I recently completed 23 radiation treatments of EBRT at Cedars Siani in LA for recurrent prostate Cancer. The cancer was in a lymph node near the prostate gland. My RO has informed me that we will check PSA in November to see if the treatments were successful. I mentioned doing a PSMA Pet Scan in addition to checking PSA and she said it was not necessary. I'm inclined to demand that we do the PSMA Pet but would like some advice from this group before I do. Thank You
It is not necessary and shows nothing useful. You just have to monitor PSA over time after you have completed your hormone therapy.
Thank You
You should had one before RT treatment as baseline to compare to. It's never late to have one for future use.
What diagnostic was performed to identify the metastasis to the lymph nodes? If it was a PSMA-PET should be in the clear and just monitor your PSA.
Depending on your insurance, they wont pay for a PSMA "just to check".
If your PSA stays up, then they will do a PSMA/PET to diagnose.
So PSA first. PSMA wont detect with ultra low PSA, its a waste of time.
What is your PSA post the radiation treatment?
I was in a similar situation.
Sept 2021 I had a RALP with epe, rt svi, pni, tertiary 5 at the bladder neck, and 36 lymph nodes clear.
Eight months later (late April 2022) PSA was at .1 and within 9 weeks was at .4.
PSMA pet showed a single right side obturator iliac lymph node about .5 cm.
2 years of leuprolide and 18 months of abiraterone. My MO and I felt that this length of time with my disease pathology and treatment's (RALP/ EBRT and ADT) should be enough to be curative. And we discussed the parameters of the STAMPEDE trial.
While my provider only uses standard tenths for PSA testing .X, I am a strong believer in usPSA testing as it gives more accurate look at treatment outcomes. So over the last year I have had the standardized testing and all have been < .1 since I started adt two years ago and integrated usPSA testing and have been < .006 for a year. I have had two usPSA tests since I stopped adt at the end of June and they have both been < .006. My current MO and I have discussed a potential blood biopsy when I have some return of T.
You asked so sharing my thoughts as a patient who has faced pelvic lymph node mets and having had multiple imaging techniques in my experiences.
Had I listened to docs and naysayres I would not have traveled to Europe in 2018 for imagining at 0.11. That imaging identified five suspicious pelvic lumps nodes - six confirmed cancerous by salvage extended pelvic lymph node surgery.
My Pylarify PSMA done in 2022 and my Ga 68 PSMA done in 2021 were clear and last years GUARDANT360 finding was "Not Detected'.
Had I followed many a docs and patients thinking I would not have had last months Pylarify PSMA and GUARDANT360 liquid blood biopsy, done at 0.03X, no ADT . The former identified a 2cm lesion on my liver. The latter identified TP53 genetic mutation. IMO very useful, as were the previous years 'clear' findings.
Necessary and usefulness have varying opinions whether it be docs, patients or pontificators. I hope this helps. All the best!
Lu-177 in Austria - Report and underlining high importance of both FDG and PSMA PET/CTs 
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PSMA PET Looks Good But PSA Rising 
The prices for Lu 177 in Germany
