What about Pylarify DCFPyL, 18F-PSMA-PET-1007 and 68Ga-PSMA-PET

[leiflines]

Did Ga68 a year and a half ago, 18F last day of May 2024 and without any suspicious metastases findings. Only four weeks after 18F I did another scan with Pylarify and surprisingly(?) 10 metastases were found. What can be said about false positive findings? The three methods are considered equal, but obviously this is not the case. Anyone had a similar experience?

[Justfor_]

Was it the 1007 that showed the metastases? If yes, there is much hype about 1007 producing false detections. They can be true false positives, true metastases due to a higher sensitivity or less masking to the urinary track, or, finaly, commercial interests. Ga68 is free to produce, Pylarify is backed by big pharma players, the intelectual property and thus royalties to be paid for the 1007 belong to a smaller German entity. IMO most probably is a mixture of all three.

[leiflines in reply to Justfor_]

Thanks, It was the Pylarify that showed them and as I understand it they also uses the appendix 1007 but then also with an added extra molecule, hence = pylarify. Correct me if I am wrong but that is my understanding from haven talken to Exini, a patent holder/developer in Sweden, true or not?

[Justfor_ in reply to leiflines]

According to ChatGPT:

"The patent for the radiopharmaceutical PSMA-1007, used primarily in imaging prostate cancer, is held by ABX GmbH, a company based in Radeberg, Germany. ABX GmbH originally developed the ^18F-PSMA-1007 compound for enhanced diagnostic imaging through PET/CT. Additionally, several scientists, including Jens Cardinale, Martin Schäfer, and colleagues, are listed as inventors on the patent, reflecting their contribution to its development at the German Cancer Research Center (DKFZ).

In Canada, the Centre for Probe Development and Commercialization (CPDC) holds exclusive licensing rights from ABX to manufacture, commercialize, and distribute PSMA-1007 within Canadian healthcare markets. CPDC has also partnered with the Lawson Health Research Institute to expand its availability through local manufacturing agreements and to conduct clinical trials in Canada​"

[leiflines in reply to Justfor_]

Thanks Justfor_Got it! My understanding though is that DCFPyL is an added molecule to the complex 1007 and I know for certain that it is sold in the Us by Lantheus and in France by Curium

[Justfor_ in reply to leiflines]

You probably either have it confused, or it is something so recent that ChatGPT ignores.

Question:

"Lantheus in the US sells a PSMA radiopharmaceutical. Is it DCFPyL, 1007 or a hybrid?"

ChatGPT said:

"In the United States, Lantheus sells a prostate-specific membrane antigen (PSMA) radiopharmaceutical called piflufolastat F 18 (marketed as Pylarify), which is based on the PET imaging agent [^18F]-DCFPyL. This radiopharmaceutical is specifically formulated with the fluorine-18 isotope and binds to PSMA, allowing detailed PET imaging for prostate cancer detection and staging.

Key Points:

Pylarify (piflufolastat F 18) is [^18F]-DCFPyL-based.

It is not a PSMA-1007 agent, nor a hybrid with multiple agents; it exclusively uses DCFPyL for its targeting and imaging properties.

Pylarify was approved by the FDA for use in the U.S. in 2021 for men with suspected prostate cancer recurrence and those with confirmed prostate cancer needing further assessment.

[^18F]-DCFPyL and PSMA-1007 are both fluorine-18 radiotracers but differ in structure and pharmacokinetics, which can affect lesion detectability and biodistribution in imaging studies."

[leiflines in reply to Justfor_]

Justfor_, I understand you are well informed, DCFPyL actually approved as SOC in the US in Feb 2021. As for me being a Biologist, cancer patient with T3bN1M0, gleason 4+5, radiated 20 + 2 Brachy in 2021, on Bicalutamide so far and surprisingly still good response pushing Psa down for the third time and now only trying to figure out why the the lesion detectability differs from the methods I mentioned in the header. No offence brother Justfor_

[Justfor_ in reply to leiflines]

T3bN0M0, GS 4+5 here, May 2019 RP, BCR 2,5 years later. Three years now being on a minuscule dosage of Bicalutamide. Monthly updates here:

healthunlocked.com/prostate...

[leiflines in reply to Justfor_]

Lots of similarities here and an interesting approach which I will study carefully. Right now I am persuing a Keto diet, or at least very low carb intake, and at the same time doing 150mg of Bicalutamide daily. As I mentioned earlier doing my 3rd Bica session my drop in Psa from 8.8 on 10th of July to 0,9 on 20th of Sept 2024 has been rapid. Waiting for my latest measurement yesterday with a certain anticipation. Take care my friend

[Justfor_ in reply to leiflines]

I understand this 8.8 PSA as someone that hasn't undertaken primary treatment like RP or RT. If so, 0.90 is a very good response, but mind overdosing, i.e 150 mg daily, which IMO can result into rendering this drug ineffective sooner than later.

[leiflines in reply to Justfor_]

Had RT march-april 2021. 17.3. - 15.4.2021 , then first round of Bicalutamide but had to stop both that and the second time after feeling really bad. This time, the third try and into the 4th month, I don´t struggle at all. This is what my RT looked like;

VMAT RapidArc radiotherapy, LNs 44 Gy , but PSMA + ad

60/3 Gy, prostate and seminal vesicles 49.4 Gy.

9.4.2021 FIRMAGON 80 mg s.c.

19.4.2021 1. HDR Bravhytherapy

3.5.2021 2. HDR Brachytherapy

2.7.2021 NADIR PSA 0

[NanoMRI in reply to Justfor_]

No way royalties, profit incentives, volume contracts etc have a role in healthcare. No way!

[addicted2cycling in reply to NanoMRI]

Just need to find a way to inject bleach into our PCa and .................................... 🤔

[NanoMRI in reply to addicted2cycling]

Politics, really?

[addicted2cycling in reply to NanoMRI]

MANY years ago I saw a program that mentioned bleach kills ALL cancer cells, so read into the post whatever you want.

[NanoMRI in reply to addicted2cycling]

Considered sharing that program or current updates?

[Don717 in reply to NanoMRI]

Chlorine Dioxide is used in paper pulp manufacturing to "bleach" the pulp. The term bleach is used in this process as an end result and not as a chemical compound such as Clorox. Household bleaches do not contain Chlorine Dioxide. There are many reports that cite the use of Chlorine Dioxide being effective killing cancer cells. True? Who knows?

[NanoMRI]

As I share, nearly seven years ago Ga68 was clear while the comparative Ferrotran nanoparticle MRI correctly identified five of six cancerous pelvic lymph nodes; confirmed by ePLND.

This past April liver MRI (checking on my hemochromatosis) was clear. Then in July a Pylarify PET CT, whilst looking for lingering PC, picked up a surprising 2cm liver lesion. Additional imaging and then biopsy confirmed metastatic melanoma.

I have come to lean there is no clear explanation why some imaging is successful and others are not. In the case of my liver met the conclusion is it was not big enough in April but raised it's head come July.

[leiflines in reply to NanoMRI]

Thanks NanoMRI,

It seems a bit too many different results with "similar" molecules and methods. RO:s have no logically coherent explanation for any differences as I see it. As you had a little more time between tests than I had, that might explain some in part but not all. As you say, there is no clear explanation and I am trying to squeeze more answers out of RO, so far without success.

[NanoMRI in reply to leiflines]

Based on my understandings, I simply accept different results from similar molecules. I also accept different findings and interpretation/reading errors. Why I seek out second and maybe three independent radiology opinions and rely on multiple methods to be assured the findings, whether clear, suspicious or determinative, are as reliable as possible.

[Retireddoc in reply to NanoMRI]

Nano, first I've read about your additional diagnosis-I'm sorry to hear that. As I am sure you know (being well informed) immunotherapy has been curative in a certain percentage of metastatic melanoma patients. Prayers and best of luck to you!

[NanoMRI in reply to Retireddoc]

Thank you doc, very thoughtful and kind. (ever consider coming out of retirement - perhaps just to teach empathy and kindness?).

Although my patient detective patient scientist efforts into this very deadly beast are just underway, I have (some) hope in these newer therapies, my fortunate very early finding and my otherwise most excellent health and fitness; save the lingering PC at my very low stable 0.03X range.

So far it seems melanoma patients are spared many/most of the disparities and misinformation we face with prostate cancer.

One frightening similarity is the lack of concern for and lack of intent to identify earliest possible onset of metastasis. Six years ago I had melanoma surgery - the final pathology was 'good enough' and with 'clear' sentinel lymph nodes there were no guidelines or recommendations for follow on imaging nor liquid blood biopsy testing. Yet, it is indeed these very investigative methods, while on (early) hunt for lingering PCa, that identified this single melanoma liver met.

[ulfhbg]

Hi !

Stupid question but is a Pylarify DCFPyL Scan the same as a F18-DCFPyL Scan?

Best wishes - Ulf

[leiflines]

Ulf, not a stupid question! As I understand it, DCFPyL has the long version; F18 DCFPyL - PSMA-1007. Then I am not the biochemist in charge so this is one of the issues that needs to be explained in more detail but probably this is also something that is not fully disclosed by patent holders, qualified guess! As I started in my headline, we have at least 3 different ways to approach diagnosing PCs, but what's different?

[ulfhbg in reply to leiflines]

Hi !

The first time I had a PSMA Pet Scan (in Sweden) then I had a 18F-PSMA-1007 in December 2022 when they assumed I had a recurrence and this together with mpMRI re-diagnosed me as a T3BN1M0

In Finland in October 2023 I had two different ones; one 18F-DCFPyL and one F18-NaF. I think the NaF Scan was better to identify any metasteses in bones according the chief ONCO (or if it was the other one…)

I remember my finnish ONCO mentioning something that the one I had in Sweden was less ’accurate’ ’ in some scannings areas of your body so I agreed to do re-scanning with the two they suggested to have a ’accurate ’ picture

Anyway, all three of them established the diagnosis of T3BN1M0 which I’ve then been treated for with salvage therapy

[Tall_Allen]

This may clarify:

prostatecancer.news/2016/12...

[ulfhbg in reply to Tall_Allen]

Hi!

Thanks TA. So I remembered correctly that NaF was extremely good in identifying bone mets compared to other ligands. Well, it seems like both F18-PSMA-1007 and F18-DCFPyL have good accuracy if I understand the percentage in the table. Thanks for good information as always.

[leiflines in reply to Tall_Allen]

First comprehensive summary that I´ve read so far, thanks a lot

[Adendino]

And, how does Posluma factor into the various choices for PSMA Pet Scans? Better? Worse?