18F-DCFPyL PET/CT OR Gallium 68 PSMA... - Advanced Prostate...

Advanced Prostate Cancer

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18F-DCFPyL PET/CT OR Gallium 68 PSMA Pet/CT scan

Christopherg
Christopherg

I appreciate your opinion on which scan to do to be detect reaccurance of prostate cancer.

Which scan is most sophisticated? The 18F - DCFPyL or the Gallium 68 PSMA?

I have rapidly doubling PSA - 6 weeks and need to act fast to determine best treatment.

Thank you for your direction and all opinions welcome.

34 Replies
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DCFPyL is more sensitive, but the big trial has ended recruitment, and I've heard there's a long waiting list at NIH - where would you get it?

pcnrv.blogspot.com/2016/12/...

Hi Allen, On clinicaltrials.org it seems that there are a few trials at various centers.

Maybe I am reading incorrectly?

Do you think the Gallium 68 is good enough?

There are a few. I think JH is still running theirs. I know Stanford has one, and there may still be a few in Canada. Contact them - you have nothing to lose.

mklc
mklc in reply to Tall_Allen

Thank you so much. Your thorough write up on scans is really valuable. You put in a lot of work. Much appreciated.

I've asked about this at Dana-Farber, but my whole-body bone scan (99m-Tc-MDP) didn't show new progression and PSA <0.02 most likely factored in. Anyway, understood the study is not taking new subjects and my current condition would've not made an exception.

How long ago have you done a scan?

Wow, I've read your profile, amazing journey, well first of all having CT and bone scan 5 years ago will provide contrast with the next scan.

It seems to me, that you're still hormone sensitive, why the castrate-resistance call? Because, your PSA rises after ADT vacation, then it goes down when ADT is resumed, perhaps I'm missing something.

Then, your Oncologist says, stop ADT again! I've seen this pattern before, even with Dana-Farber, like keeping the tumor cells from mutating with intermittent ADT.

Obviously, anecdotal with this, but I was Dx with PSA 1000+, with "extensive" pelvic metastasis and large tumor extending my prostate. Then after a month on ADT, my prostate returned to normal size and pelvic MRI showed "extensive" necrosis!

I've been anticipating, like you, to jump on ADT vacation, but my doc wants to wait a little over a year before trying it.

Appreciate your thorough historic profile...

Given your doubling rate, try for both and take the first one you can.

But given your doubling rate, it would seem even more important to start treatment without waiting around for a scan.

Unless you are considering lu177 psma treatment, in which case you need to expedite a psma scan pronto.

Christopherg
Christopherg in reply to cesces

I am on the border of being castrate resistant per my oncologist. I think it may be a little early for the Lu 177 as I think I am low volume.

Waiting for replies re the Gallium as have contacted several hospitals from the clinicaltrials.org website.

I agree re starting ADT asap.

Fingers crossed.

I used c11 Choline at Mayo clinic but my understanding is that your PSA has to be at least 1.0 for good detection rate

my last PSA which was last Friday was 2.3 so in 6 weeks will be almost 5. Need to get on the case asap.

Psa should be close to 2.0 for any of these scans for optimal results. I too have fast doubling rate so didn’t have to wait long! I’ve used PSMA and axumin; each time they found a bone met . Never used DCFPyL.

Christopherg
Christopherg in reply to Break60

It's a scary ride as I think fast doubling might mean pc gone to the bone. need to start ADT as soon as possible.

Break60
Break60 in reply to Christopherg

I did start ADT again but also radiated-bone met with SBRT

Christopherg
Christopherg in reply to Break60

at least you debulked so it must have been of some help.

I am hoping for the same.

best health and good wishes to you.

Break60
Break60 in reply to Christopherg

Doing well so far after six years

Christopherg
Christopherg in reply to Break60

That is the good news

I have done both several times...in Germany. Looking at your PSA, both are remarkable in detecting very small Mets. Look for 68Ga as it's more available.

Good luck

Christopherg
Christopherg in reply to Alinur

Would you tell me which hospitals in Germany?

Good health to you and all best wishes

Chris

Alinur
Alinur in reply to Christopherg

University hospital of cologne, Nuclear medicine clinic. They have different ligands of18F-PSMA.The newest ligand which they used in my scan on June 19 was 18F-Jk PSMA-7...more sensitive than DCFPyL. It detected 2 new bone lesions at PSA of 0.46 .I will have Cyberknife SBRT in the same hospital after 2 weeks.

Plse don't hesitate to ask if you need more information.

Good luck.

mklc
mklc in reply to Alinur

Do you mind if I ask how much it costs?

Thank you so much for your kind assistance.

How is your health now?

Best wishes, Chris

Alinur
Alinur in reply to mklc

My last one 18F-PSMA-7 was the most expensive 2300 euro.normal cost for 68Ga or DCFPyL is ~2000euro.Thank you for asking... I had rising PSA after every therapy and then PSMA scan and whenever they find something I zap with SBRT(Cyberknife) that will continue as far as my cancer is Oligometastatic. That is my approach to this disease.I don't use bone scans and CTs since I consider them obsolete and outdated for advanced PC.Apart from rising PSA and imagistic detection of cancer cells in my bones, I feel fit and "celebrating" this month nine years of good fight.

Best.

Alinur
Alinur in reply to Alinur

Discovery of [ 18 F]PSMA-7, a novel PET-probe for the detection of small PSMA positive lesions

Article in Journal of Nuclear Medicine · November 2018 with 132 Reads · Download citation

DOI: 10.2967/jnumed.118.218495

Boris D. Zlatopolskiy

Heike Endepols

33.28

- University of Cologne

Philipp Krapf

22.25

- Forschungszentrum Jülich

Bernd Neumaier

44.3

- University of Cologne

Show more authors

Abstract

Prostate specific membrane antigen (PSMA) expressed by the vast majority of prostate cancers (PCa) is a promising target for PCa imaging. The application of PSMA specific 18F-labeled PET probes like 18F-DCFPyL and 18F-PSMA-1007 considerably improved the accuracy of PCa tumor detection. However, there remains a need for further improvements regarding sensitivity and specificity. The aim of this study was the development of highly selective and specific PSMA probes with enhanced imaging properties, in comparison with 18F-DCFPyL, 18F-PSMA-1007 and 68Ga-PSMA-11. Methods: Eight novel 18F-labeled PSMA ligands were prepared. Their cellular uptake in PSMA+ LNCaP C4-2 and PSMA- PC-3 cells was compared to that of 18F-DCFPyL. The most promising candidates were additionally evaluated by µPET in healthy rats using PSMA+ peripheral ganglia as a model for small PCa lesions. PET images of the ligand with the best outcome, 18F-JK-PSMA-7, were compared to those of 18F-DCFPyL, 18F-PSMA-1007 and 68Ga-PSMA-11 with respect to key image quality parameters for the time frame 60-120 min. Results: Compared to 18F-DCFPyL, 18F-JK-PSMA-7 demonstrated increased PSMA specific cellular uptake. While target-to-background ratios of 18F-DCFPyL and 18F-PSMA-1007 were comparable, this parameter was higher for 18F-JK-PSMA-7 and lower for 68Ga-PSMA-11. Image acutance was significantly higher for 18F-JK-PSMA-7 and 18F-PSMA-1007 compared to 18F-DCFPyL and 68Ga-PSMA-11. Image resolution was similar for all four tracers. 18F-PSMA-1007 demonstrated significantly higher blood protein binding and bone uptake than the other tracers. Conclusion:18F-JK-PSMA-7 is a promising candidate for high quality visualization of small PSMA-positive lesions. Excellent preclinical imaging properties justify further preclinical and clinical studies of this tracer.

Christopherg
Christopherg in reply to Alinur

Thankful for your kindness

Good health to you

Christopherg
Christopherg in reply to Alinur

Could you please send me the contact details for cologne

Thanks so much

I think the current feeling is that there is not a lot in it, whether you use Ga68 or F18 as a label to detect PSMA avidity . That is, they are equivalent, but there are some trials testing that head to head at the moment (eg. in Peter Maccallum Cancer Centre in Melbourne). I have had both labels with comparable results. Assuming high avidity, I strongly recommend using Lu177 treatment early whilst PC lesions are limited and preferably only in soft tissue; don't wait. =Rob

xpbdb
xpbdb in reply to immunity1

You validate my feelings. I had 4 lesions detected by Ga-68 PSMA PET/MRI scan a year ago (clinical trial @ UCSF). 2 prostate bed, 1 seminal vesicle, 1 pelvic lymph node (biopsy confirmed). The lymph node met makes me stage 4 now. I wanted cyberknife, but my MO put me on Firmagon last October. Initially PSA and T went down. In December we switched to Lupron. PSA has steadily risen since then. T has stayed around 2. I really want Lu-177 PSMA, but I am in California. I am not sick enough for a clinical trial, and treatment in Australia would cost $10K per (including travel). If I wait for Lu-177 to be approved in the US, my cancer will be worse. Not a happy camper.

Christopherg
Christopherg in reply to xpbdb

Will chemo be an option?

xpbdb
xpbdb in reply to Christopherg

I will see my MO next week and see what he offers. Today I inquired about a new Ga-68 PSMA PET clinical trial at UCSF. I hope they accept me, since I had one there a year ago. My RO there did my HDR brachytherapy 10-31-17. If I find out I still only have pelvic lesions I'm calling Reno Cyberknife. They told me a year ago that they would treat me. I'm not waiting for alpha or beta radiotherapy to be available in the US.

Christopherg
Christopherg in reply to xpbdb

Fingers crossed for you.

Best wishes, Chris

Hi Rob

Thank you so much for writing

I don’t know much at all about the LU

Isn’t it for late stage??

Forgive my ignorance

Chris

Alinur
Alinur in reply to Christopherg

nuklearmedizin.uk-koeln.de/...

Alinur
Alinur in reply to Christopherg

Contact person at a glance

clinic Director

Univ. Dr. Alexander Drzezga

Chief Secretariat: Jacqueline Stengel

Telephone +49 221 478-7575 Fax

+49 221 478-7584

E-Mail nuk-med-secretariat @ uk-koeln.de

Private outpatient clinic | Assistant Medical Secretary

Central telephone number for inquiries:

Gabriele Meyer

Monday to Friday 08:00 - 15:30

Telephone +49 221 478-5024 Fax

+49 221 478-89085

E-Mail nuclear medicine @ uk-koeln.de

We can, and do, feel ignorant regularly or at least I do too. It is true that Lu is being used in late stage PC cases. That is purely because it is experimental still in most RO's eyes and of course we need to check safety and secondly efficacy in patients first who have 'less to loose'. I really cannot speak on behalf of Theranostics Aust but their communication to me was that it is most effective for soft tissue lesions and this was borne out when most of my cancer foci disappeared after 4x. They were less confident re bone mets. While I am not aware that these findings have been published because of the reluctance of people wanting to be controls with SOC, they have treated many hundreds of patients and have a good clinical grasp of 'what works'. Given the lack of side effects and the conceptually different approach to other therapies I think it ticks the box for early treatment. Pity about the $. =Rob

I am discussing with my oncologist next week

Thank you so much

Good health to you

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