Can PSMA-PET scan be used off label?

[Teddy28]

I have a friend who has had multiple MRIs and biopsies to locate his presumed prostate cancer. His PSA is high, around 20 but fluctuates and this has gone on for a number of years. He had antibiotic therapy but this did not make any difference.

I was wondering if a doctor would prescribe a PET/ PSMA scan to determine if there is prostate cancer present, and would Medicare cover such a test. I recognize there could be some clinical trials that would suffice.

Any thoughts?

[fireandice123]

Did the biopsies and MRIs show he has cancer?

[Teddy28 in reply to fireandice123]

No cancer found.

[Don717]

I had 3 biopsies over 18 months before we hit cancer. I would ask his providers what they can do to expedite a possible solution...like a PSMA/PET scan in his situation. If there are suspicious results from his MRI's he might be able to use that as leverage. How large are the fluctuations? Stay diligent as you are and thanks for helping your friend.

[Teddy28 in reply to Don717]

I don't know about the fluctuations. I was thinking his medical history could be used as justification and am hoping someone did that route

[NanoMRI]

I find outside independent 2nd imaging finding opinions crucial. Currently waiting on 2nd opinion of my recent Pylarify PSMA. Prior to my diagnosis my PSA fluctuated between 5 and 12 for number of years and my DRE's were always clear; all the while my elusive cancer was spreading. All the best for your friend.

[GP24]

In Australia a PSMA PET/CT is cheap and you can use it to diagnose PCa. See this lecture: youtube.com/watch?v=EKwY62Y...(Not working as expected?)

[Teddy28 in reply to GP24]

GP24 - thanks for sharing this. Very interesting and helpful.

[Tall_Allen]

No, and its sensitivity for detecting cancer in the prostate is low- worse than the MRI. He can get a Confirm MDx test:

mdxhealth.com/confirm-mdx-f...

[Teddy28 in reply to Tall_Allen]

Thanks TallAllen, I will look into this and provide the information to my friend

[johnscats in reply to Tall_Allen]

That's interesting I thought the pmsa scan was the top scan to find prostrate cancer anywhere in the body

[dhccpa in reply to johnscats]

Me, too, based on this very forum.

[mababa]

Teddy, my biopsy showed cancer present. This allowed my referral to an oncologist (an RO in my case). She ordered my MRI and a Pylarify CT scan. Medicare covered all of my costs. Also, I was able to select the institution that performed the CT scan.

[Gaden]

He should absolutely be getting a PMSA/PET scan. With a PSA that high and the failure to find PC using either biopsy or MRI, the definitive test is PMSA/PET. My PSA rose from 1.4 to 2.2 over about two years after having had Proton Radiation four years earlier. MRI was negative and PMSA/PET was immediately requested. Nothing in the prostate but 3 bone mets and a couple suspicious spots in soft tissue. PSA dropped to 0.23 after two months ADT and hope to stop treatment when in a month or two after it goes below 0.4.