Pylarify (PSMA PET/CT) sites

[Tall_Allen]

They posted a site locator for showing where you can get their PSMA PET scans - you enter your zip code:

pylarify.com/site-locator

[mperloe]

With increased access to Pylarify PET and GA68 PSMA11 PET scans we can more accurately determine the extent of disease and be more assured than when AS or focal treatment is planned that disease is in fact limited to the prostate.

[Tall_Allen in reply to mperloe]

For AS and focal treatment, mpMRI is better at finding cancer in the prostate. PSMA PET will almost never find occult metastases when AS is indicated, and is not approved for that use.

[addicted2cycling in reply to Tall_Allen]

THANKS FOR THE UPDATED INFO -👍👍

Partners Imaging in Sarasota has been my GO TO location for Axumin and 3TmpMRI and the addition is greatly welcomed should it be needed.

[Schwah]

All things equal, would you choose these to the PSMA scans at ucla?

Schwah

[Tall_Allen in reply to Schwah]

DCFPyL is more sensitive at lower PSAs. At higher PSAs it doesn't matter.

[plainyogurt21 in reply to Tall_Allen]

Is this from personal experience or a scientific publication that you know this?

[Tall_Allen in reply to plainyogurt21]

Here ya go:

jnm.snmjournals.org/content...

[6357axbz]

Thanks TA. Very helpful

[alephnull]

Thank you Tall_Allen!!!!!!!!!

I now have seven within a two hour drive!

[jjpeabody]

Great information Tall_Allen. I am at an important decision point and hope you can give me some guidance. It's going on a year since my PSMA PET showed and intense uptake in surgical bed at a PSA of 0.12 at the time. I've been on Eligard since then with PSA of <0.03 and testosterone <1 as of 11/19/21. MO wants to start holiday in Feb re intermittent ADT. RO I've consulted with at MD Anderson AZ (they offer Pylarify, thanks!) wants to do SRT, WPLN, and ADT (some confusion for duration and type). Also importantly my CT to chest 11/11/21 showed new noncalcified 5mm nodule to upper right lung. I am scheduled for follow up CT on 3/1/22. My questions follow 1) instead of a conventional CT would a Pylarify scan be better if I can get it even at PSA 0.03, might address lung nodule and PCa heading into SRT 2) Because lung nodule may be a surveillance issue or needle biopsy, would the intermittent ADT be reasonable with a Pylarify scan when PSA rises to around 0.5. 3) would you suggest SRT now despite lung nodule or wait, however long, to determine its nature. What would you recommend at this point. Thanks for any help you can provide.

[Tall_Allen in reply to jjpeabody]

You are jumping the gun in assuming the lung nodule is prostate cancer, which is the ONLY thing detectable by pylarify. It makes sense to have the CT first. It might be benign or totally unrelated to PCa. If it didn't shrink while you are on ADT, it is probably not PCa. A follow-up CT and a biopsy will tell you a lot more than a pylarify scan.

I don't see why you would take an ADT vacation if you will be attempting potentially curative salvage radiation.

[Tall_Allen in reply to Tall_Allen]

My friend had a small lung nodule discovered on his bone scan/CT. It had a "ground glass" appearance. When it didn't shrink with ADT, he went ahead with SBRT + 9 months of ADT for his high-risk prostate cancer. After that, they did another CT and an interventional radiologist biopsied the lung nodule in the CT machine. It turned out to be a second primary lung cancer (called an "incidentaloma"). It was curatively treated with a single 22 Gy zap of SBRT. He monitored it every 6 months with a CT scan, now annually. So far, so good. He was very lucky to detect lung cancer at such an early stage. It usually is not detected until it has spread widely, causing symptoms, or has metastasized, which would be incurable. Most lung nodules are benign.

I would not start an ADT vacation. I would get a follow-up CT scan now. If it hasn't shrunk, it probably has nothing to do with your PCa. If it hasn't grown, and doesn't have a ground glass appearance, it is probably benign and you can monitor or investigate later after SRT. If it has grown, it should be biopsied.

If it has shrunk while you have been on ADT, it is probably PCa, so there is no point in pursuing SRT. But adding Zytiga, Xtandi or Taxotere to your ADT would be a good idea.

[jjpeabody in reply to Tall_Allen]

Thank you for the follow-up Tall_Allen, I appreciate it as we all do.

[Ahk1]

Thanks, TA for posting. Very much needed information.

[Don_1213]

Great information. Hat's off to TA again. One is located at the imaging center I usually go to - about 5 miles from where I live. I suspect it will be needed shortly.

[CanKicker]

Thanks for keeping up on this Tall_Allen! This is an improvement from three weeks ago when my wife had to call to find out the two closest places (4 hours). I put in our zip code tonight and the same places showed up. So far nothing closer. We went to Northern California Pet Imaging Center in Sacramento. Today I sent the discs and their report to Dr. Mark Scholz in Marina Del Rey who will have UCLA take look just to be sure. So far nothing has escaped the prostate, so it looks like I’ll be doing the SBRT recommended by Scholz, hopefully locally here in Medford OR, by March.

[j-o-h-n]

What the hell is a zip code?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/04/2022 7:18 PM EST

[ixolib]

Thank you Tall_Allen for this info.. After you posted I located a PSMA scan just 80 miles from home. I called and they said they could work me in this week. Unfortunately since I “ settled” for an Aximun scan on Dec. 16 when I was informed by RO that the closest PSMA to me was a thousand miles away I am now being told that Medicare will not pay for another Pet CT until March or three months after the Aximun Pet! Are they correct?

[Tall_Allen in reply to ixolib]

I'm sorry, I don't know. You would have to call CMS yourself for their coverage rules.

[Farmhand]

Thanks for the info TA!

[Ian996]

Can you give me an approximate cost for the Pylarify Scan?I have hade a PSMA PET Gallium 68 scan at UCLA and from experience that cost was $3300 before travel expenses. I

[Tall_Allen in reply to Ian996]

Without insurance? $3000 just covered their cost of the radioindicator. There are also costs for doctor time and equipment. I'd guess around $10,000, but I'm just guessing.

[Ian996 in reply to Tall_Allen]

It was my understanding that the galium 68 PSMA Pet is more expensive due the specialty cyclotron needed to produce the isotope . But I too am guessing. I contacted UCLA and asked for an estimate of costs., If they reply I will share the info

[WhistlersMother59]

thank you!