SCANS WITH LOW PSA

[Christopherg]

Happy New Year

My question is:

Will a CT and BONE Scan show any Mets with a PSA of about .42

I have reacurrent prostate cancer and am on Firmigon

Thank you so much

Good health it you all

Chris

[StayingOptimistic]

A psma scan would be much better at this low psa.

[Shooter1]

My CT and bone scans with low PSA were negative. Na-Fl18 showed 2 new Mets they missed. Radiation Treatment took care of them. Better scans are needed with low PSA.

[Tall_Allen]

No. Not unless there is a very rapid PSADT.

[Shooter1 in reply to Tall_Allen]

Sadly my insurance insisted on them before okay to get a better scan with BCR.

[maley2711 in reply to Shooter1]

Thus subjecting the patient to additional radiation for little benefit??? and ultimately more, not less, cost for the insurer?

[Hidden in reply to Shooter1]

Same story here. Insurance insisted on CT and bone scans before they would allow the axumin scan I really wanted. The CT and bone scans showed nothing.

[Christopherg in reply to Tall_Allen]

My PSA has not gone to undetectable. It’s been about .40 for 5 months. Since I started on Firmigon

Would it be safe to say that both the CT and bone scan will not show any Mets?

Does reacurrent PC make any difference?

Thank you so much

Chris

[Tall_Allen in reply to Christopherg]

Highly unlikely.

[Christopherg in reply to Tall_Allen]

Thank you so much

[tallguy2 in reply to Christopherg]

See below for my experience.

[NRoundy1 in reply to Christopherg]

CT and Bone Scan are useless for detecting metastases with PSA 0.40.

Another question is why is your PSA not going much lower while on Firmagon. What is your testosterone? You want T down to something like 20 ng/dl.

What is your Gleason Score?

Ask your medical oncologist if you have high enough risk to add zytiga/ abiraterone to your therapy.

link.springer.com/article/1...

Time to get busy to learn your best options.

[Shooter1 in reply to Tall_Allen]

At PSADT of 12days,. Needed scan. Darned stuff of mine really takes off when it comes back.

[CAMPSOUPS in reply to Shooter1]

I hope all is well. The other day you said in a thread " life is good even with rising PSA".

[Shooter1 in reply to CAMPSOUPS]

Ok, but PSA didn't drop last month, this month is the important one. Wish me luck.

[CAMPSOUPS in reply to Shooter1]

Will do. Wish you luck in the extreme. We all need it. No crystal balls only luck of the draw. If it didn't require luck (some respond, some respond for a long time, so don't respond) it would be because we have a cure.A talk with our higher power for our brothers and their families and ourselves here.

[Christopherg in reply to Tall_Allen]

Hi TA and how are you?

My CT scan result stated

There are several lymph nodes left neck which measure up to 8 mm in size and these are larger than the previous study which was 2 years ago

My PSA which was 6 weeks ago was . 42

Is it possible this is prostate cancer showing with a low PSA?

My bone scan was clear

Your opinion is appreciated

Chris

[Tall_Allen in reply to Christopherg]

Yes, it is possible. But it is more possible that neck LNs are enlarged because of infection.

[Christopherg in reply to Tall_Allen]

Thanks so much for your quick replyThis is good to know

Take care and thanks again

Chris

[tallguy2]

Possibly. When my PSA hit a nadir of 0.3 last January (previous trial) the quarterly CT scan with/without contrast showed increased size of several cancerous lymph nodes and an increased size in prostatic bed cancer. It helps to have prior scans for comparison.

[dhccpa]

Lotta differing opinions about what scans can and will show, and about their interpretation.

[Hidden in reply to dhccpa]

Well said!

[Hidden in reply to dhccpa]

Lots.

[Tall_Allen in reply to Hidden]

not really - it's pretty consistent.

[Hidden in reply to Tall_Allen]

some scans work for some people and sometimes they don't work for other people. Kwon's exact words. seems to me it is optimal is to get all types of imaging. also he says interpretation is even more important. if interpretation is that important, then you can't rely on someone to read it right every single time. unless they were able to develop some type of kick ass AI software to read it the very same way every time.

[Tall_Allen in reply to Hidden]

Kwon is certainly not an expert on this - he is not even a radiologist. Better to focus on real expert radiologists like Andrei Iagaru (Stanford), Steven Rowe (JH), Jeremie Calais (UCLA), or Thomas Hope (UCSF), to name just a few. In fact, radiologist expertise is a subject I raised in my interview with Iagaru for Malecare, if you are interested.

[Tall_Allen in reply to Tall_Allen]

BTW- they have AI software:

pylarify.com/ai#pylarify-ai...

[Hidden in reply to Tall_Allen]

good. they need it

[ixolib]

My recurrent psa was .6 when I had an Aximun Pet scan and nothing was found.

[ImaSurvivor1 in reply to ixolib]

The Axumin scan is no longer state-of-the-art. It's very unlikely to find anything at .6 PSA. There is a fair chance either the Ga68 PET/CT or the F18 DCFPyL scan might find something at that PSA level -- maybe roughly 50% chance it would find what might be there.

[ixolib in reply to ImaSurvivor1]

We’ve searched all over for the nearest PSMA scan available from my area here in the south and have been unsuccessful locating one. I live on the Mississippi coast and the nearest we’ve found is a thousand miles away. Starting SRT next week and would feel so much better about the potential outcome if I knew they weren’t just radiating the prostate bed because they don’t know at this time where else it could be. The Axumin scan was done as an alternative and with my cancer ‘s PSMADT having an abnormally high velocity they felt it was worth a shot. Googling PSMA PET locations hasn’t found anywhere that I can afford to travel to. Any ideas?

[bean1008 in reply to ixolib]

If there’s any way you could travel for a more advanced scan I’d really recommend it. I’ve had two Gallium68 scans and they’ve been a big factor in my treatment since my RP in 2017. I wish I’d had one before my surgery but I didn’t know they existed at the time. I hope advanced scans are mandatory today before anyone starts treatment!

[Hidden in reply to ixolib]

TallAllen just today posted a list of locations of Pylarify scans and there are many near you, mostly in Louisiana, but also in Jackson and Pensacola. You should try to get one of those. most are saying this is the best scan now, but of course you should try to figure out which has the best radiologist interpreting it.

map

[Bethpage]

Husband had Axumin, trial C-11 acetate, and 18F-DCFPyL-Pylarify in phase II at Stanford, all at PSA 1.0. Only Pylarify found the recurrence.

[barrybayarea]

I am no expert in the matter but I can share my own experience. I was on Lupron, Zytiga, and Prednisone for 18-months. PSA was holding at <0.1. I stopped ADT in Feb 2021. PSA started rising, it reached 3.2 in May 2021. Normal CT and the bone scan did not show anything. I had a PSMA scan in June 2021, they found 3 Mets in my bones that the bone scan did not show. Restarted ADT and did radiation to the 3 bones. PSA is declining.

So the PSMA scan was great for me. Like the doc explained, they found my bone Mets earlier than other scans could.

[Hidden in reply to barrybayarea]

5-7 years early is what Kwon says. But sometimes they aren’t accurate

[barrybayarea in reply to Hidden]

What is 5-7 years in reference to?

[Hidden in reply to barrybayarea]

5-7 years earlier than standard imaging

[Spyder54 in reply to Hidden]

Yes. What Anomalous said above is what the Great Kwon said. I believe it. Good Pet Scans will see mets up to 7 years before Ct, MRI, or Bone scans will see. He added, with visuals how some men do better w Auxumin, some w Gal68, others do better w Pylarify. Just like how we respond differently to many treatments. He added Gal68 has the advantage of PSMA verification for future LU-177 when it is approved this month or next.

[bean1008 in reply to barrybayarea]

That’s excellent, Barry. I’m one year into Lupron/Zytiga so trying to make educated guesses at future treatment options. Best wishes on the PSA continuing to drop!

[dhccpa in reply to barrybayarea]

Did you have Mets when you began Lupron? If so, are these the same or different Mets?

[MateoBeach]

PSMA PET scan would be most useful. See this video why PET scans should be used over the older scans (bone and CT).

m.youtube.com/watch?v=81iAz...(Not working as expected?)

[lcfcpolo in reply to MateoBeach]

Thank you Matteo. Brilliant video that we should all watch. I just got my CT and Bone scan reports. They are positive news but I will go private now for PSMA scans to get the real news.

[Hidden in reply to lcfcpolo]

don't forget what he says. some work for some people and don't work for other people. and interpretation of the scans varies.

[isurgen2 in reply to MateoBeach]

I agree. Very informative video.

[Hidden]

Christopher, the answer is not always simple. I have had 21 sets of nuclear bone scans since March 2003. My Urologist, two Radiation Oncologists, and Medical Oncologist each had the nuclear bone with soft tissue CT scans done as a baseline. A baseline used to compare where I was that day and future scans. In May of 2004 when my PSA exploded to 32.4, I had a another set of scans. Yep, two hotspots at L2 & T3. From the initial scans by each doctor and with comparison, it was determined that the mets were resolved. Yes, they could see new bone growth in the two spots. For example, with Lupron, PSA moved down from the initial to 0.5, 0.2,1.7, 0.2, down to <0.1. Each time I viewed the scans with my doctors and could see marked changes - from active mets to resolved, and finally new bone growth. However, even with the changes, one could see where there was a potential problem.

In February 2010, I stopped ADT. Six months later at <0.1, my scans were still clean. My final set of scans was in November 2016. I remain today undetectable. For grins my Cardiologist had a test made last month - 0.014. I have been most fortunate to be able to enroll in a six months chemo - hormone therapy trial. It was heavy duty.

I assume that you had initial baseline scans. Have a competent pro compare them. Two of my guys were in academia and research and I was a "guinea pig". This is why so many scans. But I do have a track record. One thing that I was told early on, it that a lot of people just don't know what they are looking for. I cant tell you about any of the new types of scans developed since I started my journey, but I do know that your answer lies in baseline scan comparison.

One other point, in 2012, I had a kidney stone attack and the ER doctor in a small town ran various scans. As a result, he called me to tell me that he saw something specious. I explained my history, and he then understood. So even then without Lupron, he could tell than something was or had gone on...... My PSA was <0.1 at the time. Tells me, the answer is yes, mets or former mets can be detected using nuclear bone and soft tissue CT scans.

Good Luck.

GD

[Christopherg in reply to Hidden]

Thank you so much

[jjpeabody]

I had PSMA PET scan with PSA of 0.12, showed tumor in surgical bed. That was without any significant ADT. If you can get it with insurance I would for recurrent PCa. Good luck