68Ga-PSMA-11 PET/CT terminology “AVID”

[depotdoug]

What does “AVID” actually mean in PSMA terminology?? Like in my Radiology PET/CT scan report?

Depotdoug

[Tall_Allen]

It means there was significant uptake of the radiotracer by that tissue.

[depotdoug in reply to Tall_Allen]

And therefore that detected active tissue is cancerous or lesion growing correct? At that area? On my Posterior of atrophied prostate gland and both Pelvic lymph node chains?

[Tall_Allen in reply to depotdoug]

PSMA is quite specific for prostate cancer. Why is your prostate gland atrophied?

[depotdoug in reply to Tall_Allen]

Sorry forgot the original PCa treatment. I opted for IMRT Intensity Modulated Radiation treatments. 42 zap Aug-mid Dec 2005. PCa PSA from Dec 05 till April 2008 was nil. Less than 0.5ng/mL. Then rapidly PSA’s rose summer of 2008 They (Old Urologist) started me on Lupron/ Casodex. Off and on for 5 yrs.

My Urologist 2of those rascals told me my Prostate gland was Atrophied. Why because my Prostate biopsy March 2007 pathology report summary says glandular atrophy and benign tissue(2007). Caused by IMRT.

FFW to now. PSA 17.7ng/mL and PSMA ACTIVE AVID detects. 5 days till my Med Oncologist consult and treatments. TBD....

Depotdoug

[Tall_Allen in reply to depotdoug]

What IMRT dose did you get, and what was your risk level at Dx (Gleason score, PSA, and T stage)?

[depotdoug in reply to Tall_Allen]

Tall_Allen, 14 years ago wow.

What I do know from June29,2005 from 1st Biopsy GLEASON 3+4 7.

PSA @ that date June 2005 was 7.6ng/mL. 1st biopsy report says F,G,H, specimens were invasive prostatic adenocarcinoma.

As far as IMRT dose I'll have to call and stop by the Radiation Oncology Assoc. office tomorrow. I don't have those records. I was pretty much a messed up guy back in 2005-2007, not just PCa starting and treatments, but several cardiac major issues I'd rather forget about. My ADHT treatments 2008-2012 may have contributed to my sudden cardiac arrest May2011.

Let's me do some more research Tall_Allen. I can easily walk over to my Rad Oncology lab office.

Bear with me. I'm trying to slowly recreate the scene of my Cancer progress 14 yrs ago.

Doug

[depotdoug in reply to Tall_Allen]

I did find my T staging records T1c. I mentioned before that I've had only 2 Prostate biopsy's 06/2005 and 03/2007. None since then. Maybe its time for a new recent guided biopsy next week after my new Med Oncologist consult??

2017 and 2018 I've had 2 scans, CT Pelvis abdomen and a Technicium Nuclear total body bone scan. Both scans, both years, showed no evidence of metastatic disease in those scans.

Only my PSMA AVID detecting PET/CT scan 01 Aug 2019 found AVID lit up spots/areas posterior of prostate gland and both pelvic lymph node chains.

That's all I've got to go with for now Tall_Allen.

Is it time for a new modern Prostate gland guided biopsy plus biopsy's of my Lymph nodes. Have no idea. -5 days till IU Simon Cancer Center Med Oncologist consult/evaluation.

Doug

[Tall_Allen in reply to depotdoug]

The reason I asked is because back then they often didn't give enough radiation to really do the job, especially for high risk PC. The good news is that there are some salvage tools that weren't around back then. You can have salvage brachytherapy to the parts of the prostate that lit up on the PSMA scan, or SBRT to the whole gland (which is probably a better idea). Because the initial treatment was so long ago and probably at lower dose, the toxicity risk is lower.

pcnrv.blogspot.com/2016/08/...

You can also try salvage pelvic lymph node radiation to the entire pelvic lymph node area. Actually, if you can find an RO to do it, you can treat both areas with SBRT during the same 5 treatments, with a slight boost to the known cancerous lymph nodes.

[depotdoug in reply to Tall_Allen]

Thxs! That’s probably absolutely correct. 14 yrs ago technology didn’t even know what PSMA scans were. Let alone advanced SBRT.

I will definitely put SBRT & Brachytherapy on my Question Hit Action List for Dr Adra Consult evaluation Next Tuesday. I’d never thought of that.

One major side effect of my IMRT rad zaps from 2005 was I developed an Urethral Stricture. That manifested itself into me having 2 DVIU’s operations. Both temp fixes. Then March 2017 had an Urethroplasty surgery to repair that darn Stricture! Not fun! Oh I’ve had to self Cath since

Wat back in July 2005 Dx Neurogenic bladder. Not even related to IMRT or PCa.

I will call my Radiation Oncology Assoc’s this morning for IMRT dose strength. They may have to search their archived patient data bank history files.

Thanks for SBRT and brachytherapy info. Will stay in touch.

Doug

[Break60 in reply to Tall_Allen]

TA

Since SBRT is as I have read less invasive than brachytherapy is it now making brachytherapy obsolete? If not under what circumstances is brachytherapy better than SBRT?

[depotdoug in reply to Break60]

I have no idea. Where do I go for info? Not sure if my medical oncologist would know. I can message him tonight via my secure health site. Any super rad oncologist out there?

[Tall_Allen in reply to Break60]

You are confusing radiation used for different purposes. No, brachytherapy is certainly not obsolete.

[depotdoug in reply to Tall_Allen]

I was going to do brachytherapy back in Aug2005 but it sounded to invasive. It probably would of been better than IMRT. My question is: does a medical oncologist know, is knowledgeable on radiation targeted therapy’s?

[Tall_Allen in reply to depotdoug]

You are confusing primary treatment with salvage treatment - they are very different. You have to talk to a radiation oncologist who specializes in that particular therapy.

[depotdoug]

I’ve got my IU Health Simon Cancer Center Med Oncologist Appointment consult next Tuesday PM. It should be interesting! Dr Adra’s BIO says He 1. provides an expert opinion on my Prostate cancer recurrence 2. Gives his patient a comprehensive explained treatment(s) plan 3. Always reviews his patients’ Med history, Dx’d , symptoms, procedures, 4. Total body health conditions BEFORE the visit. I’m pumped for next Tuesday. Bring it on!

Depotdoug

[depotdoug]

IMRT reports & Late breaking news. I called my Rad Oncology facility this AM. One they found me in patient records circa Aug-Dec 2005. I should have my report this Friday AM.

I'm finally going to know what I did not care about 14 years ago. My IMRT dose rate, type of accelerator, progress and prognosis from now retired Radiation Oncologist.

Thanks Tall_Allen for pointing toward possible Salvage Radiation Therapy, brachytherapy and or SBRT. At least ill have more ammunition for my IU Health Cancer center Med Oncologist consult/evaluation next Tues. Bring it on, ready for the best optimum treatment. Doug

[monte1111]

go get 'em

[j-o-h-n]

"sic em"

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 08/14/2019 4:32 PM DST

[depotdoug]

Not gonna do another Urethroplasty surgery in my lifetime.

[Break60 in reply to depotdoug]

I would avoid it too. Also no more total shoulder replacements!! 🤕

[Patrick-Turner]

Hi depotdoug,

We are all avid for food and love in our lives. We want supplies of these things to keep us smiling

AVID is not a chemical. But places where there is Pca may attract radioactive chemicals when circulating in blood stream. Gallium 68 is a common harmless

radioactive substance. Another harmless ligand chemical is also in bloodstream. The ligand is a strange chemical devised by Novartis and its like a friend of the radioactive chemical, and these two friends like to linger wherever there's a Pca party going on, and get invited to join the fun. The Pca has chemical hooks on which the ligand fits while it holds hands with radioactive Ga68. The "hooks" are called PsMa. ( you can see I ain't a molecular biologist )

The pair of friends do not like to linger much anywhere else. The radiologist makes an image of where these radioactive guys are gathering. The image tells the docs how much the cancer attracts these guys to join the party, ie, how avid the cancer is to want radioactive friends to linger, and even go inside cancer in the blood vessels inside the cancer. The amount of radioactive material that is attracted to Pca sites can be measured and the avidity estimated. The avidity is also called SUV, specific uptake value, and a number is given to it, and the higher the number, the more likely it is that a man can get a benefit with Lu177 or AC225.

Lu177 and the ligand are also become close friends who enjoy who like Pca parties, and Pca invites them to come in, so Pca acts like it has a death wish it might seem, has very poor ability to choose good friends.

But cancer is also strange stuff, and can often survive its tendency to invite the wrong ppl to the party, get all shot up with beta or alpha particles, then survive and kill a man.

Patrick Turner.

[Break60 in reply to Patrick-Turner]

I also benefited from SBRt to the avid bone mets. PSMA provided great big bullseye!

[depotdoug in reply to Patrick-Turner]

So you are telling me there are active killer PCa cells that do not like uninvited party friends?

[Patrick-Turner in reply to depotdoug]

Indeed. While some Pca cells have a self destroying love hate relationship with having minor atomic Lu177 bombs exploded in right in front of their nose, there are Pca cells who don't make much PsMa, or much Psa, and they are the ones which may / may not kill a man despite whatever potions any doctor pours into a man's veins.

I've seen these mutant cells get very busy in a friend who died earlier this year. RP failed, more IMRT failed, Cosadex made Psa whoosh upwards, Pca really enjoyed a feed of that stuff, then chemo seemed to work but after 10 shots Psa was back up. Then he wanted Lu177, but paused to have DNA tested for Brca2 gene, was positive, then PARP inhibitors also fueled Psa which went from 40 to 432 in 2 months during time it took to DNA analysed and then he got a bunch of new mets in his liver that grew so fast that nothing could stop them, he became so weak and sick he could not have Lu177 which would not have worked, so he died at 59. Pca took 3 years to kill him. He had a beautiful wife of 50, two lovely kids, and they had a major tragedy in their lives, because Mr Wonderful who paid the bills was gone.

The mutant cells are killers. Not in everyone though. Pca DNA varies a lot so no two men have the same response.

[depotdoug in reply to Patrick-Turner]

And my Avidity PSMA lit up at my prostate gland posterior had a max SUV of 11.7. My Lymph node(s) avidity on both left and right lymph node chains of SUV 8.4. Guess my med oncologist DR Adra knows SUV’s and avidity? Hope so.

[Patrick-Turner in reply to depotdoug]

Looks like Lu177 might work.

Patrick Turner.

[paige20180 in reply to Patrick-Turner]

Any suggestions Patrick on where to go for LU 177? We are thinking Homburg, Germany. My husband is not hormone resistant which seems to be required to get into US studies. Thanks.

[Patrick-Turner in reply to paige20180]

Hi paige20180,

I live in Canberra in Australia and I got Lu177 in Sydney, and I know its also available in Perth, and maybe Brisbane. Look up Theranostics Australia in Google and all info you might need is at their website.

The 4 cycles of treatment is aud $27,000, not including PsMa scans and the initial consultation via Skype, which might be usd $350. But you would need to be referred by your doctor, you cannot just show up at TA and tell doc, "Hey man, shoot me up with Lutetium". Your doc in US has to know enough to be able to refer you, or have valid reasons why he would not.

Lu177 was invented in Germany, is available there, I don't know what the price is and some clinics have much better staff than others according to reports I have read here.

Its a beautiful sunny clear day here, Spring is Sprung, I is fulla sprang, and will spreng along on be bicycle to get to my café for lunch, because I feel my hip might have healed up over winter

Patrick Turner.

[depotdoug]

Looks like a good success rate for SBRt rad zaps.