CT and Bone Scan 2 weeks after PSMA PET?

[sixmongoos]

Note: for reference, my dad lives in BC, Canada. I believe the system here is a bit different than the US - we have a urologist who refers us to the RO when needed. Therefore, there is no relationship between the urologist and RO - the RO is part of the cancer institute, but the urologist is not.

My dad did a PSMA PET scan 2 weeks ago (referred by our urologist) when his PSA climbed from 0.03 (Apr/23) to 0.08 (Jun/23), then spiked up to 0.45 (Sep/23) after RP. The scan showed uptake in one of the right iliac lymph node, so our urologist sent us to a RO for salvage radiation. For reference, my dad re-did his PSA test last Wednesday (Oct/23 - so after a month), which stayed at 0.48.

Now, the RO is asking us to do another PSA test, CT scan and bone scan, before he can see us. I imagine all this would take another 1 to 1.5 months. We have seen the same RO before last year, where we agreed to re-connect after doing a PSMA PET scan when PSA reaches 0.4.

My argument was to start ADT and salvage radiation ASAP, but maybe I'm missing something here. What is the benefit of waiting and doing another: 1) CT/Bone Scan after a PSMA PET 2 weeks ago, and 2) another PSA test after a week?

[Justfor_]

1) His experience is with CT/Bone scans. PSMA pet scan is still uncharted waters to him.2) Doesn't trust the lab and/or prefers the one he routinely uses?

[RyderLake2]

Hello,

I too live in British Columbia. I have been battling PCa for a very long time (over ten and a half years. My advice, for what it is worth, is to move away from your urologist and put your faith in your Radiation Oncologist and perhaps later in a Medical Oncologist. I am assuming you live close to a B.C. Cancer Agency. I have been a patient of the cancer unit at Abbotsford Hospital for a long time. The medical team there is outstanding. I am also participating in a clinical trial at the B.C. Cancer Agency in Vancouver. The trial is investigating the use of Lutetium (Pluvicto) pre-chemotherapy. The clinical trial team in Vancouver watches me like a hawk and I am so impressed with all of them. Good luck!

[MateoBeach]

He may need those other scans for "mapping" of other organs/structures in the pelvis for planning purposes. This is usually called a "simulation CT" and is done in the radiation oncology department. The images are then "fused" (overlayed) with the PSMA scan to plan treatment margins, etc. for the salvage treatment. Your treatment plan should be targeting the entiire pelvic lymph node fields and not just the one avid iliac node. Bone scan might just be his/her routine. It is used to rule out bone metastasis not seen on the PSMA scan?

Can you message the RO and ask what his plan and timeline is? Get scheduled for a simulation CT for whole pelviic LN salvage RT? While you are at it, request a referral to an MO within his canceer center so you can cut the ties with the Urologist who is unneeded now.

[j-o-h-n]

Money......

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 10/19/2023 6:06 PM DST