Pylarify PET/CT, How Much Sooner Does It Give You Intelligence on Mets?

So this new scan, Pylarify PET/CT, how much sooner does it give you intelligence on mets?

So for example compared to existing scans do you become aware of mets a month sooner? A year sooner? 5 years sooner?

[bean1008]

Sounds like you need a PSA of at least .5 for the scan to be effective.

[GP24]

It depends how fast your mets grow. This depends on the Gleason score among other factors. My estimate is that on the average you will see small bone mets about 12-18 months before they appear on a bone scan.

All studies the guidelines refer to are done with a bone scan and do not apply to the results of a Pylarify PET/CT. However, most doctors will treat you as metastatic when bone mets appear on a Pylarify PET/CT.

Could be a problem for the nmCRPC drugs like Darolutamide. The guidelines and the insurances have to decide that you can get this drug when you have no mets on a bone scan but many bone mets and positive nodes on a Pylarify PET/CT.

[kainasar in reply to GP24]

FYI duckduckgo.com/?q=pylarify+...

[kainasar]

FYI duckduckgo.com/?q=pylarify+...

[tango65]

The detection rate of 18F DCFPyl PET/CT is around 47% if the PSA is less than 0.5 and around 90% with a PSA greater than 0.5.

frontiersin.org/articles/10...

Detection rate

[Schwah in reply to tango65]

What’s the thinking of which is better at detecting mets , Ga 68 PSMA-11, or this 18F DCFPyl PET/CT?

Schwah

[xpbdb in reply to Schwah]

I would like to get the Pyl PET scan but the isotope is not yet available in Northern California where I live. My PSA went from 1.1 to 1.9 in the last month after just a gradual rise over the last year, so something is going on. I am going to ask my MO to order the Ga-67 PSMA PET scan at UCSF where it is Medicare approved. I had one there 3 years ago and it found 4 lesions. Been on Lupron then Orgovyx and Xtandi since then. My testosterone has been <3. IThe accuracy and efficacy can’t be that different. I am sure the Pyl scan will become standard of care by 2022, but I can’t wait.

[tango65 in reply to Schwah]

18 F DCFPyl may be more sensitive than Ga 68 PSMA. There is only a head to head comparison which has been published.ncbi.nlm.nih.gov/pmc/articl...

[maley2711 in reply to tango65]

How do they determine what 100% means? Based on what? A others have pointed out, even with this advanced scanning, there are likely still many hidden metastases lurking, unfortunately.

[Justfor_ in reply to maley2711]

There is no 100% even at the most elevated PSA and/or PSADT values as there are lesions that are not PSMA avid. It tops to somewhere 94-96%.

[tango65 in reply to maley2711]

It is the detection rate, no sensitivity. It means they detected PSMA avid lesions in 47% of patients with PSA less than 0.5. With this PSA none of these patients will show any lesion in a conventional scan (CT and bone scan).

[maley2711 in reply to tango65]

Thanks fo the clarification...as that is all it could mean of course...no way of knowing how many actual sites a man has....many smaller than capability of even these better scans, and some not producing PSMA.

[tango65 in reply to maley2711]

They do not detect any lesion with PSMA which is less than 4 mm in diameter. The same happens with the Axumin scan, the Ga 68 PSMA PET/Ct, 11C Choline PET/CT etc. . It is related to minimal axial resolution of the regular PET/CT machines.

[Hidden]

Thanks. Does anyone believe this will change SOC for recurrent men?

[Dont08759 in reply to Hidden]

SOC?

[Hidden in reply to Dont08759]

Standard of care.

[Dont08759 in reply to Hidden]

Thank you! I went on a medical abbreviation site and the best they could do was Short of Breath...

[Hidden in reply to Dont08759]

I was on my phone, and definitely was lazy not spelling it out.

[bean1008 in reply to Hidden]

Absolutely! I had a Gallium68 scan at UCLA last October 31st. A bone met was found on my hip and two tiny spots on lymph nodes. I immediately started on Lupron, Zytiga and prednisone in late November. My PSA dropped from 2.5 to undetectable within two months.

[Jvaughan0 in reply to bean1008]

I am waiting for an advanced scan as well. My PSA went from undetectable for three years last December to .3 now. My MO at Duke wants my level to reach .5 first. I wonder what is the advantage of waiting if treatment is going to be ADT anyway? Is there any benefit of SABR when the cancer cells are already mestastic?

[Fightinghard in reply to Jvaughan0]

Dont rush the ADT. I would let the PSA drift up to about 1.0 before hitting it with additional ADT.

Why? The still very low PSA indicates low risk of further metastasis, and the ADT will likely eventually stop working for you.

Best is to consider the months before restarting the ADT as “free time” to enjoy without side effects

Just my opinion - sounds like your MO is being conservative.

[Jvaughan0 in reply to Fightinghard]

Your opinion seems reasonable and is appreciated. It is the opinion I'm trying to make peace with, but I'm often a confused moderate in a world that has gone to insane extremes.

[Hidden in reply to Jvaughan0]

When my time comes, if they are easily reachable I will have them zapped. Maybe it buys time before adt starts. Maybe it will boost my natural defenses against pca.

[Jvaughan0 in reply to Hidden]

Makes sense... sometimes "maybe" is all we have. It let's us live to fight another day.

[Spyder54]

Absolutely !!! They will now run you thru the scanner and if they see new Mets, hit them with SABR, and you should see PSA drop back down. If it rises again, run u thru the scanner again. Takes the guessing of where the hidden Mets are located.

[cesces in reply to Spyder54]

That will just get the larger mets.

When you get that far you need systemic treatment.

[Spyder54 in reply to cesces]

“Abscopel Effect” is real! If you remove the major Mets, you give your immune system a fighting chance against the Micro Mets. Dr Kwon of Mayo has several Youtube videos from as far back as 2014 using the older scanners (C-11 scanner) with Oligometastatic patients and getting them to undetectable w no ADT.

[cesces in reply to Spyder54]

Why not use belt and suspenders

[Cooolone]

I'm beginning to think many short step things and don't bother to actually read these studies and their results...

This contrasting agent is not BETTER at detecting PCa in the sense it is "more" sensitive. There has been NO DIRECT comparison performed as the DCFpyl and G68 agents were used at different amounts and scanned at different dwell times. The "CONCLUSION" in the study clearly states it is a comparable "ALTERNATIVE" to G68-PSMA... Meaning it is as good, nowhere does it claim to be superior in detection head to head.

Where the BETTER chimes in is in the fact that the contrasting agent when produced can be made in larger batches that are stable for longer periods of time in consideration to the G68-PSMA agent. This will be better for patients because it will allow the expanded availability and therefore use.

I think it important to understand this...

Best Regards