Stage 3a; GS 9; PSA was 1.2 at time of RALP 2 years ago; My cancer does not generate much PSA; Currently undetectable; Spoke with Dr. this week and she agreed a PSMA PET would be a good idea; I don't meet the FDA criteria for the test here in the US. I have heard they might be available Canada or Germany.
Any info would be appreciated.
We went to Sydney two years ago for psma scan and lutetium. Price for scan alone was $800. Company is called GenesisCare
Thanks.
Why do you want a PET/CT? If you a prostatectomy 2 years ago and PSA is undetectable, everything is fine. Besides with an undetectable PSA most probable the PET/CT will not show anything.
B/C an idiot doctor relied on my yearly PSA results. My cancer was not caught early and it will most likely kill me. So I don't have much use for PSA tests since my cancer does seem to produce much. I would like as much advance notice of my demise as possible. I can afford it. My current doctor thought it was a good idea.
You may find that an FDG PET/CT will show more for your low PSA-type PCa. It's covered by insurance and available everywhere. Might be a good starting point.
Thank you.
TA is right. If your cancer doesn’t produce much PSA, then a PSMA scan that uses PSA to locate cancer will likely not be the best choice.
Schwah
PSMA PET/CTs do not use PSA to locate the cancer. The tracer attach to the PSMA (prostate specific membrane antigen) which is in the surface of the cancer cells and it is periodically internalize into the cancer cell.It is consider by many that cancers with low production of PSA have also a low PSMA expression and only large mets may be visualized by the PSMA PET/CTs. If these cancers use glucose they may be seen by a FDG PET/CT.
Good Morning TA, What is a FDG/CT Scan?
Is an FDG PET also called a PET Bone Scan? Still trying to get the PETs straight.
No. It is a glucose scan. Often, prostate cancer that is not PSMA-avid metabolizes glucose.
Allen, how do you know FDG PET/CT is the right scan? Just by trying and seeing? Are there tests that show which imaging will work (i.e. FDG PET or PSMA PET)
Because PSMA is PSA-dependent, FDG isn't. Glucose metabolism starts up in more aggressive subtypes.
Thanks Allen. If I understand correctly, cancers with low or high production of PSA will not show up on FDG PET but will show up on PSMA PET. The important point being whether cancer produces PSA or not. If the cancer is not producing PSA then it may show up on FDG PET scans, right? Of course both cancer types may exist at the same time.
No. That is not at all what I wrote.
Ok, one last question Allen. Will cancer cells that produce PSA (low or high) show up on FDG PET? Thanks
Prostate cancer metabolizes glucose after it has mutated to the point where it no longer metabolizes fats (c-11 choline) or proteins (Axumin). Low PSA subtypes often metabolize glucose early and often do not express PSMA. It is possible to have some tumors with high PSMA avidity and some that metabolize glucose going on at the same time (discordant).
Been to University of Heidelberg four times . Last time was July 2020. Had PSMA scan 2018. Did LU-177 and AC-225. PSA < 0.04. No ADT now for 18 months.
Might try to get a PSMA zirconium 89 scan at SAARLAND University Germany.
When going outside to germany, I think some klinics are private. The university of Heidelberg is a German government hospital and I think the charges are standard for those who are not German. Could be wrong.
I had PSMA PET/CTs in Munich in 2016 and then based in the results treatment with Lu 177 PSMA.
In Europe the PSMA PET/CTs cost around 3K euros , in the USA may cost between $ 20K to $ 30K depending on the area of the Country. The cancer center I use locally charged $ 36,500 for a Pylarify PET/CT ($ 21,700 for the Pylarify and the rest for the execution and the interpretation).
If the insurance does not cover it, it is less expensive to have it done abroad, even when including the air tickets to Europe.
In your situation you may requested a double tracer PET/CT with a PSMA ligand and with 18F FDG . I believe they do first the PSMA ligand and then do the second PET/CT with the FDG.
What caused you to realize your disease may be progressing, causing you to seek a scan, if PSA is undetectable?
A bit confused again and I don’t think it’s from chemo fog. I was told that PSMA scans are available and approved here in the US as well as the newly FDA approved LU177. Am I wrong on my learnings?I finish 10 infusions of Docetaxel in late February with PSA at 16.3 , which was a drop from 30. It is now 19 and I am with out pain but do have a few new mets as indicated by recent bone and Ct scan.
My OC is searching for a location for a PSMA scan with hopes of moving to the newly approved FDA treatment LU177.
What do you experts know on this, I live in eastern Washington.
PSMA PET scans are approved in the US but only for two situations. At the time of diagnosis and later for biochemical recurrence.
Hi. Not Chemo fog at all. It has taken me ages to get my head around that if you want LU177 treatment then you should do both scans.
My understanding is that if the FDG scan shows lots of FDG positive cells or metastasis in different areas than the PSMA scan then you could get unnecessary exposure. Sadly a number of great members on this site have passed really quickly after a PSMA scan and LU177 treatment. I'm unsure if the MOs did the FDG scan as well.
Good luck my friend. I'm also looking into this treatment when the time is right and will be asking for both scans.
Thank you for that info. I will discuss this with my Onc. Locating a facility that provides these scans in the NW will also be a must if I plan to pursue the LU177 treatment.
My PSA at dx was 1.2 and I just completed my first PSMA scan. Now I need to ask my doc why they didn't order the FDG PET. Learn so much on this site.
I continue to be undetectable.
Wishing you the same!
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PSMA Pet Scan results 
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