At what point for scan ?

[positive-thinking]

Hi.

Currently just had # 4 chemo. Live in Canada so PSMA has never been done . Bone scan and CT scan. I'm wondering at what point it would be good to get a scan ( they already said it would probably be a CT scan as that's all we have in my province and eventually another bone scan which He has to fly to get. Below is the PSA numbers so far. Zoladex and nubeqa are the treatments that were started before chemo . Positive for BRCA2 with blood test . We do not have an oncologist in this province and the doctor has training and gets advice from oncologist in Vancouver Prostate Centre . Mets on diagnosis , ribs, shoulder and several in pelvic. Gleason score 9

PSA-

4.13 ( May ) Referred to oncologist in July and diagnosed in October of 2023

35 ( Nov 29 )

2.79 ( after 5 weeks of ADT )

0.45 ( after # 1 chemo )

0.27 ( after # 2 chemo )

0.14 ( after # 3 chemo )

[JohnInTheMiddle]

Go PT! All the way to zero! Also don't forget to exercise! Many threads on this forum on that topic.

May I ask if you are a fasting two days or so around your Docetaxel?

[positive-thinking in reply to JohnInTheMiddle]

No fasting and doing as much exercise on days that the fatigue / pain allows . ( snowshoeing ) Does exercise help with side effects or is it make the chemo work better?

[Leaffan57 in reply to positive-thinking]

Exercise of any sort helps, I walk my 10-12000 steps, throw the weights around a couple of times a day while working at home. Good luck and keep it up.

[HikerWife in reply to positive-thinking]

Both! And fasting helps the chemo attack the cancer cells while having a protective effect on healthy cells.

[jfoesq]

It's my understanding that typically the PSA must reach .20 for a PSMA to be effective in showing any possible changes to tumors. I am far from being an expert, but I do wonder why they didn't do a PSMA before beginning chemo so they would have something to compare a follow up PSMA scan to and see if the tumors have changed or will change.

[positive-thinking in reply to jfoesq]

They don't do PSMA scans in Canada, you either have to pay a great deal out of pocket ( even than they are hard to get booked for ) or be in a trial. They did bone scan and cat scans. We have a cat scan here where I live and have to go away to get another bone scan one day .

[tn12 in reply to positive-thinking]

Where in Canada are you? You can easily book one in Montreal

[positive-thinking in reply to tn12]

I live in the Yukon and we only have ct scans here, have to fly to Vancouver from here just to get a bone scan.

[jfoesq]

Well- at least it appears as though he is having a good response so far. I hope he responds well to treatment for a long time. BTW- I used to be a proponent of "social medicine" in the US but after reading stories about the time it takes to get appointments for certain appointments and surgeries along with the refusals or delays for the countries who have social medicine to make available certain diagnostic procedures and/or treatments. I think I have changed my mind. Hoping for the best.

[positive-thinking in reply to jfoesq]

Thanks for your kind response and really hope the best for you also. Things really do need to change in regards to the medical world , sadly you are right

[j-o-h-n]

Thanks for reminding me to remove "Moving to remote Canada" from my list.... (Best wishes and keep fighting)....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Islandboy2021]

I live on Vancouver Island and get treated in Victoria. They tell me if you have multiple Mets that show up on CT Scans then you don't need the PSMA scan to locate the micro Mets. If and when you get LU-177 then they will give you a PSMA scan. They have one in Victoria and one in Vancouver. I asked these same questions and was upset that these scans were not offered. I am slowly staring to understand the reasoning. There is so much to learn about this disease in a short period of time. You need to educate yourself so you can make the right decisions. I am starting to get educated but wish I could have learned more early in my disease.

[positive-thinking in reply to Islandboy2021]

Yes it a great deal to learn , my husband relies totally on me and has no interest in learning or even asking about anything. I'm no doctor and I get freaked I'm going to be blamed when he turns castrate resistant , him thinking it was something I suggested. I'm not saying he would ever do this and it is probably just my own fear and anxiety . Why do they give you the LU-177 ? Is it only given if you are getting this scan ? I never understood this part?

[positive-thinking in reply to Islandboy2021]

I was just reading your last post and wondered if you ever went into the trial for Pluvicto ? Of so how is that going ? Hope you are doing well

[Islandboy2021 in reply to positive-thinking]

I am currently doing chemo for the second time. I will try and get into the LU-177 Trial once the chemo fails.

[Cackalacky_cyclist]

My question in this case would be “What change in treatment, if any, might occur given data from a PSMA scan”? I am totally on board knowing absolutely everything about the Mets that exist, but given the current PSA decline, would the higher resolution scan change the treatment? I believe a PSMA scan after a clear CT scan would be of greater benefit, since the higher resolution would show everythi else that needs to be attacked, and new treatment decisions could be made.

Or, am I totally off base?

[positive-thinking in reply to Cackalacky_cyclist]

Sorry about all the confusion but I was never asking about a PMSA scan as they are almost impossible to get . My post was asking about a scan ( Ct scan ) after chemo is complete . At what point down the road should my husband get this scan since his PSA was always so low before diagnosis.

[Cackalacky_cyclist in reply to positive-thinking]

Ah, I understand now. I’m not an expert or dr., but I would guess no scan until the PSA begins rising. How much depends on the expectation of what a CT scan can see, which the Dr. would pinpoint for you.