PSMA scan with PSA < 0.20?

[ron_bucher]

Has anyone had a PSMA scan before PSA reached 0.20? If so, were any tumors detected?

[Echotango51]

My Medical Oncologist told me a PSMA scan had to be 0.5 or greater for anything to show up. I had mine when my PSA reached 1.09.

[LowT]

Yes, twice. Negative results. 0.1 and 0.2 ,

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

Any chance of me fixing you up with Simonapo?

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/07/2023 10:11 AM DST

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

MRI revealed new enhancing nodule in prostate bed one year ago which is not PSMA avid.

[samill]

My PSMA and pet Choline analyzes detected 3 lesions including one in the L1 vertebra with a psa of 0.18.

It's not the number of psa that counts only for detections but also the doubling time. My PSADT was very fast. I don't believe it will detect anything for you.

Good luck

[Justfor_ in reply to samill]

Absolutely correct about PSADT being a more important metric than PSA for low values of the latter. I first learned about it from a Heidelberg paper some 4 years ago. Since then, there have been similar mentions in a number of relevent papers. In my thread entitled: "Contradicting silly doctors' parrots" I draw up my personal view regarding this from a purely mathematical viewpoint.

[Schwah in reply to Justfor_]

Could you please provide a link to that Heidelberg article and any other relevant articles on the subject of PSADT? I’ve heard it matters but I have no idea what’s a fast and what’s a slow PSADT. THX

SCHWAH

[Justfor_ in reply to Schwah]

Sure, I will when I am back home, mid next week. I tried a quick Google search, but got many other pertinent links unfortunately not this one. The original was about a cohort of 1000+ patients they had scanned at Heidelberg and performed regression analysis publishing in table form the relevant weight coefficients. There are 5 such different analyses having to do with the data they had for each patient. Patients that had PSADT and/or PSA velocity data were about 150 to 200 in number. It is my favorite paper because I could compile an Excel spreadsheet using the provided coefficients and thus have some "what if" comparisons. Interesting stuff.

[Justfor_ in reply to Justfor_]

The Heidelberg paper (2017): "Diagnostic performance of 68Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients".

link.springer.com/article/1...

A multi-variable nomogram about the probability of a positive 68Ga-PSMA-11- PET/CT detection, from Bolognia:

evidencio.com/models/show/2063

[Justfor_ in reply to Justfor_]

The PSA "magic" number of 0.5 but a longer PSADT, Detection probability 30% (less than half of case #1)

Case #2

[ron_bucher in reply to Justfor_]

Thanks for the links!

[Justfor_ in reply to Schwah]

Two examples:

1) Low PSA, Short PSADT, detection probability 65%

case #1

[Benkaymel]

I had a PSMA-PET scan with PSA at 0.21 and it showed multiple sites of PSMA avid disease in the prostate, right pelvis, nodes and bones.

[Keniszen]

My scan was clear , and then I got ADT shot and begin radiation therapy about a month after my Lupron shot.

[Hidden]

PSA <0.1 , PSMA/PET still detected my shrinking "hot" lymph node after radiation. (2 weeks ago)

Yeah I know it was 2 weeks after radiation, a little early!!

[Bcgkelly]

My PSA was 0.123 when tested in Heidelberg the day I had my PSMA scan and he repeated the scan for a second time fing cancer in a lymph node. Had radiotherapy to it. That was four years ago and my PSA has increased to 0.423. I will be having another scan soon. The general view in Ireland is that the closer it is to 0.5 the better chance of finding it.

[Nusch]

Yes, I’ve had two scans with PSA around 0.2, both clean.

[RS265]

I had a GA68 scan in January 2017 when my psa was between .01 and 0.2. It gave a false positive on my spine which just stupidly added to my stress whilst managing my mother's passing. Never seen any activity at that location in five scans since then.

Do not bother at this point as it contributes nothing to staging your treatment protocol.

Coping with the anxiety isn't easy, but take several deep breathes and relax into the fellowship😀

[Daddysgirl83 in reply to RS265]

Aah! My father is there now. They say a false positive lesion on his Spine L3 with a PSA 0,23. Anxiety is hard us now.

[fmenninger]

As psma pet scan is relatively new vs psa testing as a marker, is there a study on comparing the two? As we know, we can be psa negative but have lesions detected on a psma pet scan. Many say that to truly know our pca is in check us to have both a zero psa score and a clean psma pet scan. This maybe hard to get due to insurance as psma pet scans are not cheap. Other markers can be used as well in conjunction with a psa test. Let’s all warriors not forget that we are fighting pca, not our psa score!

Stay strong

[Bethpage]

My husband was the last patient in phase II of Stanford's trial of F-18 DCFPyL. The threshold PSA for the trial was 0.5. The trial found my husband's BCR - barely - at PSA 1.1. Mayo's C-11 choline, threshold at the time PSA 1.5, did not find it.

[fish7days]

Will the PSMA scan only detect distant metastases or does it also show whether there are lesions on the gland or not. If a scan is “clear” does it mean no metastases AND no lesions on the actual prostate gland? Thanks.

[ron_bucher in reply to fish7days]

"clear" just means whatever tumors you have are not large enough to see on the scan images. Or it could mean that your cancer does not express PSMA (less than 15% of cases as I recall).

[Clays711]

I am now getting PSMA PET scans every 6 mos. My PSA is undetectable at <.02. They are able to see my metastatic lesions just fine and provide SUV numbers.

[ron_bucher in reply to Clays711]

"SUV"?

[Clays711 in reply to ron_bucher]

The standard uptake value (SUV), also known as standardized uptake value, is a simple way of determining activity in PET imaging.

[jjpeabody]

I had PSMA PET at PSA 0.12, it showed intense uptake at a spot in surgical bed and nowhere else. Had SRT to bed and lymph nodes 1 year ago, PSA at 0.006 for now. Good luck.

[shortPSADT]

Mine was clear with a PSA of 0.484 and a doubling time of 2 months. Waiting for PSA of 1,0 for a second try.

[LongTimeRunning]

My PSA on ADT was dropping before my PSMA scan: 0.31 4 days before, and 0.16 about 10 days later, so it was likely under 0.3. The report found 3 sites of mets, with 2 of them PSMA-avid, SUVmax 1.1 and 4.1. It was enough for the Novartis white coats to have me partake in the PSAMaddition clinical trial.

[Cvit]

About 4 years ago, a few months after radiation & beginning ADT, my PSA was 0.05. Even though my radiation oncologist thought a PSMA scan would show nothing, I insisted, got the scan and it revealed a new bone tumor, which the doctor irradiated. My PSA then quickly fell to undetectable & remained so for over 2 years.

My doctor was surprised to see the tumor show up when the PSA was so low.

[ron_bucher in reply to Cvit]

What was your PSA before ADT?

[Cvit in reply to ron_bucher]

135 before initial radiation & ADT treatments.

[slpdvmmd]

I had a PSMA scan at Mayo Rochester in March with an "undetectable" PSA i.e. below the ultrasensitive level of <0.01 ng/mL. You can look at my profile to see my treatment history. The study was positive and demonstrate a mass behind my abdominal aorta that was PSMA avid with a significant SUV. I underwent 4 weeks of fractionated external beam radiation in April and May. I am getting a follow-up scan at Mayo Rochester next week. I know from talking with Dr. Kwon that he has a series of patients, of which I am one, who fall in this category of "undetectable" PSA and PSMA avid lesions that are classified as significant. I also know from talking with Nat Lenzo in Australia that they also have a series of PSA "negative" patients with PSMA avid lesions with a significant SUV.

[RMontana]

Yes, I did and was glad I had the scan before I proceeded with my sRT (salvage radiation)...here are some links that may help. Rick

healthunlocked.com/active-s...

healthunlocked.com/active-s...

PS Dr Calaise at UCLA told me personally that if I had a tumor of significant size that it would light up even when my PSA was very low; the antigen (surface) would still be available for the ligand to attach to...that is what I was told by a good authority. I had the scan before sRT to make sure I did not have MET...otherwise why bother as I would just have to have Chemo afterwards at some point...TNX

[john4803]

I had a scan at 0.4 PSA and it showed a lesion on the Lamina of the T-4 Vertebrae. Had it radiated.