How related is a rising PSA with a result in a second PSMA PET CT?
Are they quite related? This with bone AP quite stable.
In other words: if doing a first PSMA PET CT at a certain PSA level, PSA rise or decline would predict a rise or decline in second PSMA PET CT results.
Faster PSADT tumors are more detectable, if that is what you're asking.
My question is more if doing a first PSMA PET CT at a certain PSA level, PSA rise or decline would predict a rise or decline in PSMA PET CT results.
At your PSA, PSMA-avid mets should be detectable. But not all mets are PSMA avid. You might want to try a different PET scan (choline, Axumin or FDG). Combidex at Radboud University is good at detecting cancer in pelvic LNs.
Interesting this ferrotran mri, here in europe we would have to go to the Netherlands, I think. Are they good for looking at all mets, or only lymph nodes, and much better to PSMA MRI or PSMA PET CT? Would it be relevant in case of whole pelvic LNs radiation, could it be relevant to target better radiation?
Just lymph nodes.
With a Gleason 9 and a PSA value of 35 you have to expect to see a number of mets on a PSMA PET/CT. As Allan suggested you can also get a FDG PET to see if there are more mets which are not PSMA avid and were not detected by the PSMA PET/CT. This can happen in a few situations.
In any case you will not wait any longer and start treatment if you get your results. No need to worry what a second PSMA PET/CT will show if you do nothing.
The PSMA PET/CT with PSA 28.2 did not show a number of mets, maybe 2 points that are not sure. The point about treatment delaying was 1) heart issues for ADT and 2) not sure of mets for radiation. Maybe now we can have a better picture.
In any case delaying did not change too much till now, but I agree, there is a limit to that. Just not sure if treatment really delays progression, I mean in OS and QOL.
PSMA should be better than choline, maybe combidex better for lymph nodes that are very little. Not sure if really relevant in case radiating whole pelvic LNs. Will ask.
With a Gleason 9 and a PSA value above 20 you are high-risk and I recommend to get treatment. To avoid heart issues with ADT you can either:
a) use Degarelix injections
b) use the patches: "These promising new findings suggest that we might be able to use oestrogen patches or an oestrogen gel to treat prostate cancer without significantly increasing the risk of heart disease and stroke."
imperial.ac.uk/news/119570/...
If the new PSMA PET/CT does not show mets, get the prostate radiated. It is possible to radiate the rest of the pelvis in a second step when mets are detected.
I have read that combidex can result in a number of false positives. I prefer a PSMA PET/CT. In case you are PSMA negative, I would get an FDG PET/CT. Maybe that detects mets.
Any ideas if patches better than degarelix for heart issues. I did not find any study on that.
But there is a study saying patches as good as lupron, and a study saying degarelix better than lupron...
Only more results on patch trial will only be available next year.
In my opinion you should not wait for trial results but decide now how to treat this life-threatening disease!
Nobody compared degarelix versus patches and probably nobody will in the foreseeable future. Degarelix is an approved drug while patches are offered in clinical trials. Therefore the straightforward route is Degarelix.
This review article contains a section discussing cardiovascular risks of ADT and how to mitigate these:
Allan, Androgen deprivation therapy complications
erc.bioscientifica.com/cont...
This article discusses the side effects of ADT. This is what you doctor should have discussed with you before the first Lupron injection. 
My husband is in the same side. PSMA PET/CT show meds stable but psa is rising with zytiga and dextam. Doctor recomended us have radiation in the only two bone mets. I don't know if this is a good option 🤔
Hi, I’m from the UK and through research i’ve found that taking Metformin for diabetes you can increase your PSA result by another 14%. Also taking Durastride you can increase your PSA result by 50% (double it). I was diagnosed in 2012 with a very small tumour with a Gleason score of 6 and a PSA of 2! Therefore I was put on wait & watch. February this year I insisted I have a NPMRI Scan which they did. I now have a very large localised tumour in my prostate. My last PSA was 6.6 and I take metformin so my PSA is 7.5 actually. I’m now have a prostectetomy booked for 15th October 2019. So all I can say to every gentleman, don’t be fobbed off by your Doctor/Consultant, you now your body!!! Check the medications you take and what is does to your PSA
Kind regards
Bazza
Just to clarify. Do you mean if a person's on metformin that the PSA reading will be lower by 14%?
Hi there, You are correct in saying that. The place where I found the information was
"European Journal of Cancer" Volume 51, Issue 6, April 2015, Pages 725 - 733
Kind regards
Barry
PS I have a screenshot of it but I can't copy it to attach it to this reply
That's ok. Thanks for replying. My husband is on that diabetic drug and although he'd previously had his first Lupron 3 monthly shot and was ready for his second we were very surprised in early August that his PSA was 0.01. Up until then we'd never received any good news since Nov 2015 so it seemed a bit odd to me, though I did expect the Lupron to have had some effect. So what you're saying is that maybe you could add 14% to that reading and if research is right that would be closer to how things really are.
not sure about it, but there is a lot of research saying that metformin helps for PCA, lots of trials going on. Once the disease is advanced, glucose and insulin spikes is a pathway, whereby metformin adds to stop the pathway. That's at least the metabolic theory.
We had already some discussions here, if a PSA can be lowered "artificially" in the sense that it has no effect on disease, and the opinions vary a lot on this (quite oppose stand points of view).
So especially under ADT I think taking metformin is a good idea.
Yes I agree. I've been pleased my husband is on it, as like you mention, I've read that there have been some positive results in one of the trials. It's all such a guessing game isn't it !
Hi there, before a male has any radiotherapy/Prostectomy or chemotherapy the PSA is artificially lowered when they are taking metformin. Say his PSA marker is 5.0 then his actual PSA marker should be calculated up by 14.9%. Making their real PSA marker to 5.74. If a person was taking durastride, then what ever their PSA marker is, you have to double it, eg, if it’s 5 then the real PSA marker is 10.
Oh. He didn't have metformin before his prostrate removal or his radiation which followed. He's taking it now to guard against diabetes. He's recently started Lupron and his PSA went from 2.7 to 0.01 and so I was wondering if that might be a bit of a false reading and if the research is correct it would really be 0.01 x 14%
If, it would still be 0.0114!
PSMA PET Looks Good But PSA Rising 
18F-DCFPyL PSMA PET/CT Scan Result
Risk vs rewards of allowing psa to rise high enough for a PSMA PET CT
SUVmax PSMA F18 PET/CT Scan
PSMA PET/CT
