Bone scan vs PSMA scan: This was a... - Advanced Prostate...

Advanced Prostate Cancer

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Bone scan vs PSMA scan

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This was a presentation at a conference. The scan results between the bone scan and and PSMA PET scan astounded me.

24 Replies
Tall_Allen profile image
Tall_Allen

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

in reply to Tall_Allen

Tall_Allen, what's your take on the two scans? I'm totally uniformed when it comes to reading scans. To me it shows that the bone scan is missing a lot of bone mets. I did read your link. Is the PSMA PET showing what's "really there" in terms of bone mets? I'm confused. Thanks.

GP24 profile image
GP24 in reply to

Yes, a PSMA PET/CT is much more sensitive than a bone scan. Therefore most patients who have CRPC without metastases show a lot of metastases on a PSMA PET/CT. And this are not false positives!

The image you presented was made at the APCCC in Basel and not at the ASCO! At the ASCO they have different lecterns.

in reply to GP24

Thanks for the correction.

Tall_Allen profile image
Tall_Allen in reply to

It's showing what's really there in terms of all mets, not just bone mets. But it is a mistake to assume that that is all that's really there. Even a PSMA PET scan has detection limits and some (rare) tumors don't show up at all. For some purposes, a bone scan/CT is all that's needed.

Schwah profile image
Schwah in reply to Tall_Allen

So if I read it right, your blog says the F 18 tests are even better than the PSM a test. Where would one get the F 18 test and how much do they cost? I’m assuming Insurance doesn’t usually pay? It’s especially important to me to get early accurate scans to see if My cancer is back, since I’m on vacation from drugs and I will have no way of knowing if a rising PSA will be due to my 60% remaining Prostate or my cancer coming back

Tall_Allen profile image
Tall_Allen in reply to Schwah

The F18-DCFPyL PET is more sensitive than the Ga-68-PSMA-11 PET- They are both PSMA-based PET scans. You just missed the big US trial of the F18-DCFPyL PET scan for recurrent PC. There are a few places still doing it - NIH, Johns Hopkins, Stanford, and Columbia,. It will probably be about 9 months until the FDA approves both and they become widely available.

whatsinaname profile image
whatsinaname in reply to Tall_Allen

Yes, this is the scan that I get done at Breach Candy Hospital in Bombay.

I mean the F-18-DCFPyL PET scan. And, yes, it is more sensitive.

At least in this respect, we are lucky that we have almost the most advanced

equipment here in Bombay, India.

Schwah profile image
Schwah in reply to Tall_Allen

Is it available if paid out of pocket in the interim and if so , whats the closest to Southern California? Once again TA, your knowledge is incredible!!!

Schwah

Tall_Allen profile image
Tall_Allen in reply to Schwah

In the US, it's only available on clinical trials with specific requirements at the institutions I mentioned as far as I know. NIH doesn't charge, but the others might - you have to check.

AllenMarco profile image
AllenMarco in reply to Tall_Allen

Question: if the F-18 DCFPYL scan only picked up two small lymph nodes (supraclavicular and internal iliac) but no bone mets, what is the significance?

Thanks

Tall_Allen profile image
Tall_Allen in reply to AllenMarco

The supraclavicular lymph node is outside the pelvic region, so the cancer has obviously traveled systemically and requires systemic treatment. Have you discussed Zytiga?

AllenMarco profile image
AllenMarco in reply to Tall_Allen

Scan (at NIH) and follow up biopsy (unsure if core or needle) was negative. Trying to put off ADT as long as possible. Will discuss with MO, but thinking I could wait until bone mets to begin. Do you still feel systemic treatment needed now?

Tall_Allen profile image
Tall_Allen in reply to AllenMarco

By putting off systemic therapy, you lose time off survival. Your choice.

AllenMarco profile image
AllenMarco in reply to Tall_Allen

Thank you.

NPfisherman profile image
NPfisherman

Yep.... Nothing was found on my bone scan...on my Axumin scan, 1 met found at PSA=3....the newer scans are so much better to determine oligometastatic state but even they are limited by how small a lesion they can find....Thanks for posting....

Don Pescado

LearnAll profile image
LearnAll

If Insurance does not allow ,how much does it cost to have whole body PSMA PET CT scan ? I called a hospital in new delhi, India and they gave me a quote of Rs. 15000 (one $ equals 72 rupees)

The name of hospital is Max super speciality hospital, delhi.

whatsinaname profile image
whatsinaname in reply to LearnAll

My personal choice is Breach Candy Hospital, Bombay.

It costs INR 25,000/- or US$ 350 approx.

Absolutely fantastic service. Start to finish just 2/3 hours with a meeting with the doctor who explains to you in detail where exactly your tumors are, what size, etc, etc, etc.

However, the cost differential of INR 10,000/- might prompt people to get it done in

the cheaper place. To each their own.

lewicki profile image
lewicki in reply to LearnAll

900 Euros at the university of Heidelberg.

Ldb01 profile image
Ldb01

These are the scans my husband has on his ACT 225 trial. Very frightening to see the very first scan. After second and third injection my husband’s images were 90 percent clear of black spots or red blotches. Amazing to see.

lewicki profile image
lewicki in reply to Ldb01

Hi ldb01, Where did your husband do an AC-225 trial. Also, how are things going for him?

gourd_dancer profile image
gourd_dancer

Comment. I started with nuclear bone scans with a soft tissue abdominal CT scan in 2003. I have had 25 sets. 24 were through 2010 and the 25th was in 2016. I have no plans to do any other new generation scans. As a result of comments in this group, I have read about the differences and their capabilities. In most cases, the the scans which I have had work extremely well; besides, I have a complete history of the last 16 years for comparison.

My understanding is that comparative scans over time determine how old mets have progressed as well as new mets arising. Think what the cost would have been if I had 25 comparative of the new generation of scans. I doubt very seriously that few in this group could afford a comparative study utilizing the newer generation of scans.

Gourd Dancer.

tom67inMA profile image
tom67inMA in reply to gourd_dancer

Thank you for reminding us that some men have survived PCa despite being diagnosed prior to PET scans, Zytiga, etc. :-)

tallguy2 profile image
tallguy2

Thanks for posting. I will have my 3rd PET/CT with Axumin in two weeks. It’s part of me to have the data. But I at the same time don’t look forward to the results.

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