PSMA versus Traditional PET scan

[Lousantoro]

I have been discussing a PSMA scan now that it is approved, but test site ( UCLA) 1,000:miles away. Thinking of accepting a traditional PET scan. Main question, PSMA, or traditional PET scan. At this time one lymph node showing on contrast PSA up to 1.9 Doc recommended Cassodex to control rise till vaccine administered, and I could travel long distance. Open to suggestions, not criticisms.

[Tall_Allen]

What treatments have you had? Have pelvic LNs been treated? What decision do you want the PET scan to help you make?

[Lousantoro in reply to Tall_Allen]

2008 Prostate removed, 2011 35 radiation, 2014 34 lymph nodes removed, no treatment since 2014; however slight rise in the past seven years to the current 1.9. A year ago 12/19 PSA 1.1, this 12/20 1.8 , had a contrast CT scan of pelvic and abdominal , found one lymph node in the pelvic area. Just started on three Casodex daily.

[Tall_Allen in reply to Lousantoro]

When you had the radiation in 2011, was itlimited to the prostate bed or was the entire pelvic LN area covered? I'm wondering whether you can still have salvage radiation of your pelvic LNs. with 3 years of ADT.

[JamesAtlanta]

I am having a PSMA PET scan at UCLA in March. It was easy to schedule, requiring just a referral from my MO from MD Anderson. Cost is $3300 for patient pay. The scheduler at UCLA told me most insurance will not pay for it.

Hope this helps.

James

[hadleycash in reply to JamesAtlanta]

How did yuh out get your MO to order the scan outside of the state they are licensed in? Mi e won't do it! He says it is considered practicing outside of the state he's licensed in.

[maley2711 in reply to hadleycash]

can you consult with a CA MO, and ask him to do the referral? Or just ask someone else locallY??? weird to me

[MateoBeach in reply to hadleycash]

He’s an idiot. He is doing the REFERRAL on his own state. The docs at UCLA are then doing the FDA approved scan In their state.

[j-o-h-n in reply to hadleycash]

Hello hc

Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 02/21/2021 10:03 PM EST

[dhccpa in reply to JamesAtlanta]

Do you know if Medicare will pay for that scan?

[dhccpa]

Good question

[rscic]

Advantage of PSMA:----Sensitivity ..... you may see (more) metastasis which Traditional PET (T-PET) doesn't.

Disadvantages of PSMA:

----Cost

----Far away/Availability

Advantage of Traditional PET (??Axumin??)

----Cost

----Availability

Disadvantage of Traditional PET:

----Not as sensitive as PSMA

KEY QUESTIONS

----At PSA of 1.9 will PSMA be able to reliably detect metastasis???

----If you will get the PSMA and metastasis are detected how would this change treatment???

----Since Traditional Pet (T-PET) is paid for by Insurance & PSMA is not, can you get the Traditional PET 1st and then decide if PSMA (you would pay for the PSMA anyway so it can not be denied by insurance .... it already is denied by insurance) would give additional information which would change treatment???

----If you got the PSMA test 1st would insurance then deny Traditional PET making a comparison of these 2 modalities impossible???

----would getting PSMA delay treatment initiation vs T-PET due to scheduling/availability & travel for the PSMA

----if you only got a PSMA does this mean you would need to get follow-up PSMA studies in order to make valid comparisons???

MY THOUGHTS:

----get the Traditional PET 1st and then decide if the PSMA study, if it yields additional information, would change treatment. You are likely able to get the Traditional PET quickly while the PSMA you will likely have to wait around for.

----SCHEDULE BOTH a T-PET & a PSMA .... PSMA is less available & will likely be scheduled for some time in the future. Get the T-PET right away ..... THEN decide if the PSMA might change treatment & if not cancel the PSMA.

----getting the Traditional PET (insurance pays) will not preclude you from getting a PSMA (you pay) but an insurance company might deny you a Traditional PET if you already have a PSMA &, as a result, you would lose the opportunity to compare these .... if a comparison is a thought.

----my recollection is a PSMA study only begins to detect metastasis reliably at a PSA of 2.0 ..... you are close at 1.9 so maybe but you should probably ask about this.

----Tall_Allen has a good point .... you might be able to receive additional Radiation Therapy (RT) if the whole pelvis & iliac regions were not covered in the original RT you received.

----the question you need most to be able to answer most is, "will PSMA change treatment over T-PET" & I do not think this question can be answered until you get a T-PET .... ask your MO.

Just some thoughts.

GOOD LUCK

[MateoBeach in reply to rscic]

PSMA can detect mets as low as PSA of 0.20. That is the cutoff for UCLA. I found two avid PLNs at PSA of 0.25

[Justfor_ in reply to MateoBeach]

Silly doctors parot silly hard cut-off values. 0.2 is an administratively endorsed round, hence easy to remember, number and nothing else. Hopefully, mother nature functions in a analog and not in a binary manner. There is a recent post here confirming a positive detection at 0.12.

[rscic in reply to Justfor_]

Always exceptions but these cut-offs are there for a reason.

Just my opinion.

[Justfor_ in reply to rscic]

If someone told you that keeping the road speed limits you will be certainly safe and on the other hand if you violated them you would had an accident, how would you judge him. A lawful burocrat or a knowledgeable scientist?

[rscic in reply to Justfor_]

Given the statement, ".... keeping the road speed limits you will be certainly safe and on the other hand if you violated them you would had (have) an accident ....", is untrue & I would classify the individual who made this statement as ill informed on this subject .... whether they are a bureaucrat or not is a question which requires more information .... they might be or maybe not.

Medical criteria in imaging are there for a reason. Without criteria being met, the chances the imaging will reveal anything are quite low (almost nothing is zero in medicine). Sometimes, even if adverse signs are not seen (like a fall in an elderly person especially with head impact, but without symptoms) imaging (a Head CT for example) is considered necessary to avoid missing a subclinical injury. These criteria are usually well thought out. PSMA scanning is relatively new & while some general criteria are in place based on what we know now (data we have now), these criteria might change over time.

BTW, given the statement, ".... keeping the road speed limits you will be certainly safe and on the other hand if you violated them you would had (have) an accident ....", were true, I would say the individual making the statement might be a scientist, a bureaucrat or a combination of these 2 depending on how they came to utter this statement.

IMO it can be complicated. There will always be exceptions where findings will be made even though the patient does not meet criteria. However, these situations are exceptions to the general rule.

Just some thoughts.

[Justfor_ in reply to rscic]

They are exactly the same thing. No doubt that the higher the driving speed the higher the probability for a traffic accident and more importantly the severity of it. It is in general a monotonously upgoing function with other parameters underlying (driving conditions, driver's experience and state of mind, etc). Trying to slice it into two ranges by setting speed limits is only useful for administrative reasons. A sane and seasoned driver can adjust his speed better than looking out for the numbers on the road sign. Silly drivers just follow the signs. Substitute doctors for drivers and you get the wider picture.

[rscic in reply to Justfor_]

There is no doubt there are some Doc's which just follow the guidelines without knowing the reasoning behind them and thereby might not be as alert to the possible exceptions. However, these Doc's are not (at least by & large) the Doc's who set the guidelines.

[Justfor_ in reply to rscic]

Guidelines are the safe harbour for mediocre professionals in any field. Imagine an architect that designs only by the building code. For the currently ongoing pandemic there were no guidlines. They had to be invented on the spot and not undergo the usual 10 years of maturation period. This tell us that when in need people put their gray cells in action.

[rscic in reply to Justfor_]

"..... Imagine an architect that designs only by the building code. ....."

---probably a safe building without special features at a reasonable price (though the cost may be variable) ... likely what many want .... they hire an architect to avoid trouble. Now this type of Architect will now give you much in the way of design. Makes one wonder why they hired them.

Guidelines in medicine are often largely data driven. This does not mean they can't be wrong only that they are unlikely to be wrong & if wrong are most likely exceptions or the data is changing for some reason or maybe there is now more complete vs the original data, etc.

There are nearly always exceptions with any general rule in medicine for various reasons.

Whether the current PSMA guidelines are good one's only time will tell. For now they are what we have & as near as I can tell are based on what we know.

I agree there will always be some in any profession who hide behind the guidelines.

[Justfor_ in reply to rscic]

Your last paragraph finds us in perfect agreement.

[rscic in reply to MateoBeach]

Thanks for this info.

[HopingForTheBest1]

After having searched for a PSMA clinical trial for several months, I was able to get in to one at Stony Brook University Hospital in Long Island, NY. A 2 1/2 hour drive from my home in NJ. No out of pocket cost; fully covered by the trial.

[jjpeabody]

I had PSMA at UCLA with a PSA of 0.12 on 2/9/21. 1000 mile round trip, no problems. I paid for it myself and don't expect insurance to pay anything. I felt it was worth it to pay from my savings, while not a large savings account i was interested to see what it could do and haven't given it a second thought. I mainly wanted to see what it could detect and to contribute to my treatment plan decisions. See doc Monday but have seen report and it states no distant metastasis and focal tumor, I can feel some chronic discomfort, in bed at baldder... I will start back on casodex Monday followed by lupron and maybe zytiga depending on whether I will do ADT + SRT or ADT only for treatment plan. I am 70 with mild incontinence and expect 10 years hopefully, QOL important to me. Already 2 pads for 2 years and you are aware of it daily, if SRT worsens then really have to think twice. Insurance should cover PSMA within next 6 months i imagine. Best of luck, Jim

[j-o-h-n]

Hello Lou,

Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 02/21/2021 10:05 PM EST

[Schwah]

FYI, because the PSMA scan has now been approved by the FDA, insurance will start to pay for it. I am having a scan at UCLA tomorrow and I am in the process of fighting with my insurance company to pay for it. My MO needs to contact their peer to peer review company to make A final determination. Definitely worth a try. By the way the people at ucla have been very helpful in this regards.

Schwah