Screening for Pluvicto

[MyDad76]

Thanks to Tall_Allen I have learned about the necessity of both PSMA and FDG PET CT in screening for Pluvicto.

I got referral for my dad for both screenings and ok, there is PSMA PET CT and than on referral from oncologist for FDG it is written: PET CT with 18F - FDG.

Is this referral for FDG PET CT with 18F correct? Or it should be without fluorodeoxyglucose?

There is no experience in our country with this process so I would like to double check not to take my dad to the wrong screening.

Thank you in advance

[Tall_Allen]

It’s fine.

[MyDad76 in reply to Tall_Allen]

Thank you 🙂

[MyDad76 in reply to Tall_Allen]

Is it a problem if they do PET CT with choline? So if under this abbreviation it is PET/CT with 18F-choline and not fluorodeoxyglucose?

[Tall_Allen in reply to MyDad76]

Choline PET will not work at all. FDG PET scans are widely available - how is it a problem getting it?

[Miccoman in reply to Tall_Allen]

I wish I could get my MO or RO to order a FDG PET scan.

I guess it is not written in the SOC so they come up with all these excuses and it never gets ordered. Their favorite objection is that it needs pre-authorization -- but I'm on standard Medicare with full supplemental so there is no pre-authorization. But URMC is a medical school so they have a huge problem doing anything not explicitly laid out in the SOC for a particular treatment.

To my amazement they are completely unaware of the difference between private insurance, standard Medicare and Medicare Advantage (I think that means advantage to the insurance company, right?); so it's a battle over things that shouldn't be. And I'm just too tired of it all to battle again.

Based on my experiences URMC generally views patients as inconveniences to be suffered in order to get paid. SMH

[Tall_Allen in reply to Miccoman]

Very frustrating! If you can, get your MO to read this:

euoncology.europeanurology....

It may not help, but at least you will have done all you can do.

[K-xo in reply to Tall_Allen]

We’ve run into the same problem. Three MO’s gave us pushback with FDG, including Dr. Dorff. For many of us, it’s just not possible.

[Tall_Allen in reply to K-xo]

I understand the argument against FDG. The VISION trial, which did not include FDG, found a benefit to PSMA alone in determining whether Pluvicto will work. Because it did not explore discordant subgroups, it is not a requirement for patient selection. OTOH, the Australians (who advocate FDG too), are saying that some patients can be spared the side effects of Pluvicto.

[K-xo in reply to Tall_Allen]

I’m with you and the Australians. Yes, that’s exactly right, TA. They base their decision on VISION, Phase 3. Unfortunately, many will be denied FDG here in The US

[MyDad76 in reply to Tall_Allen]

Thank you, will make sure it is not choline scan.

[j-o-h-n]

So tell us............ where is your dear 81 year old Dad located?

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 08/09/2023 5:48 PM DST

[V10fanatic]

My PSMA came up negative, so my MO suggested an FDG. It picked up 4 bone mets, so I am discordant. My United HealthCare Advantage plan covered both. Still waiting on the co-pay amounts on them, but in a conversation with a UHC rep I was told the cost would only be the $105 as spelled out in their literature.

[GumpaD28]

Not to be nosey or anything but it seems ur insurance is kinda of giving u the run around.