Rising PSA

[JolleySprings]

What are the most Accurate scans for detecting hot spots of cancer?

Husband has had several PSMA scans and CT with contrast yet nothing shows up.

He had one lymph show up in 2017 on an Auxium scan and it was radiated. 7 years later PSA rising… up to 14. Yet scans show nothing definitive.

CT with contrast showed what they described as “Unchanged” Lymph node suspicious for cancer metastasis yet not conclusive.

Does he need some other type scan? Should he proceed with radiation on “suspicious” lymph?

His and has been on Lupron for 6 years and recently and added NUBEQA about one year ago.

In one year PSA has been rising. Up to 14 now.

Dr. Aggarwal says no longer treat PSA # only scan results. Yet, CT with contrast is not definitive.

Thoughts?

Thank you!

[StayingOptimistic]

may be his cancer is not psma avid and he needs an FDG scan? Just a guess

[JolleySprings in reply to StayingOptimistic]

Thank you! Would a CT with contrast not show spots which are not PSMA avid??

[StayingOptimistic in reply to JolleySprings]

Good question. I thought about it but unfortunately I do no know the answer.

[God_Loves_Me]

super scan may be jnm.snmjournals.org/content...

[dhccpa in reply to God_Loves_Me]

What interpretation did you draw from that?

I was struggling to relate it to the post.

[God_Loves_Me in reply to dhccpa]

I am addressing this line "PSMA scans and CT with contrast yet nothing shows up", i think super scan or FDG Scan will show more things

[dhccpa in reply to God_Loves_Me]

Thanks. I've never heard of it. Do you know if it's readily available in USA? Or has another name?

[God_Loves_Me in reply to dhccpa]

It is clinical trial and available in USA. Please chekcout nearest location and touch base with them

Here is the press release as well

ir.ambrx.com/news/news-deta...

[dhccpa in reply to God_Loves_Me]

Thanks, that clarified it.

[Derf4223]

Consulting with Dr. Google "nubeqa versus abiraterone" this came up

ncbi.nlm.nih.gov/pmc/articl...

excerpt:

"Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined by rising levels of serum prostate-specific antigen (PSA) despite androgen-deprivation therapy in the absence of metastases on conventional imaging (1,2). Among nmCRPC patients, higher PSA levels and shorter PSA doubling time are associated with increased risks of metastases and mortality (3-5). Three androgen receptor inhibitors—apalutamide, enzalutamide, and darolutamide—have been developed as add-on therapy to androgen-deprivation therapy for nmCRPC since 2018. Phase III randomized controlled trials (RCTs) demonstrated their superiority to placebo in delaying PSA progression, metastasis, and death (6–8), "

[JolleySprings in reply to Derf4223]

NUBEQA did not work for him. Side effects were worse than Lupron, unfortunately! Also, it did very little, and only at commencent of treatment, in bringing down his PSA.

They are planning to do targeted Radiation on this lymph node that, as report states is “suspicious for metastasis.

I’m not sure it is a good idea to radiate on “suspicions”… 🤦‍♀️

[God_Loves_Me in reply to JolleySprings]

Have you talked to DR about side effects ? Dr should prescribe XTANDI that can help you with side effect

[Seasid in reply to JolleySprings]

You could ask for nano MRI to see if the lymph nodes are infected or not.

jnm.snmjournals.org/content...

[Nfler in reply to Derf4223]

Yes I figured it had something to do w nubeqa as the rise in psa occurred a year ago when starting nubeqa. Maybe do an fdg or super scan like mentioned above…

[Maxone73]

64Cu-SAR-bisPSMA would be the most precise, but maybe at the moment he would have to be enrolled in a trial to use it

[Chris52981]

my dad has same thing his scans show stable every three months psa goes up to 10 now - the dr said sometimes he sees this - so they monitor him very closely

[JolleySprings in reply to Chris52981]

Ugh! I hate that! I want to know where it is in hopes of radiating it!!! 😩

[Seasid in reply to JolleySprings]

Ask for nano MRI to see if the lymph nodes are infected or not.

jnm.snmjournals.org/content...

[Chris52981]

can we just radiate it rather than going on new meds

[NanoMRI]

Would be interesting if you share blood biopsy results. Your bio suggests to me you have an excellent multi-disciplinary team. Dr Kwon of Mayo has informative YouTube discussion about different types imaging. Six years ago I went to Europe for Ferrotran nanoparticle MRI with PSMA for comparison. At usPSA 0.1 nanoMRI identified five suspicious pelvic nodes whereas the PSMA was clear. Cancer was confirmed by salvage pelvic lymph node surgery; so at least in my case the nanoMRI was better.

[JolleySprings in reply to NanoMRI]

His blood biopsy result was he has CDK12 mutation. He recently had FRACTIONATED Blood biopsy from which I understand it will specify percentages of the load of mutation. Not sure it will change treatment plan whatever the result is.

[Tall_Allen]

For non-metastatic CRPC, Erleada, Xtandi or Nubeqa are indicated.

[JolleySprings]

Dr. Aggarwal has ordered To add Zytiga to his Lupron. NUBEQA did not work for him. 😩

[Retireddoc]

PSMA PET is the most sensitive/specific Imaging test available.

[treedown]

I am in a similar boat though it seems you husband is CRPC and I am not yet. I am in that scan and see part of treatment as well. If he is not is pain that also makes it harder for a Dr to trace mets. However, if there is no pain as with me I am just going to enjoy this time as best I can. I went a year between recurrence and new scans. Now they want them again in 3 months. I feel good and PSA is low but for some reason they are concerned the cancer has morphed to a low psa version. Not sure why. I asked my Dr if I am just waiting to become CRPC and he said yes. After watching the posted video by Dr Scholz I am/was thinking about consulting with him ot somebody like him. Your Dr is top of the heep and has me rethinking it if any value in a another opinion.Thanks

[RoseDoc]

Consider consulting Dr. Kwon at Mayo. He does a Choline PET there. He claims lesions show on that scan that PSMA PET scan won’t show. If PSA is rising, you have metastatic disease

[dhccpa]

Great question. I recently had a somewhat similar experience.

[God_Loves_Me]

Following two clinical trial may work really good base on your post and bio

clinicaltrials.gov/study/NC...

clinicaltrials.gov/study/NC...

[jazj]

Can anyone actually point to any scientific articles that actually document an imaging modality that detected lesions where 68Ga PSMA-11 or [18F]DCFPyL PSMA CT scans didn't as I've never seen one myself. Of those two, [18F]DCFPyL is supposedly slightly superior and outside a clinical trial I would assume is the most accurate you can currently get. (Sorry can't remember the study where they did a comparison between the two.)

Seems like there can always be an "exception to the rule" though but you would think it would be documented in scientific literature somewhere based on occurrences with multiple patients out of the millions of PCa patients since PSMA CT scans started to be used.

The other possibility that hasn't been mentioned here is incompetence (or more politely put as an error) in administering and/or analyzing his scan results. What might be described as "suspect" may be positive for cancer and responsible for the vast majority of his PSA level. This to me seems like the most plausible explanation. If it's not human error, tell them to fix their machine (joking, sort of.)