Scans

[6357axbz]

Does a PSMA GA68 Pet-CT scan accomplish everything traditional Bone and CT scans do or do the bone and CT scans provide info you don’t get from the PSMA scan? In other words if you get a PSMA scan is there any added benefit of getting the other two?

[Tall_Allen]

A PSMA PET scan completely replaces the bone scan. You have a CT scan with both of them.

[6357axbz in reply to Tall_Allen]

Thank-you

[6357axbz in reply to Tall_Allen]

I suppose the one thing the traditional scans offer that PSMA doesn’t is that they give a read of your metastases when your PSA is very low or undetectable..

[Tall_Allen in reply to 6357axbz]

The opposite. A bone scan detects nothing with a PSA below 10 (usually not below 20) or without a rapid PSADT.

[6357axbz in reply to Tall_Allen]

Why do you suppose MDA give me, and others here, bone and ct scans while PSA is undetectable?

[Tall_Allen in reply to 6357axbz]

Part of a trial?

[6357axbz in reply to Tall_Allen]

I think perhaps while bone scan can’t detect cancer it does detect “discontinuities”, for lack of a better word, in the bone structure. If subsequent scans show that area getting smaller with continued ADT then it’s cancer.

[Concerned-wife in reply to 6357axbz]

We have wondered the same thing. I think these are still included some national guidelines. Doctors might be worried about lawsuits if they don’t do them. They might also feel they reassure patients.

Thanks for asking the question. We had the same one and have researched it to be able to “ just say No”, “ thanks. “

[TJGuy in reply to 6357axbz]

What nuclear medicine scans are available at MDA?

[6357axbz in reply to TJGuy]

If your referring to PSMA scans none. They’re expecting to be online with the GA68 PSMA scan in November.

[TJGuy in reply to 6357axbz]

Wondering if they might offer Axumin, or Choline scans?

[cesces in reply to Tall_Allen]

Tall_Allen

What about the fdg scan to catch the types of prostate cancer that don't respond to psma?

[Tall_Allen in reply to cesces]

I'm not sure what you're asking. Yes, FDG may sometimes pick up PC that does not express PSMA.

[cesanon in reply to Tall_Allen]

So the FDG scan will pick up prostate cancer that the PMSA scan will miss.

That's what I thought you were recommending at some time in the past. Coupling the FDG scan with the PMSA scan.

I was asking if that was still a valid approach, or not.

[Schwah]

I was told personally by Dr Czernin (head of nuclear medicine at ucla) that it made no sense to do any other imaging if I did the PSMA SCAN. He said the P SMA scan included a pet scan so I was covered. All of the clinical evidence today indicates that the PSMA scan sees cancers that are far smaller and far earlier than any other conventional scan. It was recently approved by the FDA so hopefully insurance will cover it soon. In the meantime it costs about $3000. About three weeks ago and saw a very tiny spot On L-5 that I will be getting treated with SBRT and possibly going back to systemic treatment. I was told by my oncologist Dr. Scholz and an oncologist at UCLA that I was probably seeing it at least 1 to 3 years earlier than I would’ve seen it with conventional imaging.

Schwah

[Justfor_ in reply to Schwah]

Your PSA at the time was?

[Schwah in reply to Justfor_]

My PSA was 4.9 but I am a bad example. Eight years ago I had a focal cryo-procedure leaving me with 60% of a rather large healthy Prostate. There is never been any sign of additional cancer in that prostate so the thinking is the “horse escaped the barn” before the procedure. However the negative with the focal procedure Is that I will always have some level of “normal” PSA without any new cancer. So since I started my “vacation“ 15 months ago I have done a PSMA test every six months to determine if there is a new cancer and I must end the vacation. The previous three PSMA tests were negative despite PSA levels of .01 to 3.9. This was the first one that saw any sign of potential cancer and they were only about 80% sure it was because it barely lit up.

Schwah

Schwah

[Hidden in reply to Schwah]

Did a dr schedule the Psma scan when you had a .01 psa. Was it because the cancer can grow at that low of a psa? Always wondered if I should get one after 2 years post radiation treatment.

[Schwah in reply to Hidden]

Actually I insisted at .02. My MO and Dr Czernin (UCLA head of nuclear medicine) both told me it was highly unlikely I’d find anything at that low PSA level. But I knew I was going to be using the PSMA scans to monitor the progress of my disease during my “vacation” because as I said my PSA was not a reliable indicator given my existing 60% of a healthy prostate. And I really wanted a baseline scan to compare future scans because I’d experienced false negatives and I thought having one to compare as a baseline would lessen any chance of a false negative. I’m very anal about this stuff. Lol

Schwah

[6357axbz in reply to Schwah]

I was just told by one of my MOs that even if you’ve had the PET PSMA CT scan, and even if you have undetectable PSA that it’s important to get periodic CT scans. That 20% of patients develop tumors that don’t express psma. Comparing subsequent scans can point to changes.

[Danish-patient]

With a CT scan you sort of need to know where in the body something has an unusual size. Then you can guess where the cancer might be located. With the PSMA PET/CT scan you will have light signals indicating exactly where the cancer is present, guiding you to look at the correct spots in the CT part of that scan.

[Hidden]

Good idea. Mine has never been that low but stays around .04. Mine was also pretty low at 4.2 when the tumor was out of the prostate. So I’d like to get one someday soon. Was it in California?

[rscic in reply to Hidden]

I think UCLA does PSMA ...... likely one of the San Francisco area Univ sites (maybe UCSF??? I know they have one of the best Radiology/Imaging training program @ UCSF & PSMA is a Nuclear Medicine study which is part of Radiology/Imaging) as well .... others will likely know more & with FDA approval PSMA is likely to expand to more sites. Even when insur pays for PSMA they are not likely to pay for it at a PSA of 0.04 so, you are likely on your own financially with PSMA.

Just some thoughts.

[6357axbz in reply to Hidden]

I received mine at UCLA prior to FDA approval. $2,800

[Tony666]

Psma pet scans give more information if you know you are metastatic. However, they also sometimes show false positives (other things besides cancer make psma) so you have to be careful using them at the beginning of the journey.

[MateoBeach]

If you wanted to use darolutamide, which is approved for non-metastatic CRPC, the bone and CT scans being negative are the accepted standard, even if the PSMA PET is positive (it may be ignored).

[Chazem in reply to MateoBeach]

Also approved for metastatic CSPC. Typically being used with Lupron or such.

[cesces]

Go listen to Dr Hope starting after about the first half hour of this youtube of the Online PCRI Video Update.

He explains everything about all types of scans, in a great deal of detail.

Listen to it three times and you will become an expert. I don't think there is anything he doesn't explain or any question he doesn't answer.

But there is so much there you might not absorb it in one session.

Really Really Really Good Online PCRI Video Update! ("2021 Moyad + Scholze MidYear Update")

Https://healthunlocked.com/advanced-prostate-cancer/posts/145799882/really-really-really-good-online-pcri-video-update-2021-moyad-scholze-midyear-update

[6357axbz in reply to cesces]

Thank-you cesces.

[6357axbz in reply to cesces]

Cesces, could you please provide a link that works? Thanks.

[Bethpage in reply to 6357axbz]

I'm obviously not cesces, but I looked it up when he mentioned. I think this will work. pcri.org/#welcome

[6357axbz in reply to Bethpage]

Thanks Bethpage!

[Bethpage in reply to Bethpage]

You're most welcome. I went looking because of you and now I'll benefit as well.

[6357axbz in reply to Bethpage]

Serendipity 😊

[brucesam in reply to 6357axbz]

You can also watch on YouTube (skip to 1:16:30 to see Dr. Hope):

youtu.be/mQzpdvLBeVM(Not working as expected?)

[6357axbz in reply to brucesam]

Great! Thanks brucesam

[6357axbz in reply to brucesam]

Worked perfectly. Thanks again bruce

[Chazem]

Dr Hope layed out all the imaging considerations. Ga68 PSMA are available at UCLA and UCSF. Mine at UCLA the same week Ga68 was approved was $3,300. They don't bill MC, but you can submit for the PET scan portion. Not sure when MC will get coding in place to cover the rest.

By summer Dr Hope expects many more sites will offer the PSMA once "kits for making Ga68 are approved".

[LastMohikan]

I had psma-ga68 when psa was 0.22(before SRT) but it could not catch nothing, this January my psa was 0.364 and had again psma-ga68 than it catched 1 point metastaz in my costa lateral. ıt was applied in Istanbul

[6357axbz in reply to LastMohikan]

It’s my understanding that one should have a minimum PSA of at least 0.5 to 1.0 for the scan to be effective.