Imaging

[billd50]

2 Questions about PET PSMA

Are the results of Gal68 PET better/worse/same than the newly approved Pylarify?

Are either reimbursable under Medicare?

Thanks,

[Tall_Allen]

Pylarify is slightly better:

jnm.snmjournals.org/content...

I heard that Lantheus has started to roll out distribution of Pylarify.

I don't think Medicare has yet agreed to reimburse either. I expect they will eventually reimburse both for recurrent and high risk patients. Let me know if you hear different.

[Pcnmyy in reply to Tall_Allen]

Hello TA, will Pylarify detect PC progression for PSA <0.1? If not, what is the best scan to closely monitor the beast for low PSA values? Thanks.

[Tall_Allen in reply to Pcnmyy]

no it wom"t. There are no imaging that can detect that.

[TJGuy in reply to Tall_Allen]

Tall AllenIn the case of PC which is not putting out PSA. What scans would be effective. Wouldn't a eyes to thighs Choline scan be able to detect such a cancer?

Or possibly MRI in the pelvic region as well?

[Tall_Allen in reply to TJGuy]

I'd start with FDG - if not, maybe Axumin or PSMA

[Pcnmyy in reply to Tall_Allen]

TA, then how would one determine when to start a vacation from ADT? Thanks.

[Tall_Allen in reply to Pcnmyy]

When you feel you need a break from the side effects.

[tango65]

DCFPYL is approved and the Ga 68 PSMA can be done at UCLA and UCSF only. My information is that they are not covered by insurances so far. It seems DCPYL may have a better detection rate a low PSA values (<1) than Ga 68 PSMA. There are not studies I know of comparing one technique with the other at different PSA values in the same patients.

[Dont08759 in reply to tango65]

I am not sure if it is the same, but I had a F18 Pet Scan at NYU two years ago as part of a focal prostate cryo ablation study two years ago. The study picked up the cost and my results we negative for metz…

[Hawk56 in reply to tango65]

cancernetwork.com/view/fda-...

As to when Medicare and other insurance will include it in coverage, I can't say, perhaps when the NCCN guidelines are updated to include it. In my last consult with my urologist we talked about it, he said as a practice they were discussing how to incorporate it into their clinical practice given FDA approval.

[Zorro4]

I have had both Gallium 68 and Pylarify PSMA Pet scans. The results were exactly the same. They are both excellent , outstanding in their ability to find mets with low PSA levels. I had the second scan to confirm a prostate met that was in very risky of an area to biopsy. They would not radiate without confirmation. So rather risk the biopsy a second prostate specific scan PSMA did the trick. As far as procedure exactly the same, as far as side effects NONE. I must note that Pylarify is a lower dose and actually takes a little shorter time in the scanner.

Hope this helps. - August 30, 2021