psma findings

[Mikes21]

Haven’t heard from my Mo but I just opened the psma report and I don’t have any finding of metastasis. So I guess I run another psa? Monitor I guess? Anyway I’m happy for sure. I guess we will stay on top of it with psma and psas. Surprised my mo hasn’t called yet lol. She last said she was intrigued when I had the regular pet ct that didn’t light up so I wonder what she thinks now. Crazy I was <.006 in March and in June have .014 so I’ll still be vigilant going forward. Any guidance is always appreciated warrior brothers

[Tall_Allen]

PSMA PET/CT will probably not show anything until PSA reaches 0.5 - it is highly PSA dependent. IDK why you had a PET scan at such a low PSA, but the results are meaningless. Waiting is is a self-fulfilling prophecy - by the time PSA increases enough so that you will see something on a PSMA scan, you will reach an incurable stage.

I don't understand why you didn't have your pelvic lymph nodes irradiated, but if you want to cure your PCa, you need to get that done + 3 years of ADT +2 years of abiraterone.

[Mikes21 in reply to Tall_Allen]

Yeah I trusted what the mo said and the ro. So are you saying I can just spray the pelvic bed now and adt and pred and can be cured? Is there a particular order to start things out meaning radiate first? Would that be salvage radiation? I’m looking to consult with a new MO. Thanks TA

[Tall_Allen in reply to Mikes21]

I'm not guarateeing anything, but you only chance at a cure is salvage radiation of the entire pelvic lymph node area + 3 years of ADT + 2 years of abiraterone.

[Mikes21 in reply to Tall_Allen]

Sorry to ask TA but is there now a short course of salvage therapy like in a week or is it still multiple weeks every day? I see a lot of old posts where people had longer weeks of radiation and I have seen recent posts with one week of radiation. Thanks a bunch

[Tall_Allen in reply to Mikes21]

It's usually about 5 weeks.

[Mikes21 in reply to Tall_Allen]

TA would I also do chemo? I’m only on trelstar at the moment. Could I get zytiga going now too?

[Tall_Allen in reply to Mikes21]

No chemo.

[SViking in reply to Tall_Allen]

Why no chemo?

[Tall_Allen in reply to SViking]

Chemo is only beneficial when there are actively growing distant metastases. You would only get side effects and no benefit if used without metastases.

[Mikes21 in reply to Tall_Allen]

So chemo wouldn’t mop up any cancer cells? So I’m pushing for a repeat psa and if it pops from .014 couldn’t I go on zytiga with prednisone while salvage radiation is getting scheduled? I’m currently on Trelstar as the adt part. Thanks so much

[Tall_Allen in reply to Mikes21]

Once again--- chemo ONLY kills actively growing cancer. There is NO benefit if there are no actively growing distant metastases.

[SViking in reply to Tall_Allen]

So given that every few months a few more bone mets appear, it's highly probable that I have micro mets-- Chemo would not kill those? If not chemo for the mets, what's next? Already failing Xtandi mono therapy with PSA rising about a point a month.

[Tall_Allen in reply to SViking]

I don't understand - if you have increasing bone metastases, what makes you imagine that chemo wouldn't be beneficial?

[SViking in reply to Tall_Allen]

my question is, will chemo kill the bone micro mets that keep popping up? I’m sure the chemo will kill what has turned into tumors, but how to kill the micro tumors?

[Tall_Allen in reply to SViking]

Sorry, I have no idea what you are talking about. Chemo will kill actively growing metastases.

[Boacan in reply to Tall_Allen]

At what point (PSA) would you recommend salvage radiation along with ADT & Abiraterone? I’ve been undetectable for 4 years following RALP, but last 2 ultra sensitive PSA’s in April & July 2024 were .03 and .02 respectively. MO wants to continue monitoring until PSA reaches 0.20 before considering PSMA scan and possibly salvage radiation.

[Tall_Allen in reply to Boacan]

Good plan (0.2)!

[Mikes21 in reply to Boacan]

Sounds like we are in the same boat. I don’t like the waiting game. How are you holding up without stressing? I’m trying to stay confident that if my psa hits .2 that the psma will show where it is and we can zap the crap out of it.

[Boacan in reply to Mikes21]

I don’t like the waiting game either but I am retired professionally and now stay busy running my farm/ranch. Cattle & especially horses are therapy for me. I’d rather play the waiting game than go blindly into radiation. Tall_Allen has provided several studies that suggest the outcomes are no different waiting until 0.2 to begin salvage radiation…

[StayingOptimistic in reply to Boacan]

I did the SRT blindly at .07 psa and it failed.

[Mikes21 in reply to StayingOptimistic]

So what are you doing now treatment wise and how’s your psa? Thanks

[NanoMRI]

I too am awaiting results on my latest PSMA, and also liquid blood biopsy. Because you asked for "any guidance" - I have very different views based on experiences. I too had RP - mine over eight years back. My nadir was 0.050 and we accepted cancer had spread beyond the prostate as I rely on <0.010 as best indicator. After my unsuccessful salvage RT at 0.11 I learned from docs in UK that they begin PSMA imaging post RP at 0.030 - yes 0.030. Yes, findings are rare but for the men that it does indicated suspicious sites, very useful.

As I share, after my salvage RT I wanted alternatives to pelvic irradiation, ADT and possibly chemo. I was recommended and accepted into the STAMPEDE trail - I declined.

Instead, when my uPSA was back up to 0.11, I went to Europe for Ga68 PSMA (I was declined acceptance into US trial) and 'better' Freetown nanoMRI. Not surprising, the Ga68 was clear while the nanoMRI identified five suspicious pelvic lymph nodes. Six were confirmed cancerous by salvage ePLND with frozen section pathology method, yielding a nadir of <0.01.

The PSMA imaging results I am waiting on are my third since my uPSA rose to 0.030 post ePLND. My diverse, multi country medical team supports imaging at this value in hope of finding something. Results, even when clear, are by no means meaningless to me and my team. Same with the liquid biopsy.

Hope this is helpful to you. All the best!

[Mikes21 in reply to NanoMRI]

I really appreciate the feedback. Thanks a bunch and hope your psma goes well too 🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻

[Sagewiz in reply to NanoMRI]

Where is Europe did you have your tests?

[NanoMRI]

Had mine during trial at Radboud University, Nijmegen, Netherlands, in Jan 2018. Glad to see others are sharing as well - ,there is very limited availability at this time. The company SPL Medical is wrapping up Phase 3 and hoping to have general available later this year, likely first in Germany. Search SPL Medical - splmed.com, and you can reach out to them - very friendly.