ct/mri vs PSMA SCAN

[Jroc1]

i’ve already had a prostatectomy and subsequent radiation and a ADT treatment. PSA has now started to rise again after a year off of ADT and is at approximately 1.5 Psa. after 12 months of active surveillance. A PSMA scan was done when it was at .8 and found nothing. Also CAT scan MRI was done when It was .8 and found nothing. My oncologist wants to do another CAT scan and MRI before he does a another PSMA. Does that make any sense Since a PSMA will show everything an MRI or CAT scan would show and much more. So why do the Ct or mri at all?

[Tall_Allen]

It's a lot cheaper. Your insurance may insist.

[Jroc1 in reply to Tall_Allen]

thanks Allen. I suspected as much but I think my doctor should try to give me the best care rather than waste time on tests that have been replaced by PSMA.

[tango65]

If your insurance pays, get the PSMA PET/CT. They could do the PET/CT with a diagnostic CT scan instead of the low definition CT they regularly use with PET/CTs.

[fmenninger in reply to tango65]

what’s the insurance qualification in order to have insurance cover a psma per scan vs fdg pet and mri? How can you tell if you psma avid before taking the psma pet scan?

[tango65 in reply to fmenninger]

You can determine if the cancer is PSMA avid by doing IHC analysis of metastasis tissue obtained by biopsy.

Medicare covers PSMA PET/CTs in metastatic recurrent PC and in patients suspected of having PC metastases.

I have had a PSMA PET/CT with diagnostic CT scan and a FDG PET/CT done 3 days later and Medicare paid.

I also had a PSMA PET/ CT with diagnostic CT and then a MRI of a controversial bone metastasis which were also covered by Medicare.

I do not know what other insurance systems require to pay for these studies.

[dhccpa in reply to tango65]

Did you know in advance the Medicare would pay for the PSMA? I've never been clear if Medicare gives pre-approvals. Thanks

[tango65 in reply to dhccpa]

Once the nuclear medicine department gets the doctor's order, they start the pre-approval process with Medicare. It takes 3 to 5 days.

[dhccpa in reply to tango65]

Thanks I'll ask how my scanning center handles Medicare.. I've already had an Axumin so that may be all I need for a while.

[runtrails]

My insurance required negative bone and ct before they would pay for PSMA pet

[RMontana]

I would go straight to PSMA PET...its the SOC now; other scans should really no longer be used. See;

healthunlocked.com/active-s...

healthunlocked.com/active-s...

[MichaelDD]

That is the way I have it.. I was part of the trial scans at UCSF for PSMA GA 68. What Allen told you is very correct. I need to be scanned every 3 to 6 months. As nice as it would be to have the PSMA Pet at request my insurance doesn't let me have it when I want it.

[Cooolone]

Order of preference for me...

1. What is best or most beneficial (test)

2. How or Where may I obtain it

3, When can I schedule it

.

.

.

10. Is it paid for (Insurance)

I know that's not everyone, but whether or not insurance covers it is the last of my worry.

On the question of what's better, best? Don't forget that they do see different things. But you get a CT along with the PET, you don't get a separate report, but it's there in the imaging. The MRI allows some sight, past the spots that might be saturated by the PET tracer. The tracer collects especially at the Bladder, and is why they like to say it for distant met detection. So they all have value in their place. PET being most Superior of course, but that doesn't dismiss others.

But I would want all that can be done, to be done. If Pet, then MRI as well. If on ADT add bone (density) scan every few years... etc., and as an example.

Best Regards

[gsun]

PSMA PET only shows PSMA expressing cancer if I'm not mistaken. Follow it up with an FDG scan.

[6357axbz in reply to gsun]

why?

[gsun]

Some PCa cells do not express PSMA. The PSMA PET scan won't find that.

[JavierVM]

hello, if possible go directly to PSMA PETCT or Pylarify are more sensitive than Axumin, see posts above by rmontana

the NCCN guidelines state the sam

“The NCCN panel has recognized the increased sensitivity and specificity of PSMA-PET tracers, compared to conventional imaging (CT, MRI) for detecting micrometastatic disease, at both initial staging and biochemical recurrence. The updated guidelines state that the NCCN Panel does not feel that conventional imaging is a necessary prerequisite to PSMA-PET and that PSMA-PET/CT or PSMA-PET/MRI can serve as equally effective, if not more effective front-line imaging tools for these patients.”1

best!

[Thesledge]

I have had the same outcome after receiving a prostatectomy back in 2018. I also completed 39 radiation treatments back in Feb 2021. I really need info as to where the PMSA scan can be obtained as it apparently is not available in my area. I live in southwestern Montana

[docbulldog]

Thank you for the info…..and keep up the fight!