I heard on a PCa support group call, from a retired MD, that if your PSA is below 0.1 a PSMA PET scan isn’t useful because it requires a certain level of the PSA to find metastases. Does anyone know if that’s true or is it more of a wives tale or just anecdotal?
Thanks!
Pretty useless for PSAs below 0.5, unless other signals of progression (e.g., PSADT or radiographic).
What if you have Gleason 9 or 10 that may produce little PSA or none at all? Can't it mutate to neuroendocrine histology, for example?
One treats the disease one has, not the disease one imagines that someday one might have. Neuroendocrine doesn't show up on a PSMA PET scan at all.
Yes, my MO at MUSC told me PSA had to be above 0.5. My PSA jumped from 0.46 to 1.06 in 45 days and then I had the scan.
I was 0.2 first PSMA/PET (Pylarify) then <0.1 PSA second scan.
Found a high SUV lymph node that CT wouldn't detect.
Not useless in my case.
Tribute to the improved performance of the recently discovered fluorinated radiotracer.
We found 2 lymph node mets with PSA around .3. Test was ordered when PSA was .14. Wasn’t useless for us either.
My husband had 44 radiation treatments after his first psma scan at .4... found LN recurrent PCa.
now he is <.0.05......that was baseline, now 2nd one is scheduled for 7/6/23...... likely psa too low but MO said it's useful for comparison purposes.....
Just for context, my last PSA was 0.009.
Hi my last PSA was 0.009 and PSMA showed no uptake in bones or lymph glands but showed SUV 4.4 prostate so good to be able to compare with previous PSMA
I had a PSMA PET scan at a PSA of 0.23 ng/mL and it was inconclusive. The only good thing was that it didn't light up like a Christmas tree.
My insurance provider at the time wouldn't pay until my PSA hit 1.0 ng/mL because of the lack of sensitivity at low PSA levels.
Please take a look at Figure 2 in this paper to get an idea of what PSMA PET scans can see at which PSA levels.
pubmed.ncbi.nlm.nih.gov/309...
Hi Dan,
I applaud you for being the only one in this "popular" thread to provide a reference.
And I see (agree with) you and raise you one.
I quote from an informal (non-research paper) Urology Grand Rounds.
grandroundsinurology.com/pr...
Gallium PSMA detection rate (at 0.2 – 0.5 PSA level is 65 percent). Admittedly, on the high side of reports. And Pyarifly(DcPyl-F18) appears better, admittedly minimally better.
The arbitrary cut point for all the qualifying trials for the PSMA-based ultrasensitive advanced imaging was 0.2. The cut point was chosen because it is one of the common definitions of biochemical recurrence (BCR). I was actually a trial subject in both. Gallium at UCLA and Pylarify at Stanford at 0.2. The trials that lead to their FDA approval. Pylarify was FDA approved June 2021, and like most emergent technologies, not readily available. Who knew it takes time to ramp up scale?
I was one of only 27 trial subjects that got both. And of those 27, I was the only one that had completely discordant results. Otherwise, the Gallium and Pylarify findings were very comparable.
Concerning my PC journey post-prostatectomy, after having been on both UCLA and Stanford's waiting lists, when I reached the trial's BCR cutpoint of 0.2, in Nov. 2019, I ran to both UCLA and Stanford to be in the studies. And though I should not be giving medical advice, if one has "high risk BCR" - in my case PSA DT of 5 months, I would strongly recommend running when one reaches 0.2 because there is an emerging new stage in PC : the oligometastatic stage; admittedly very new, with few studies with short followup; and better yet if one is PSMA+ in the prostate bed only or if one is negative, one can rest more easily that the SOC, salvage RT+/-ADT has a better chance of cure.
On the flip side, if one has "low risk" BCR, especially if one's PSADT is > 15 months, I highly recommend, a completely opposite approach, active surveillance. Believe it or not, prostate cancer is the only cancer (Geez, it is unique) for which there is an emerging concept of active surveillance for a "benign" recurrence.
To be complete, there is a third state which I will call very high risk for which one should not wait, but do adjuvant therapy up front: RT + ADT
a. node positive
b. if node negative - at least two of the following:
clinical stage T3 or T4, Gleason score 8–10, and PSA ≥40 ng/mL
Thanks for sharing your story and the additional resource, Allmo.
I can relate to your comments about active surveillance for recurrence, because that's what I did for almost six years.
My PSA became detectable again (0.05 ng/mL) 54 months after surgery in September 2015. It had such a long PSA DT that we agreed to just monitor it, and it took almost six years for it to reach BCR of 0.2 ng/mL in July 2021. But we also noticed that the rate of increase was accelerating, and that salvage radiation therapy (SRT) was likely on the horizon for me. I wanted the results of the PSMA PET scan to be able to guide the radiation oncologist as to where to aim his death ray.
After fighting the approval powers that be, the earliest I could get my PSMA PET scan was 30 November 2021. By April 2022, my PSA had jumped to 0.33 ng/mL—a sizeable increase over a short period.
We opted to do SRT with a concurrent round of androgen deprivation therapy (ADT). A six-month dose of Eligard was given to me in early May 2022, and there were 35 sessions of SRT in July and August 2022.
The jury is still out as to whether the ADT/SRT combo meal was effective. My 3-month post-SRT PSA reading came in at 0.05 ng/mL, but my radiation oncologist and urologist both agreed that was most likely as a result of the ADT more than the SRT. (My radiation oncologist said it could take 12-24 months after the SRT ended before we know its true impact.) I had PSA tests in March (0.13 ng/mL) and May (0.11 ng/mL), showing that the 6-month dose of Eligard has worn off. They make us cautiously optimistic that the SRT is taking root in taking out the cancer. I have my next PSA in November, and I'm okay with that for now.
I had a PSMA-PET scan when my PSA was 0.21 and it showed multiple sites of PSMA avid disease in the prostate, right pelvis, nodes and bones. I've not had one below 0.1 so can't comment on that.
My radiation oncologist said my needed to be .06before the scan would be useful. I've just reached .07so VA is scheduling the scan with a community provider now. Im 5 years post surgery and had 1round of 39radiation treatments completed 12months ago
new enhancing 0.4 x 0.9 cm nodule in prostate bed on prostate MRI. PSA 0.1. PSMA/PET-CT negative. Soon to repeat imaging studies. PSA now 0.24
It doesn't require any specific PSA in order to detect any metastases in any patient, but the detection rate is significantly lower for tests done at lower PSA.....ultimately the benefit of testing at lower levels will be if , for those metastases that are found at lower levels, does the subsequent earlier treatment result in a greater life expectancy? The testimony from others here tells us that many Docs do believe it is useful at lower PSAs!
My PSA was 0.2 and the scan found 4 mets
Did you zap them and lower your psa as a result? Thx
Yes, radiation, lupron and zytiga. PSA <0.04 for 2 years so far.
Thanks so much. My psa <.006 three months ago and now .014 so I’m getting a psa.
Sorry to bug. When your psa went up did you have weight loss and now how is your weight? I have been stressed so I’m sure not eating as much is part of my issue. Being on adt I have weighed the most ever at 170. Thanks so much
I had a similar conversation with my radio oncologist last week at MD Anderson. While not directly on point, I was told that cancer cells must be present in the millions for them to become avid on a PSMA scan. My regular oncologist at MD Anderson has also told me that PSMA scans are not useful/indicative with low PSA (my PSA is below 0.5 after ADT). Hope this helps,
My MO, Dr. Sartor, waited till l reached close to 0.2 before suggesting that I get one. I had been undetectable for 6+ years and on ADT for close 9. It detected a spot on one of my ribs that I had treated with SBRT. It has since fallen back to 0.08, seems to be holding there.
Ed
I'm a patient of Dr. Sartor also. My situation is a little different from yours ( LOL aren't we all) in that I'm not on ADT yet but he suggested a Pylarify scan for me between .3 and .5 . Had one at .4 and it was negative.
I would like to thank you for the time and effort you've put into giving so much information on profile/biography . It is really helpful information and it also tells me you are a warrior. Good luck and keep on keepin on my friend.
I was to start my ADT vacation after 2 years of treatment. My PSA was 0.03 and my T was 3. My oncologist ordered a PSMA scan, Aetna Medicare Advantage denied coverage. Having been on this site for several years I was not surprised and did not appeal…
my husband is undetectable and has no other signs of spread other than PSMA scan lighting up .
Could it be false positive? What is the psa? Do you have pain?
That's what I've been told. Just had the new Pylarify PSMA at 0.91 and picked up 2 Mets in 2 lobes.
0.2-0.3 psa for six months and CT scan found T5 vertebra met confirmed by PSMA scan. I viewed scan with oncologist and it was bright yellow-orange and unmistakeable. About 1.3 cm. I completed SBRT yesterday, 5 fractions 3500 cgy total. To answer your question (not really) it depends on the result one is seeking.
I believe that the 0.5 threshold is the general rule. My PSA began rising from undetectable after 5years following salvage radiation. When it got to 0.18 I had a Pylarify PSMA PET/CT and it showed 2 metastases. Lucky I guess. BTW insurance did cover it. Best wishes.
Just my two cents...and believe that's about what it's worth. If you feel comfortable that your insurance will cover an early scan (below .05) and it will not prohibit coverage on subsequent scans, whether it's positive or negative, it never hurts to establish a base to work off of. Again just my opinion.
I initially had a pet scan with Auxim when my ultra sensitive PSA was .52. It did not die anything. Recently when my PSA rode to .78 my doctor recommended a PSMA pet scan. It identified 2 tumors in my lymph nodes. They were radiated and I will go for another PSA test in August
I think thoughts on this are evolving. I had a PSA below the level of an ultrasensitive test and still had a positive PSMA PET/CT. I know Mayo Clinic has a case series they are collecting, as does Nat Lenzo in Australia, of patients the are PSA "negative" and have PSMA PET/CT positive lesions. An obstacle to case collection is insurance policies/contracts that do not allow payment for PSMA PET/CT unless PSA thresholds are reached. So I do not think there is valid dogma about this question.
My PSA was 0.31, 4 days before my PSMA CT pre-screening scan for PSMaddition trial and dropping (2 weeks later down to 0.16). I was PSMA avid enough for acceptance into the trial. Of note, the locations of the mets were mostly in the same location as noted on the bone/CT scan a few months before. The only difference was a met first noted on the spine was not noted on PSMA scan and one on the rib was noted on PSMA scan, but not noted on the earlier bone/CT scan. Either resolution difference between scans or changes in mets between scan (ADT start half-way between scans). It was about 3.5 months between scans.
Late spring 2022 my psa went from .1 to .3 and to .4 over about 12 weeks. There was another 3 weeks after the .4 because I got covid.
At the known .4 the psma scan showed 1 deep right iliac obturator lymph node.
That obviously went to adt, 33 rounds of EBRT and abiraterone in January 2023.
PSMA pet scan
PSMA PET scan results 
PSMA PET Scan
pSMA scan question 
PSMA PET scan
