PSMA PET Scan - What To Expect

Good morning Warriors:

The journey continues. I have been in a battle with the PC Beast for 20 years. Had RP, Radiation, and Chemo. All worked for a while. I just received my 3rd injection of Radium 223. My PSA is still 9 but my ALP has dropped from 178 to 58 which seems very encouraging.

My MO at Phoenix Mayo just asked me to have a PSMA Pet Scan versus my normal Bone scan and CT scan. My mets are only in my bones. What should I expect from the PSMA scan??? I know it is new. Any experience or opinions would be very helpful.

Thank you so much for your input. We all fight the bast together.

Tom

[fireandice123]

I had a PSMA scan a couple of weeks ago. It was pretty painless. They injected the tracer into me and I waited for 90 min. I also drank a bottle of the solution that’s used for the CT contrast. The scan is like a long CT scan, about 30 min. Just lay there not moving as you’re slid through the tube. I almost fell asleep. The worst part was that my arms were raised above my head throughout. After 30 min they were rather stiff but back to normal quickly. No after effects.

Good luck.

[Hidden in reply to fireandice123]

ThanksFireandice123.What did you see in the results that were different from a Bone Scan and a CT scan?

So appreciate your input.

Tom

[Hidden in reply to Hidden]

This was exactly how it went for me.

[fireandice123 in reply to Hidden]

It lights up the areas of PCa quite nicely. The PSMA scan is prostate specific so it what is lit up is almost certainly PCa. Whereas the bone/CT scans are not prostate specific so they just show abnormalities that could be caused by a variety of problems, like arthritis. Other information like PSA levels have to be used to determine if what flagged is really PCa. And the PSMA scan can pick up much smaller amounts of cancer than either the bone or CT scans.

[Hidden in reply to fireandice123]

Thank you Fire and Ice for the clarification.Appreciate it.

Tom

[RyderLake2]

Hello, Your oncologist might be considering you for Pluvicto (marketing name for Lutetium-177) which has just recently been approved by the FDA.

[Yadifan in reply to RyderLake2]

I was wondering the same. It's my understanding that you need to wait a year to be able to use Pluvicto after xofigo. Our MO wasn't sure of the wait time between treatments or if at all. Could it have been ordered to get a better picture?

[Hidden in reply to Yadifan]

Yes he is talking to me about LU 177.

My concern is the same as you guys.

If Xofigo is working why not wait until it stops working???

Thanks Yadifan.

I will ask him next week.

Tom

[bglendi53 in reply to Hidden]

I believe you can only use Xofigo one time for 6 injections every month, but I could be wrong on that.

[Hidden in reply to bglendi53]

I don't know. Thanks so much for your input.

Tom

[leebeth in reply to Yadifan]

My brother had his 6th Xofigo in January and had a PSMA scan April 1. I have not seen anything stating it was necessary to wait a year. Do you have the reference to that? Curious; if that is true, we have made treatment decisions based on that scan.

[Yadifan in reply to leebeth]

Our MO mentioned a year wait time between Xofigo and Lu177 at our last appointment. I would like to see something definitive on this also. I'd hate to think we're all just guessing. What is the wait time for your brother's treatment?

[leebeth in reply to Yadifan]

There was no wait time mentioned. He was having a lot of back pain, and the bone scan didn’t show anything. The PSMA scan showed a lesion in the area of his pain, so he had palliative radiation which resolved the pain.

[Yadifan in reply to leebeth]

I saved a post from 12 months ago "Lu-177 switch from Xofigo. How long an interval?" posted by baltha. Nalakrats replied by doing the math on this - which makes good sense and is good knowledge to have. It will be helpful for us on our next appointment. His reasoning says 3 months wait time. It didn't occur to me at our last appointment to ask why the year wait. He made a comment about "if at all". This may apply to us personally. Of course there will be guidelines from the drug manufacturer that may dictate a different wait time and probably insurance hoops to jump through. These questions are added to my list. Best of luck on your treatments and your brother's. And may God bless us all and guide us through all these tough decisions.

[Hidden in reply to leebeth]

Thanks so much for your information.Tom

[Hidden in reply to leebeth]

What were the results of the scan after Xofigo?

[leebeth in reply to Hidden]

Bone scan showed nothing. He was having lots of back pain in the sacral area. His MO wanted to send him for a steroid injection. I suggested he hadn’t had a PET in quite some time, (18 months) and I was highly suspicious it was cancer, not orthopedic. The PET showed widespread intensely avid osseous metastases including a sacral lesion with SUV max of 35.5.

Exactly where his pain was.

[Hidden in reply to RyderLake2]

Yes he is talking to me about LU 177.My concern is the same as you guys.

If Xofigo is working why not wait until it stops working???

Thanks Ryder Lake.

Tom

[Max-well in reply to RyderLake2]

Sorry to say but Novartis discontinued its production of Pluvicto/Lutetium-177 until 2025.

[Max-well in reply to Max-well]

It is not currently available in the U.S.

[leebeth in reply to Max-well]

It was only on a pause and is back in production.

[Nusch]

Great fight - congrats! PSMA PET is the best you can get and will provide a much better picture compared to CT and bone scan. I‘ve had three already, no side effects so far.

[Hidden in reply to Nusch]

Thanks, Nusch for the insight.KEEP FIGHTING.

Tom

[Fitzbruce1]

Piece of cake. The results are so easy to read because the metastasis lights up like a lightbulb!

[Hidden in reply to Fitzbruce1]

Oh MY!!!All I need is more excitement.

After 20 years - starting to get used to it.

Thanks so much Fitzbruce.

Tom

[RS265]

Hi, have just had my fifth combined PSMA/CT scan (in Australia) and all have been without after effects. Typically a 15 minute walk and 30 minute drive afterwards. Got a false positive at PSA<0.2 but otherwise invaluable for treatment planning.

[londoncyclist48]

I've had this scan. Other than the fact you have to wait around for an hour for the radioactive water to penetrate your bones, it's an easy one. It lights up all your bone mets like a Christmas tree. You can find pictures in Google images. I was never given a copy of my own. I understand the scan is considered somewhat "experimental" but viewed in conjunction with other scans, it gives your consultant a lot of detailed information.

[Hidden in reply to londoncyclist48]

Thanks so much for the info.Tom

[pilot52]

Hi, I have had 6 PSMA scans..three here in the states and three in Delhi.. Also Lu-177. If you are PSMA avid it will show areas of concern much earlier than anything currently out there. My current PSA is 0.16 and has doubled in the last 9 months ..We retest with blood work in July and a new scan in September . Just think of it as another scan with contrast...Early detection with new paradigms of treatment give us some edge for a change...Blue Skies

[Hidden in reply to pilot52]

Thnks so much Pilot.Did LU 177 work.

Appreciate your feedback

Tom

[j-o-h-n in reply to pilot52]

Where the hell were you..... circling the airport waiting for permission to land?.... Woof Woof

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 05/26/2022 11:19 PM DST

[MateoBeach]

Lutetium works best when it is used early. This argues against waiting until failure of all other treatments. The wait time between Ra223 relates to bone marrow suppression. If your blood counts are OK you probably don't need to wait. Lu-PSMA-617 has low marrow toxicity anyway. If your PSMA scan shows avid lesions (lights up cancer sites), then you should really think about pursuing treatment promptly, in my opinion. Since Novartis cannot reliably source Pluvicto, you might need to go abroad (Germany, India, Australia and others) in order to get timely treatments. It is your decision and it has consequences. Good luck.

PS: I just finished my Lutetium treatments in Australia today. Paul

[Hidden in reply to MateoBeach]

Thanks so much Mateo Beach - What did the LU 177 do to your disease???So appreciate your input.

Tom

[MateoBeach]

Time will tell, Tom. I just had the second dose yesterday. It has a 6.6 day half life and is slowly excreted through the bile. So it will be working to kill cancer for the next 2-3 weeks. I am staying on my high dose testosterone as advised through the next two weeks. Then will drop that and go on a 4-6 week low T cycle with Orgovix. PSA levels will then give some measure of the effects, especially after the Testosterone levels go high once again with SRT.

[Hidden in reply to MateoBeach]

Thanks Mateo:A friend of mine is on hight T and it is working.

Please keep me posted.

Thanks - Tom