G68 PSMA vs Pylarify

[wilcoxsaw]

If insurance covers both, at the same psa number which scan is more sensitive to locate bone metastases or soft tissue/ lymph node metastases. If there have been any comparison studies/ data please share. Thank you!

[Tall_Allen]

Pylarify is more sensitive than 68Ga-PSMA-11 for recurrent PCa:

jnm.snmjournals.org/content...

But NaF18 PET/CT is more sensitive for bone metastases:

prostatecancer.news/2016/12...

But a skilled radiologist can be more important.

[wilcoxsaw in reply to Tall_Allen]

Thank you for the study and for your article. Both are dated 2016. Has there been any other data published in the past 6 years that might be available comparing the two scans? What both say reinforced what I have also seen to be the case, if you run across any studies or data with more recency please pass those along.

I agree that the skill of the radiologist reading that scan is very important. If one were to choose a site in Southern California to get one of those scans, in your opinion what would be the top three sites and the scan to choose at each of those sites ? Would City of Hope be part of that list or a good choice.

Thanks!

[Tall_Allen in reply to wilcoxsaw]

I update my article frequently - it was originally published in 2016. If I had anything more recent, it would be there. There is no need to re-do trials that have already been done.

UCLA has the most experience anywhere in the US.

[tango65]

There are not large head to head studies comparing both tests that I know. My understanding is that these studies seem to have same detection rate. Some may argue based in small studies that Pylarify has a better detection rate than Ga 68 PSMA in patients with PSA lower than 0.5.

[wilcoxsaw in reply to tango65]

Thanks! If you run across any studies or data done recently please pass those along. I'm not sure if you are familiar with Southern California but if you are what three facilities might be considered the best to have these scans done with the most experienced Radiologists and team interpreting them.

[tango65 in reply to wilcoxsaw]

There is only one, UCLA .

[TJGuy in reply to tango65]

Both UCLA and UCSF are leaders although UCSF is not southern California.

[tango65 in reply to TJGuy]

It is true UCSF has a lot of experiencie having started doing PSMA PET/CTs around 2015, but they are not in southern California.

[TJGuy in reply to tango65]

Yes I was one of the participants in the UCLA Trial that got Ga 68 PSMA scan FDA approved. In July 2018 I flew across the US to obtain the scan. My prescription to obtain the PSMA scan in that trial was written by a doctor in NYC. That trial cost about $2,700 at UCLA, A similar trial in NYC was to cost $10,000. He wrote the prescription so I could save money. A good doctor.

[tango65 in reply to TJGuy]

I was part of the UCSF PSMA PET/CT trial in 2016 and then of the UCLA trial in 2017. Since then I never had a bone scan or a CT scan.

My therapy is guided by PSMA PET/CT studies.

All the lymph nods mets I have are normal size nodes undectable by CT scans.

If this approach offers an advantage is unknown. It has been 7 years since diagnosis of metastatic cancer and I do not have bone mets yet.

I wish you the best of luck.

[ragnar2020]

Hi Scott,

I’ve been thinking about you and hope you’re in the limbo of stability of PSA, no or manageable bone met pain and plenty of exercise. I finished my SRT with PBT at UPenn and a follow-up MRI revealed the single bone met gone. Compression fractures being managed with some pain meds. Next PSMA PET in June ‘23 and doin some yoga to strengthen spinal muscles. It’s coast and watchful waiting time. Investigating DIY BAT since COE SOC docs aren’t there yet. Hope your scan finds nothing.

Jeff

[wilcoxsaw in reply to ragnar2020]

Hi jeff, I sent you a message through this forum just now let me know that you got it. I know I have your email but wasn't sure which one it was let me know what that is please, Scott

[ragnar2020 in reply to wilcoxsaw]

Hi Scott,

Got it. We live in Northampton, MA now having sold our FL place last June. We decided that we’re liberal Yankees and living on a rural north FL coast an hour and a half from a decent ER was not conducive to extended long life.

My email addresses remain the same at:

[e-mail]

[e-mail]

and both cell numbers forward to our land line in our condo.

352-543-9307 mobile

413-584-0761 mobile

Jeff

[wilcoxsaw]

Perfect, thanks jeff. PSA today came in at 0.206 with T at 501. Looks like it is rising perhaps .05 every 3 months. Once it reaches 0.5 I will reimage and see what we are dealing with and talk to Rossi and Dorff and come up with a plan.

[TJGuy in reply to wilcoxsaw]

BCBS is often setting requirements I read about from other " brothers," here for PSA to be 1.0 or greater in many cases. And on top of that that you first have a bone scan and CT before they approve a PET scan.This is and has been happening with me. I'm waiting for the rise to happen. Multiple hospitals I go to say the same thing

Guess I could fly to India or Europe for it if I felt was necessary to get it sooner. And cheaper.

[wilcoxsaw in reply to TJGuy]

Thank you, but Medicare will approve below that number. Friend has had 2 psma's both below 1.0 psa, has Medicare, no issues with coverage.

[swwags in reply to wilcoxsaw]

Just wondering and thinking aloud here. Can someone help me understand at what point any reading that unveils itself on a scan at such a level is actionable?

[wilcoxsaw in reply to swwags]

Both the oncologist and radiation oncologist agree that a psa of 0.5 is the time to image in my case. That has revealed hot spots successfully which have been treated successfully with no recurrence and having only minimal time on ADT.

Your case may be different.