Baseline PSMA-Pet scan?

[duxlubber]

My MO has given me instructions to end treatment 7/31. I've been on Lupron & Zytiga/5mg prednisone since 8/1/2022. I started out with Gleason (3+4) 7. Last May I had pelvic radiation to hit lymph nodes as per a 2021 PSMA-Pet scan. Now it's time to stop all treatment at the 2 year mark. My MO just kind of mentioned off the cuff that we should probably get another PSMA-Pet scan to use as a "baseline." My question: is that necessary or even sensible? My PSA and Testosterone have been suppressed to <.1 and <4 for two years now. Isn't it pretty likely that the PSMA-Pet will be inactive for the most part?

[6357axbz]

Interesting. My MO also had me do a psma pet scan when my PSA was undetectable for a “baseline”.

[Tall_Allen]

I agree with you. I have no idea what a "baseline" means in this situation. If there were a rising PSA, a PET would be useful to guide further treatment. Why would a patient get one if there is no indication?

[duxlubber in reply to Tall_Allen]

thanks so much for weighing in..

[Still_in_shock in reply to Tall_Allen]

I think it's a Kaiser thing. Im at <0.1 PSA and <4 T. Was given a "baseline" PSMA coming into Kaiser. Also CT, and DEXA. They are talking about a Bone Scan, just for the heck of it!!

[j-o-h-n]

Can scan or can the scan?

Good Luck, Good Health and Good Humor.

j-o-h-n

[VanHalen84]

My Petscan show uptake areas that were indeterminate, later thought to be from an old hip injury. Maybe the baseline means to find uptake areas that aren't cancer?

[lowT163]

mayo won’t do one until .6. Got a buddy waiting now for his to rise back to that point with an open appointment when it rises to that. Whatever that’s worth.

[duxlubber]

Yeah, I appreciate the discussion. I think I'm going to "can the scan" and get that 5 yr colonoscopy instead! Thanks!!

[Nfler in reply to duxlubber]

😆 😆

[Still_in_shock in reply to duxlubber]

I would wait longer than a year for a colonoscopy post radiation.

[duxlubber in reply to Still_in_shock]

I’ve wondered about that especially with “factory medicine.” Two years? Three years?

[Still_in_shock in reply to duxlubber]

Ask your RO, when they think its safe, they know how much your colon was exposed, not the GI doc

[Mgtd in reply to Still_in_shock]

In the interim have you considered a Color Guard test? Not perfect but will allow you piece of mind during the delay from radiation.

[NanoMRI]

At usPSA 0.13 I traveled to Europe for imaging. The Professor of Radiology who did that imaging, a recognized international top-researcher (now retired), spoke to the value of baseline imaging. Well, that imaging was more than a baseline, for it identified suspicious pelvic lymph nodes. Several were indeed confirmed cancerous. It is logical to deduce those cancerous nodes were there at usPSA <0.10. Imaging in my experiences is indeed sensible, even when no concerns are identified; this was also my experience when I had an ‘all clear’ knee MRI.

[Lewellen]

I'm in a very similar situation to yours and stopped my ADT 2 months ago. I just had that PSMA discussion with my MO yesterday!I agreed with him, no point in doing it.

As a side note, I wasn't offered a titration schedule to get off the prednisone, and that gave me some trouble. Even at that low .5 dose it would have been good to wean off of it. You may want to ask about that.

Have fun getting your T back! 🎉

Feeling that tickle of libido start to return after 2 years of treatment was... life affirming 😁

[duxlubber in reply to Lewellen]

Thank you!!!

[duxlubber in reply to Lewellen]

I'm assuming you would taper off the prednisone after the Zytiga is stopped altogether and then maybe adjust the dose for a week or two?

[Lewellen]

Yeah, I imagine something like that. Cut back enough to let your system know to start making it again.

I don't remember it being truly awful, but since I wasn't expecting it I didn't know what was happening!