MY PSA is 2.3 but both bone scan and CT scan show negative findings - doctor recommends i get a PSMA PET scan - thoughts?

[coachmark]

Hello - I had my prostate removed in 2010 due to discovery of prostate cancer - stage 3. For the next 9 years my PSA under 1 - IN 2019 PSA was 1.0

Now this year (August, 2021) my PSA shows 2.3. My Urologist thinks its recurrence of PC - so he had me take a bone scan and a CT scan. Both came back Negative. Now a different Urologist wants me to take a PSMA PET scan. He mentioned radiation treatments as a possible treatment should the PSMA PET scan disclosed anything. He also mentioned Hormone injection IF its worse than expected. I have read and been told by many people that there is also the possibility the 2.3 PSA is NOT a reflection of prostate cancer and could be from a bladder infection etc. IM going in for a urine test next week. Anyone have any thoughts on this? Many thanks.

[tango65]

Since you do not have prostate, the PSA may not be coming from a bladder infection and associated prostatitis.

I believe a PSMA PET/CT is a great idea. Bone scan and CT scans are notorious for the false negatives when compare with the PSMA PET/CTs.

The PSMA PET/CT may show where the PSMA is coming which could be from limph nodes in the pelvis and the correct treatment may be curative.

It may also show distant metastases which may require systemic treatment. IMO bone scan and CT scans are studies from the past and it should not be used to stage a patient with BCR.

[coachmark in reply to tango65]

I got the PET scan results and - they came back Negative! No cancer was found. What could all of this mean? I have NO idea. Thanks

[tango65 in reply to coachmark]

It may mean the cancer has lesions which are smaller than 4 mm and they can not be detected by the current PSMA PET/CTs,

[Tall_Allen]

"I have read and been told by many people that there is also the possibility the 2.3 PSA is NOT a reflection of prostate cancer and could be from a bladder infection etc. " They are wrong. The prostate and prostate metastases are the only significant sources of PSA. UTIs only increase PSA when there is a prostate - yours was surgically removed.

Get a PSMA PET scan.

[cesces in reply to Tall_Allen]

If it has metastasized, do you really need the pmsa scan to move on to treatment?

At least not until you see some real doubling rates. It's not like you are going to be using localized treatments?

And if you do a pmsa scan, isn't there a non-pmsa scan you should do as well. Called FUG scan or similar?

[Don_1213 in reply to cesces]

I'm not TA - but I'd have to question where it might be treated? Are you talking ADT or systemic treatment? If you can't see it with the current tests that have been done it would be awfully hard to target it for radiation. And he has doubled PSA - in 2 years from under 1 to 2.3. For a guy without a prostate that's actually a significant number, and one where treatment is usually indicated.

[Tall_Allen in reply to Don_1213]

The purpose is not for targeting, the purpose is to rule out distant metastases. If it shows cancer within the prostate bed or pelvic lymph nodes, but none apart from that, they can receive a little extra dose.

[Tall_Allen in reply to cesces]

The PSMA PET scan (or Axumin) is necessary to rule out distant metastases. If there are distant metastases, there is no point in undergoing salvage radiation.

[Kittenlover50 in reply to Tall_Allen]

Or c11 Choline that Mayo in Rochester has had for over 7 years. It is also at two other facilities, one in Decatur IL and one out East. Definitely found husbands distant lymph Mets andcwas uded to direct treatment. They also have the PSMA.

[Tall_Allen in reply to Kittenlover50]

It is inferior (lower sensitivity) than either PSMA or Axumin. I don't see a role for it, although Mayo will no doubt keep pushing it to recoup its investment.

[Don_1213]

I think you got great advice in the previous comments. I can't see a reason for not doing a PSMA PET/CT.

At best it shows nothing and you'll be relieved and can go back to monitoring your PSA. There may still be some recurrent PCA but it's not going to kill you right now. At worst - it will show where some PCA has recurred and it can be treated before it gets out of control. I don't see a downside unless your insurance won't pay for it.

I'd stick with the urologist who suggested the scan. I think he's forward-looking and concerned for your health.

[coachmark in reply to Don_1213]

Many thanks Don - im going to do what the new Urologist suggested - and that is get the PET scan - etc = im waiting for Kaiser to call me to schedule it - (they recently went on strike so it might take extra time for them to schedule it) Im kind of fortunate in that the new Urologist i have is also the same doctor who operated on me 10 years and removed my prostate. (I think that is a good thing?) LOL - Maybe not? He was cool and actually apologized to me and told me IF he missed taking out all of the cancer 10 years ago - he was sorry) Also - no problem with insurance paying for it - I have Kaiser Senior Advantage - they handle it)

[maley2711 in reply to coachmark]

As I'm with Kaiser, does your Kaiser region now offer PSMA PET? Or Axumin scan? Now aware that they are available here in the NW region. Perhaps Kaiser will refer you out to another institution for such a scan?

[coachmark in reply to maley2711]

Honestly - i "assume" they have it - why else would my Urologist tell me i need PET scan? Im assuming they have it - if i dont hear from them this coming week i will call them for follow-up. Thanks

[dockam in reply to coachmark]

Hi, when I was down in Orange County, CA, Kaiser had did several Axumin scans and it was in a huge trailer in the back of the East Anaheim Kaiser megacomplex.Had another Axumin scan post Docetaxel rechallenge and this was done via Kern Radiology in Bakersfield, CA.

Possibly Kaiser has a contracted Radiology group that does it in your area.

My best to you Brother

Randy

[maley2711 in reply to coachmark]

Thanks......which is your Kaiser region in Ca?

[coachmark in reply to maley2711]

Hey Maley - FYI - in answer to your comments and quesions regarding whether or not Kaiser does offer a PMSA PET scan - etc - they utilize a Mobile Unit -- where they bring in a mobile unit 2 times a week. Thats what ill be using.

[maley2711 in reply to coachmark]

Thanks Coach!

[j-o-h-n]

"I'm kind of fortunate in that the new Urologist i have is also the same doctor who operated on me 10 years and removed my prostate."

I think you're entitled to a rebate.....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/14/2021 12:36 PM DST

[Manilo]

I had 0.25 PSA from 0.05 the year before.PET CT PSMA showed 2 tiny bone mets that don't show in other studies.

And some PSMA also in the prostate bed.

I went to 177Lu in July one cycle with 8 mBq

PSA is stable and will do another PET CT PSMA in Jan.

Then decide if another Lu177 cycle and/or SBRT to those sites

[coachmark in reply to Manilo]

Thanks

[coachmark in reply to Manilo]

I have a dumb question - my PSA is 2.3 - is that the same as 0.23? Or is 2.3 much higher than 0.23? Thanks

[Manilo in reply to coachmark]

Above 2, doctors will do PET TC etc SBRT...

At 0.2 it has been me insisting on doing things

It is my believe that doing something as soon as possible, it is better

[Manilo in reply to coachmark]

No number is high or low.

I had 0.05 last year.

0.2 is x4 , so I worried about it before it is x40

[Kittenlover50]

Yes, get the Pet scan. Before Bill had surg his MRI was neg. however found in pelvic lymphs at surg.. PSA didn’t go below 3 after. Went to Mayo in Rochester where c11 choline pet found in lymph in chest area. This was 6 years ago. They now have the PSMA and have for a few years, under research and but continue to use both. Your PSA is high enough where it should show up with accuracy. Go for it.

[coachmark in reply to Kittenlover50]

Many thanks - im waiting for the PET scan to be scheduled at Kaiser - God Bless You!

[Seasid]

You can't find micromeths with the pet scan. The safest way is start with firmagon injections (ADT) and in 2 months when you are deeply castrated start with docetaxel chemotherapy. 6 cycles. Then you can think about the rest.