Where I am receiving treatment, ADT, LD Brachytherapy, LINAC radiotherapy (15) sessions.. PSMA pet scans are not available (Japan). I planning on ending adjuvant ADT therapy within a few months and am aware of the lasting effects on testosterone (will take 6-12 months for decent testosterone levels ..hopefully). While traditional CT scans and bone scans showed no Mets, I want to get a PSMA scan soon or sometime post treatment. Would a PSMA scan be beneficial sooner than later or should I wait for testosterone to recover. I’m assuming that since my current PSA level is so low (.01) a scan at this point would be pointless. At the same time adjuvant ADT should be taken longer if there is some metastasis. I guess the best scenario would have been to fly overseas to get the scan beforehand but I didn’t. Any input appreciated. Thanks!
Post treatment post ADT time to PSMA ... - Advanced Prostate...
Post treatment post ADT time to PSMA test
PSMA PET is pointless unless PSA> 0.5
Thanks TA.
these statements of yours puzzle me - ? I had my first Ga 68 in January 2018, at usPSA 0.1, at Radboud UMC Nijmegen in conjunction with Ferrotran NanoMRI. My second in December 2021 and Pylarify for comparison in June 2022, at different centers in Houston, TX, done at 0.030 (yes, 0.030). The professors and docs I consult with in US and Europe would not agree these are pointless.
Neither do I. You may check my 2 years back reasoning here
healthunlocked.com/prostate...
Most excellent!!! Thank you for sharing. I, and my medical team, find "clear" imaging results very useful. My focus, from the outset of my diagnosis nine years ago, is to delay ADT/chemo for as many years as possible. Clear imaging contributes reliable investigative data to delay ADT and chemo. So far, no ADT/chemo. My treatments include RP, salvage RT and salvage ePLND . I am most grateful and remain on guard as I have learned to not give this beast time and obscurity.
You are doing excellently. My complements!
Just out of curiosity: Was your salvage PLDN, PSMA detector guided using the 1st generation robotic arm radio-tracer probe? I gather the second generation one is too recent to apply in your past case.
Thank you! (been 'insulted' a few times within this group - makes no sense to me). No, not PSMA detector guided. 'Simply' a 'traditional' robotic ePLND. Surgery done by: alexmottrie.com/about
PSMA expression is closely tied to PSA. At a PSA of 0.2, the probability of PSMA PET finding anything is about ⅓. It may be higher if PSA is rising rapidly. The docs you consult with are mistaken if they said otherwise - where is their data?
I will take a 1/3 chance, even less. Given the annual death rate is rising, as is the number of men on ADT, the guidelines and standard thinking cannot be right. Am I correct you are just a patient, apparently not facing any remaining cancer threat, may be "cured", and you're suggesting the doc's I consult are mistaken? I appreciate you hold some level of esteem here - I will stick with my doc's thank you.
You clearly have the resources to pay for wasted tests. Many patients don't. If money were no object, why not get all these useless tests? The only caveat is you have to know they are useless, otherwise you are lulled into a false sense of security.
We all have the ability to look at the same data. If you choose to forgo that option and not ask questions of your doctors, that is your choice.
It's a tough road on what's right and what's wrong timing.
I pushed for a psma at .1 and my RO said NO too low. I told him that we needed another psa test, it had only been 7 weeks. It came back at .3 and he agreed to order a psma. That uncovered a sing obturator lymph node that got a boost of EBRT.
It's all debatable and depends upon what numbers and data you want to hang your hat on.
We need a 66% chance or better to do something. Or we're willing to try at 33% to do something. What's right? What's wrong?
Well done on the push! I do not see it as a rough road on what's right and wrong, but I certainly do understand the sentiment as we face considerable disparate information. As I wrote elsewhere, with the annual death rate rising, as is the number of men on ADT, standard guidelines cannot be right. Even the often cited Dr Kwon of Mayo Clinic says this, encompassing all the new technologies and advancements. I choose to utilize all available investigative techniques to not give this beast time and obscurity, to do all I can to delay my need for ADT and chemo and even newer late stage therapies for as many years as possible.
There is little to debate about, apart from the degree of laziness vs ignorance of some docs. At low PSA the dominant metric affecting PSMA detection probability is the PSADT. Your personal example just validates this simple assertion. From 0 .1 to 0.3 within 7 weeks your PSADT was somewhere between 1 and 2 months.
Fortunately I was raised to save for rainy days, and I did. Had I followed the more common US clinical guidelines and thinking I would be on ADT and likely chemo. Instead, as I share, my docs and I think out ahead of clinical guidelines, outside of the box. Again, with the annual death rate rising and number of men on ADT also rising, the guidelines and data cannot be all that right. For you to presume I do not ask questions nor understand how to parse data, simply shows, well, others can draw their own conclusions about our little chat.
It only concerns a small minority, but surely not pointless if a (growing) cancer does not express PSA...
Then it probably expresses little PSMA either. Pointless for most patients, and worse, it gives false negatives.
I appreciate all input. My questioning revolved around a few specific points. Since I’m ending a 9 month session on ADT. I expect my PSA to very low until testosterone recovers so just wanted to confirm that number where a PSMA scan could possibly even detect or pick up that cancer is still present. Expecting a bounce and eventual baseline PSA level somewhere months after the final ADT, aware now of these critical levels .2 and .5 and of course the known doubling time referenced concerns. Assuming with PSA monitoring if needed I’ll be able to get a PSMA pet scan which would require me to fly out of the country so a bit more difficult but won’t hesitate where it could be beneficial in diagnosis and treatment. Part of my questions while obvious to some are on part because I’m in a different country with a language handicap and very different culture. While I have a partner who is bilingual it’s not the same and the facility, while good, is quite crowded. Overall I’m happy with my medical treatment so far which I feel has been very too. Appreciate everyone’s input . Good luck to all.
I had a PSMA scan when my PSA was >.5. based on the trajectory, it was probably in the .7 - .8 range. No cancer found. It can be a crap shoot at lower levels.
What tracer did you have? I have heard Dr. Kwon talk about using the 3 or 4 different tracers as they seem to provide better imaging from person to person.
While I ordered mine (Pylarify) at .3 my psa was rising quickly and could have possibly been at the .5 - .6 ish mark by the time the scan was performed. = single (.5 cm) deep right iliac obturator lymph node with uptake.
8 months after RP I was at .1. Seven weeks later .3 and two more weeks after that .4. So in nine weeks I went from .1 to .4.
So many variables as far as treatment goes .. I had brachytherapy radiation with a boost… from what I read RP is a different path … throw in hormone therapy and everyone is trying to compare apples to oranges. Always wondered why it’s not common to use some form of radiation with RP, of course depending on the staging. With each perspective though I learn a lot .. for example the tracers .. such a crash course here. My PSA pet scan in the future, if required .. hopefully not, will probably be Thailand as it’s fairly close and I’ve been to some of the medical tourist hospitals …as referenced in Morgan Spurlocks special. Thanks for your input and good luck to all.
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