My PSA has been undetectable for 2 and 1/2 years. My Oncologist abruptly left Florida Cancer Specialists. The new Oncologist is suggesting a Pylarify PET scan for PSMA. My last Axumin scan in 2020 showed PC in multiple lower abdominal and bilateral pelvic lymph nodes and prostate.
Is this scan a good idea for me at this point? Am I correct to believe that since I'm undetectable it's not going to tell us much if anything. I don't want to get all radioactive for no reason! HELP scheduled for this Tuesday!
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ReMarcAble
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My MO who seems to be highly regarded nationally had me get a Pylarify scan even though my PSA is undetectable. She said AC he wanted it for a baseline by which to compare subsequent scans.
I agree with you - there is no point unless your PSA reaches 0.5 or starts increasing rapidly. Even then, the conversation should be - what will we do about it if it shows something?
TA, I have been 0 PSA for 3 years on Eligard and Erleada. I’ve read about pca growing with (low) psa’s after long term use of adt. Do you think this can happen with an undetectable PSA and would you recommend a yearly CT/Bone scan to provide some insight to anything going on? Thank you for the time you spend providing answers for us.
22.3 prior to RP and prostate bed radiation. Bounced around for 2 years from .5 to .9 and then a quick rise to 5.6. Axumin scan found 3 active lymph nodes. That’s when I started Eligard and Erleada. Last 3 CT and bone scans showed NED.
That is a normal high PSA type of PCa that responds well to hormone therapy. IMO, I don't think that scans are useful for him right now. Just take the win on the PSA 😀
If you get Lupron and Xtandi, a PSMA scan could show lesions even at low PSA levels. However, I would ask the oncologist what change to the treatment he plans based on the results of the PSMA scan. It could be radiation of the detected lesions.
"I don't want to get all radioactive for no reason! " I had ten PSMA scans now and have no side effects from these.
I am on Prostap & Xtandi, PSA=0.2 and had a PSMA-PET scan for that very reason of identifying tumours that may be worth radiating. However it's just the symptomatic ones that will be zapped along with the prostate itself which still has a large tumour.
I would recommend it as it’s so much more advanced than the aux. It can detect pca with a psa of .20 at about 92% accuracy n can give a jump on any new pca that may be developing n need radiation. I’ve had 2 aux n2 Psma no side effects as it’s reported to leave your system within 19 hours and it will give you the most accurate reading for a baseline, imo
From a quantification I tried in the past, in accordance with a Canadian occupational hazards directive, the radiation dose one receives from the scan is equivalent to 5 transAtlantic air travels.
The PSA doubling time has a big influence on treatment. There are treatments for men whose prostate cancer had recurred and is getting worse despite anti-hormonal treatment with Lupron Depot.
Treatments for recurrence of prostate cancer that hasn't spread:
PSADT of 10+ months: Observation is generally preferred. Secondary hormone therapy can be considered.
PSADT of three to 10 months: Treatment with Erleada (apalutamide), Nubeqa (darolutamide), or Xtandi (enzalutamide) is preferred. Additional secondary hormone therapy is also recommended.
PSADT of three months or less: Treatment should be aggressive, such as six cycles of Taxotere (docetaxel) along with Lupron Depot.5 Some medical providers may consider new drugs like Zytiga (abiraterone acetate), Xtandi, or Orgovyx (relugolix).
note : info was -- By Mark Scholz, MD Updated on July 25, 2022
i agree with you. At this very low PSA the scan is not likely to provide much actionable information. Count yourself lucky that PSA is staying very low and enjoy your life.
Xtandi and relugolix, total penectomy about 2+ months ago. The girls no longer fear me...I have my left kidneys ureter being strangled so I'm going in very soon for either a Stent but they tell me they want to do the tube and bag out the side. Already have a suprapubic catheter so I can actually stand up to pee. I have 30 minutes of energy before I have to lay down to recharge. Was really counting on the plavicto as I don't have any interest in chemo. Other than that I do have enough energy to comment on J-O-H-N's wise alec posts...I will update my profile soon. Love ya brodda!
The problem, is if you talk to a qualified MO who is experienced with metastatic disease, they will tell you that they don't "treat" PSA. Chasing it is a bad idea as well.
There's nothing wrong with taking a "look"... Nothing to lose either except the time doing the test. As a matter of fact, I believe once mets are detected, yearly scanning is expected. CT and Bone scan for the purpose of pre-emptive action at the very least. In other words, why wait until the disease rears its ugly head and PSA is doubling like a rocket to act? Are you on a yearly, 6 month, or 3 month testing regimen? Arrrrrgh... A potAto or pOtaato... But really, not everyone differentiates PSA, not every patient responds the same. We are all different...
The conundrum of our journey! Lol
But if the Doc wants to do some extra peeking around, what really is the drawback? No PSA, and then nothing or no evidence on scans is a comfort many of us would enjoy!
My husband has had 2 Pylarify scans within a year, and although I know that he is not currently radio active I also worry about too much radiation. You should absolutely have it done, it is one of the most definitive tests to know for sure where the cancer is and if it is growing, even if your PSA is low. It's better than Axiom and will give you a baseline for future medical decisions. Hope all goes well.
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