dr. Smith at MGH agreed...but he too was vague about when you start. Again, a scan "proving" metastatic cancer will shake things up but without that I guess I follow the vague guidance to chill until...well I'm not exactly sure when.

[Tall_Allen]

This is controversial, and is still a matter of judgment. There are 3 situations in which salvage ADT is CLEARLY indicated:

1. DETECTABLE metastases on a bone scan/CT

2. High PSA (there is no definite PSA limit)

3. Rapid PSADT (less than 9 months)

Since you meet #3, I think it is worth considering. I think the decision should be yours.

[shueswim in reply to Tall_Allen]

I had the scan yesterday and should get the results shortly. In the meantime I received the pre-scan PSA test results. My number doubled to 2.954 in 1 month. Looks like I need to begin ADT immediately. Local Urologist is saying Firmagon. Anything else I should be considering?

[Tall_Allen in reply to shueswim]

There are lots of choices: intermittent or continuous? if intermittent, using what protocol? GnRH agonist/antagonist or anti-androgen? if anti-androgen, how much? tamoxifen?

[MichaelDD]

I too was told that the Axumin was my next choice. My personal MO consulted with UCSF. He wanted to go something "better". They got me into the GA68-PSMA UCSF. Went in at PSA 1.99 .PSADT every 3 to 5 months.There was much surprise with just lung metastasis. My regular MO was the same ..he was reserving any ADT until 10. With the diagnosis after PSMA, UCSF MO and my regular started the ADT. My UCSF MO wants to see my CT scans that are being scheduled now. Once the PSMA was done and mets found its all go to fight. Lungs there is or had been a question of is it prostate metastasis? PSMA clears that question. Thinking you will get great results from PSMA!

Michael.

[George71 in reply to MichaelDD]

Micheal,

were you given ADT for 6 months while doing RT ?

[MichaelDD in reply to George71]

No ADT. Through all my procedures/scans from 2016 to November 2018 nothing given. My MO didn't just want to throw that in without knowing where the metastasis was. After the GA-68 in October with the lung metastasis found I was started on Lupron and Zytiga December 1st. Testerone went from 708 to <10. PSA from 1.99 to 0.03.

[Bethpage]

Hold on for those PSMA results. Neither the Axumin nor the C11-acetate caught my husband's reoccurrence at PSA 0.8. 18F DCFPyL (PSMA) did catch it at the same 0.8 PSA.

[joekaty in reply to Bethpage]

It is so scary to me that which scan you receive determines accuracy of results. I’m sure that sounds kind of stupid but I’ve been reassured so many times about my husband based on what I (now) realize we’re very outdated or not appropriate scans. It’s frustrating. Now finally had another bone scan done at UTSW and anxiously awaiting those results.

[Bethpage in reply to joekaty]

joekaty, fingers crossed for you!