PET scans

[Roscoaus2000]

My psa has slowly risen from 0.001 to 0.10 over a 2 year period on Zytiga, Prednisolone and quarterly Zoladex and Denosamab injections. I have a good Qol, no side effects, sleep soundly 7 hrs a night. Am 81yo and reasonably active. Some Lowe back pain and stiffness but don’t need painkillers. Onc. Says now psa is 0.1 a pet scan may be worthwhile to see if there is limited cancer that could be zapped with R/T. 5 years ago my psa was 9000 and whole body scan showed Mets in every bone. I was in major pain and had no bladder control. Do you think it is possible I may now only have a few treatable Mets? Onc has given me choice. I am sceptical of chances and wonder whether the side effects of R/T would make it worthwhile. My overall health is excellent, BP, sugar, chol. Trygl. And liver are all well within normal range. I may live another 10 years and ultimately have bone pains from the prostate cancer. Do any of our elderly cohorts have experience of becoming disabled by advancing Mets. I have until mid January to make up my mind.

[Schwah]

You should do a PSMA scan. Much more sensitive to locate any mets. Zap them With SBRT if they are in a safe location and continue with systemic treatment. At least do the scan and then make an informed decision. I did The SBRT twice to 4 mets zero dude affects

Schwah

[Tall_Allen]

I can't imagine what you hope to gain by a PSMA PET scan now. You already know you have metastases in every bone. You can certainly zap any metastases that are painful. You may get better survival by using Xofigo now, if your oncologist can convince your insurance company that you are becoming castration resistant.

[Roscoaus2000 in reply to Tall_Allen]

Thank you. I agree about the mestasteses. I said that to Oncologist. He said there was a chance that the majority may have been resolved and there are only a few causing pain.I looked at Xofigo information sheet and am concerned that the side effects may be worse than doing nothing. The pain I have now is tolerable without painkillers. I think my general health is good enough for me to live many more years but am unsure of progress of cancer pain.

Xofigo is not covered by Australia’s Medicare system and I doubt I could afford the cost.

How does one die from Prostate cancer? Is it due to it spreading into the organs. There was no indication of spread there and minor indication in the lymph nodes which resolved within 4 months of hormone treatment.

[Tall_Allen in reply to Roscoaus2000]

In Australia, youu should be able to get Lu177PSMA617. I know Peter Mac in Melbourne has several excellent trials.

PCa doesn't have to invade organs to be deadly.

[Magnus1964]

Your doing ok. If bone mets are your primary worry have a bone scan. There are other ADT drugs to go to if zytiga is failing.

[tango65]

With a PSA of 0.1 most scans will not show anything. If you decide to do one , it shoul be a PSMA PET/CT (Ga 68 or Pylarify) which are the ones with the highest detection rate and they are covered by Medicare. The detection rate with a PSA of 0.1 may be less than 30%. The doctors I consult with in Germany advises me to do these scans with a PSA around 0.5.

Since your PSA is going up when in abiraterone the cancer is becoming castration resistant. You could discuss having Provenge , a vaccine covered by Medicare which has shown to offer a survival advantage.

If you do the PSMA PET/CT and there are mets you could consider getting Lu 177 PSMA treatment abroad, if financially possible. It is available in many places in Europe and India. It is a systemic treatment which offers a survival advantage . Side effects are usually low unless there is diffuse bone marrow infiltration by the cancer.

[hansjd in reply to tango65]

Unfortunately in Australia, Provenge is neither covered by Medicare nor available, however, Lu 177 PSMA is available at a cost of about A$10,000 a treatment. There are currently some trials with Lu 177 but these are limited.

[Roscoaus2000]

Thanks everyone for your comments. I do not need to do anything yet. I am seeking information on the likely progression if I do not have any fu have any additional treatment. At 81 I can accept dying. However, I would like to know the likely steps. Is there any literature describing experiences?

[j-o-h-n]

At 81 find yourself a Sheila and enjoy yourself............

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 10/21/2021 6:36 PM DST

[Roscoaus2000 in reply to j-o-h-n]

Thanks J-O-H-N. Fortunately that’s one thing I do have. Over 60 years now. I am very grateful for my life. Had I got into the System, as recommended 16 years ago, would have had a prostatectomy then and no more sex life. Instead I had a good 10 years with no symptoms, I then had a poor 9 months between being diagnosed with psa 9000 and successful adt and chemical castration. I had minimal side effects to Casodex and none with Zytiga. It is my Onc. Who is urging pet scan. I am not convinced and am seeking information of what progression will be like. I can’t find any literature on progression to end point.

[Seasid in reply to Roscoaus2000]

As tango65 said at your low PSA most probably no scan will find anything. You could still do the nuclear medicine bone scan and an MRI of your spine and pelvis in order to exclude bone marrow infiltration of your cancer and to make sure that your cancer didn't turn into low PSA producing cancer (what I doubt because of your initial PSA of 7000. The above scans should be covered by Medicare so you could live the money to your wife.

ChatGPT said about how to request the MRI in order to exclude bone marrow involvement.:

You could approach your oncologist with a clear, logical case for an MRI of the spine (or spine & pelvis) by emphasizing its clinical benefits while acknowledging their existing recommendations. Here’s a structured way to frame your discussion:

---

1. Acknowledge Their Plan

"I understand that you're recommending a full-body CT scan and a nuclear medicine bone scan. I appreciate that these are standard for monitoring metastatic prostate cancer."

2. Explain Why MRI is Important for You

"However, since I’m specifically interested in detecting early bone marrow involvement, I believe an MRI of the spine and pelvis (or at least the spine) would provide better sensitivity than a bone scan or CT."

3. Provide Supporting Evidence

MRI detects marrow involvement earlier than bone scans and CT, before lesions become visible.

Spine and pelvis are the most common sites of bone metastases, making a targeted MRI a practical and efficient alternative to whole-body MRI.

PSMA PET-CT is excellent for detecting lesions, but MRI is better for early marrow changes that PET might miss.

4. Offer a Compromise

"I understand whole-body MRI may not be feasible, so I’d be happy with a spine MRI as a targeted, time-efficient alternative. If possible, including diffusion-weighted imaging (DWI) would improve sensitivity."

5. Address Hospital Concerns

"I know MRI slots are limited, but a spine MRI is much quicker than a full-body scan and would provide valuable information to guide my treatment."

---

Additional Approach (If Needed)

If your oncologist is hesitant, you can ask:

“Would adding a spine MRI change my treatment decisions if it detects early marrow involvement?”

“If I develop bone marrow progression, wouldn’t it be better to detect it earlier with MRI?”

This makes them think in terms of clinical benefit rather than just protocol.

Would you like me to tweak this for your specific situation or concerns?

ChatGPT said

[j-o-h-n]

Well good going with her for another 60 years, lucky man.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 10/21/2021 7:05 PM DST