I need some guidance on next steps to deal with my recurrent prostate cancer. [Surgery for Gleason 4+3 March 2013, IGRT radiation concluding May 2016 with concurrent 6 months ADT)
In April 2018 I had a 18F-DCFPyl-PET/CT PSMA PET/MRI scan at NIH when my PSA was 0.5 and no cancer was detected. PSA continued to climb with doubling time around 10-11 months and I then had an Axumin PET/CT scan Nov 2019 at PSA 2.1 which did not find any cancer.
I would like to do another PSMA scan to determine where the prostate cancer is located and if possible treat with spot radiation. If treatment is not possible, then I will at some point progress to ADT.
Assuming I can get into a clinical trial in the metro NY area (there are 3 for which I think I would qualify for), should I wait until PSA is around 3 or even a bit higher before having the scan or does it make sense to do it as soon as I can get into a trial?
Should I care which tracer is used assuming the choice is 18F-DCFPyl or 68Ga-HBED? I read Tall Allen's summary of ratings of these and it appears the 18F-DCFPyl is somewhat better but perhaps not significantly better for my situation.
Is there any other next step that is preferable to what I have outlined? I am seeing my MO next week and will get his opinion and may seek a few other opinions as well. Does anyone know if Medicare will pay for multiple MO consultations within a short frame for the same condition?
Appreciate everyone's thoughts.