Head-to-Head Comparison of 68Ga-Prostate-Specific Membrane Antigen PET/CT and Ferumoxtran-10–Enhanced MRI for the Diagnosis of Lymph Node Me

[Seasid]

jnm.snmjournals.org/content...

I found this article. What do you think about this?

[Tall_Allen]

If you want to go to Nijmegen to detect many more of your LN metastases for some reason, Radboud U is the best. You should also be aware that NaF(18) is better at detecting bone metastases than PSMA PET. The question to be answered is what is the benefit of detecting more metastases in patients in whom some have already been detected?

[cesces in reply to Tall_Allen]

"You should also be aware that NaF(18) is better at detecting bone metastases than PSMA PET. "

I thought psma pet was the best scan out there.

It NaF(18) is better, under what circumstances would you choose a psma scan?

[Tall_Allen in reply to cesces]

PSMA is the best overall, but Combidex MRI is better at detecting lymph nodes, and Na F is better at bone metastases.. But for some purposes (such as deciding whether you are a candidate for debulking, or if you are tracking progression) a bone scan/CT may be preferable. If your PCa has been around a long time, FDG may be best. So if you don't know which you have, PSMA is your best choice, sometimes along with one of the others.

Whichever you get, remember you aren't seeing everything.

[Schwah in reply to Tall_Allen]

TA, I know you don’t make definitive statements unless you have strong clinical evidence to support. Can you please provide a link to the study that proved to you that the “NaF(18) is better at detecting bone metastases than PSMA PET”? And if so “better” to what degree? Thx

Schwah

[Tall_Allen in reply to Schwah]

Sure. NaF was twice as sensitive. In fact, I discussed this with Andrei Iagaru for a video that Darryl will release in December as part of his Malecare series.

jnm.snmjournals.org/content...

In men with bone metastases:

54% of all bone metastases were detected only by NaF

37% of all bone metastases were detected by NaF and by DCFPyL

9% of all bone metastases were detected only by DCFPyL

So 91% of all bone metastases were detected by NaF vs 46% by the PSMA PET scan.

It's a shame that CMS decided that Medicare would no longer cover NaF PET scans. Fortunately, they aren't nearly as expensive as any of the PSMA PET scans.

[Bkraus1]

Sounds like a helpful study especially in staging patients at diagnosis. Could be helpful for surgeon to remove suspicious lymph nodes rather than random lymph node dissection which is currently done.

[tango65]

Thanks for posting this article. I think it is very important for staging correctly the patients and even for deciding and planning treatment in BCR and during initial treatment.

[GP24]

It is possible that nano-MRI detects more false positives than a PSMA PET/CT. This could explain why it detected more lymph node mets.

[cigafred in reply to GP24]

I had the nano-MRI and do not think there is much problem with false positives, though it has been years since I researched this

[GreenStreet in reply to GP24]

My experience is that it was better at detecting in the lymph nodes. At Radboud University a PSMA scan “detected” an equivocal node at a PSA of 0.11. The combidex scan the next day pin pointed the same area and another as highly suspicious ( 4 out of a 5 rating) . RMH could not read the equivocal node although it is used to doing PSMA scans. After my PSA doubled to 0.22 I had a PSMA scan at RMH and it detected something in the same place that had been picked out by Combidex earlier. I think it is important to have someone very skilled to interpret the imaging. Radboud does a 5 point scale with 5 being nailed on and 4 being highly suspicious and 3 equivocal. Nothing is going to be 100% perfect though I agree.

[j-o-h-n]

Greetings Sid,

Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

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THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/29/2021 6:19 PM EST

[Seasid]

clinicaltrials.gov/ct2/show...

Clinical trial with the nano MRI