So... I've completed my Docetaxel course and had my follow up tests. But the interesting thing to me is that these tests are looking for Osseous Metastasis as defined in the reports.
So, in my mind, tests should be done to check and see any differentiation from pretreatment to post treatment, especially if suspect lesions or hot spots were identified. Does this make sense?
In line with the thought of not waiting for failure, ie, PSA rise for more sensitive testing. CT imaging and bone scan was done... What about MRI? Or more sensitive tests too. What would be the justification in conversation with the MO for those tests proactively being done NOW, rather than later? And would there be benefit to introducing choline or fluciclovine tests after or as an aside to the PSMA test?
Thoughts?
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Cooolone
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Personally, I would want to add a Pylarify PSMA PET scan as this is more sensitive and would show if mets have high PSMA expression. This would have treatment implications with Lu-PSMA ligands either in or out of trials. Unfortunately approval for Lu-PSMA-68, expected later this year, will be limited to mCRPC. So that means going abroad for it if a trial doesn’t fit. Congratulations on completing docetaxel. Stay Coool.
You had a baseline bone scan/CT, right? The radiologist will report changes from thee previous scan. That's why you don't want to change scans mid-stream - is the change because the treatment failed or because the new type of scan is more sensitive?
Yes, base line 2 years ago, last year and just now, post Chemo. Had conversation with MO to review value of comparative scanning between pre-treatment and post-treatment tests. I want to "see" if, and what, the effect of therapy was.
Newest Scans came back clean, no Osseous Metastasis. But like I mentioned, what about soft tissue? My scans post RP (2018) and last year, both noted some suspicious area near SV & Bladder where +margins were. Confirmed in PSMA scan as well. So I want to see if this has been affected now after +6 months of ADT and Docetaxel.
If not, then whether or not there's benefit to zapping or removing any lesions there (local). I know typically once Stg.IV, this is moved on from with systemic therapy, but I'm ok to whack the mole idea, lol, if it pops its head up. Point is being proactive, not waiting for failure and PSA climb prior to additional scanning and addressing anything that appears or is remnant.
We did discuss, and I acknowledge, that this may not have any effect on progression or OS! But in my mind, if it's there, I want to zap, cut, burn, freeze, starve it, kill it! Hahahaha
There are two parts to the bone scan/CT. One is the bone scan, which picks up bone issues. The other is the CT, which picks up soft tissue issues.
There are many more metastases that are too small to see with any kind of imaging. That's why no one thinks it's a good idea to play whack-a-mole when there are multiple metastases. Systemic therapy is a proven solution.
Makes sense, and yes, once metastasis is present, we don't know where those little seeds might have planted themselves! So far my nodes have been clear. But had mets in Peritoneal and Appendix.
Like I mention, there was suspicious areas at the margin where SV were and Bladder/Prostate all conjoined. So my concern is if left there, will it grow, spread, seed from there?
Hahaha, my apologies, I'm like an old record player sometimes, I get stuck on something and keep repeating my thoughts. Can't shake it out, and is probably why I was ok with and did the RP as primary treatment, even knowing I would recur at some point based upon my diagnosis and evidence of adverse features. I just want it all "out"...
Thank you TA for your continual insight and responses.
Metastases spread from micromets (which you can't see), detectable metastases, and from any left in the prostate area. When you had a prostatectomy, they completely removed your seminal vesicles, so that is no longer an issue, but the cancer remnant at the bladder neck may still be a source. It's an area you want to be very careful about irradiating because of the possibility of urinary side effects.
I like to be proactive and I am scanned only with PSMA PET/CT. Bone scan and CT scan have a significant lower detection rate than PSMA PET/CT. Depending on the PSA values they can miss 60% or more of the lesions. If you have a PSMA PET/CT and there are still mets after your treatment you could discuss doing a different treatment to try to reduce the tumor load and not wait until they show in a CT or bone scan.
Thank you, and yes, I'm aware of the efficacy of PSMA scanning. I've had 2 so far. But typically this scan isn't going to be offered unless the PSA climbs to a point that allows it to work, or upon recurrence, (one and the same). We all know this threshold is at least .5ng+ PSA.
My issue, or point is to not wait until then (failure and PSA rise). My PSA is <.05ng, so undetectable! They aren't going to do a PSMA for the purpose of "just because". But to do some sort of scanning that isn't typically done. Like an MRI, etc., to see what has happened from treatment. I'm really surprised how PSA is the driving mechanism for advanced disease as well.
I would venture into using a different contrast agent if in fact my PCa was shown to be PSMA naive, but it's not. Like most things we come across while walking this path, it's all a conundrum!
Cooolone, you write that PSMA is not offered unless Psa climbs to a point that allows it to work. I had undetectable PSA yet a PSMA scan confirmed a met.
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They aren't going to do a PSMA for the purpose of "just because". But to do some sort of scanning that isn't typically done. Like an MRI, etc., to see what has happened from treatment. I'm really surprised how PSA is the driving mechanism for advanced disease as well. 
Docetaxel 
Docetaxel or Erleada.
Ultrasensitive PSA tests in US, how low to they go?
Memory loss with Docetaxel
