PSMA Scan to be scheduled - thank you Tall Allen

[Geno2853]

I want to thank Tall Allen for his suggestion that I see an oncologist.

I had a RP followed by radiation in 2013. My PSA was undetectable until 2021, when it started to rise. This week I saw a radiation oncologist (whom I found through a friend) to ask him a lot of questions and to get his advice. The upshot of that meeting is that he is going to schedule a PSMA PET scan and we will go from there. My latest PSA value is 0.51. The oncologist and his resident pulled up a study during our meeting that showed that, with a PSA of .5, a PSMA scan likely would show the location of the cancer cells 50% of the time. The oncologist said that, if the scan shows localized spots, he might be able to radiate them, reduce my PSA to zero, and delay my need to begin ADT treatment for maybe two years. In other words, the scan might buy me an additional two years off ADT.

[Tall_Allen]

You're welcome. If your only spots are in pelvic lymph nodes, you may be able to irradiate the entire pelvic lymph node area (with a boost to the spots), and take 3 years of ADT and 2 years of abiraterone and get cured.

If there are bone metastases, they can be zapped but ADT is permanent.

[Jmr11820]

What was your PSA when you had salvage radiation and what was the time between surgery and radiation? Thanks.

[Geno2853 in reply to Jmr11820]

Radiation followed 6 weeks after my prostatectomy.

[Jmr11820 in reply to Geno2853]

Thank you for sharing that. What was your PSA after your prostatectomy that led you to starting radiation so soon? I only ask because I had a fairly similar diagnosis and did radiation six months after my prostatectomy. I’m five years out now and so far still undetectable. It caught my eye when you said you were eight years out before you had recurrence.

[Break60]

I had my CTPET scans when psa was in the 1.0 to 2.0 range when they’re more accurate. Just sayin.

[NanoMRI]

Your post is interesting as my treatment strategy since my RP and salvage RT to prostate bed in 2016 has been to defer ADT/chemo/CR as long as possible. The dichotomies within this discussion exemplify challenges we face with this beast. Emphasizing general population percentages of success/failure have and continue to puzzle me - successes for the individual are wonderful whilst negative investigative results do indeed provide additional information. And if I read correctly, your oncologist has a strategy to delay ADT while another member advises a regime of ADT and abiraterone just may cure you.

After my salvage RT nadir of 0.075 I qualified for the STAMPEDE trial but said no and at 0.10 had Ga68 PSMA along with Ferrotran nanoparticle MRI. Although the PSMA was clear the nanoMRI identified suspicious pelvic lymph nodes. With NED in bones and organs I chose salvage ePLND which confirmed cancer in common iliac and para aortic nodes, yielding a nadir of <0.010 (that was March 2018). For the past two years my usPSA has been holding steady in 0.03X range, still no ADT. In 2022 I had second Ga68 and Pylarify for comparison – both were clear (not unexpected). Last year I had GUARDANT360 blood biopsy – result reported as Not Detected. (I appreciate some say imaging and blood biopsies at 0.03 are a waste – but this is not how my independent multidisciplinary team sees it). If/when my bi-monthly testing indicates rise into 0.04X range I will have choline PET – and may return to Europe for the nanoMRI. All the best to all of us!