Best alternative PET for PSMA negative PCa

[Vynbal]

Asking for a friend. He was diagnosed 3 years ago with high risk high volume (Gleason 3+5) PCa. Treated with EBRT + LDRBT + ADT (18 months). His PSA was undetectable but is now rising (3+) but PSMA-PET was negative, even in the prostate - implying PSMA non-avid cancer. What would be the best non-PSMA PET scan for him?

[GP24]

You could just wait until the PSA value reaches 5 or more ng/ml and repeat the PSMA PET/CT. Otherwise I would try a choline PET/CT, it is more sensitive than an FDG PET/CT. Another alternative is an Axumin scan.

[dhccpa in reply to GP24]

Is a choline PET known by another name? Thanks

[GP24 in reply to dhccpa]

In the US it is mainly offered by the Mayo clinic where it was developed:

mayoclinic.org/tests-proced...

Outside of the US it is offered by many clinics. However, the demand for scans detecting PSMA negative tumors is low, so usually a PSMA PET/CT is done which is more sensitive.

I had a PSMA PET/CT which did not detect anything and therefore wanted to check for PSMA negative tumor. The choline PET/CT did not detect anything as well. Three months later the PSMA PET/CT detected mets.

[dhccpa in reply to GP24]

Thanks. Yes, I wondered if that was the one at Mayo. I didn't realize no one else in USA offered it.

I have had four Axumin scans, last on 1/3/2024, but have not had the PSMA scan yet.

[Tall_Allen]

Instead of fishing for metastases, he may be better off with a short, intensive hormone therapy as in these trials:

prostatecancer.news/2023/05...

prostatecancer.news/2022/09...

[Mascouche in reply to Tall_Allen]

Hi TA. I always prefer to read your own articles to those on PubMed as they are easier to understand. Did you ever write any about STOMP or about ORIOLE? If so, would you be so kind as to provide the link to those?

EDIT: Never mind, I have fixed my laziness and found how to search your articles.

Got this one for ORIOLE: prostatecancer.news/2019/09...

and this one for STOMP: prostatecancer.news/2017/12...

Thanks for having written them

[Tall_Allen in reply to Mascouche]

See also Section III of this:

prostatecancer.news/2020/07...

[lokibear0803]

you might look into 64Cu-SAR-bisPSMA:

urologytimes.com/view/fda-a...

[V10fanatic]

I waS PSMA non-avid and an FDG-PET picked up the latest round of mets.

[NanoMRI in reply to V10fanatic]

At what PSA? I am learning even at very low PSA values one of available imaging methods may be successful - which one is the challenge.

[V10fanatic in reply to NanoMRI]

I was at 7.25

[NanoMRI]

I see great value in imaging (fishing) for mets at very low PSA values, with intent to reduce tumor burden - not just to affirm cancer remains. Over six years ago, after unsuccessful salvage RT, at 0.11, I traveled from US to Europe and had successful imaging. I chose surgery to remove identified pelvic mets as an alternative to STAMPEDE trial protocol. Today, with PSA holding very low stable 0.03X range, and with unsuccessful Ga68 and Pylarify PSMA PETs, I am considering either fluciclovine/Axumin or Mayo's Choline combined with mpMRI. Yes, well ahead of common practice, but I have learned to not give this beast time and obscurity. I would prefer the imaging I had in Europe, but currently it is not available; in my words it is tied up in bureaucracy.