This suggests that those with GL 7 or PSA over 10 were considered prior to moving forward with definitive treatment. With the advent of new focal or local treatments the ability to more precisely evaluate patients prior to treatment should improve the success associated with Tulsa Pro, HIFU or FLA by identifying the extent of disease more precisely than CT or MRI alone.
It's not very good at finding lower grade prostate cancer within the prostate. mpMRI is much better. In fact, the false positive rate is so high that it's worse than a coin toss. The false negative rate is very low, so it's better at ruling cancer OUT than ruling it IN.
My case MRI suggested Tulsa Pro would be fine with PSA 4, GL4+3, I delayed PET until after Tulsa Pro due to Covid and found high SUV in seminal vesicle. If we can identify direct extension or distant spread initial treatment can be better tailored. PET will not likely replace MRI, but may be selected for some .
And, it should be restricted at best to GL 3+4, not 4+3. Not sure most know it was not studied in GL4+3 and is not approved for treating prostate cancer.
Yes, BiTE. Absolutely one of the drugs turned on my immune system to go after anything expressing PSMA. Got dry mouth as it turns out the salivary glands express PSMA. Will know in 6 weeks how things are going. But I went into the hospital with blood clots and blood in my urine thanks to a 1” x 2” PCa met in the bladder. Cleared up.
Unfortunately PSMA isn't as specific to prostate cancer as we would like it to be. The tissue in salivary glands, tear ducts and kidneys express it. In pre-clinical study, pretreatment with the PSMA-11 ligand was able to reduce damage to salivary glands without reducing effectiveness of the Ac225-PSMA radiopharmaceutical. Maybe it will work for BiTE too.
I want to highlight what tall Allen said about the danger of “false positives” since PSMA is expressed by other things besides prostate cancer. I was in an NIH trial for this scan last year with high risk (Gleason 9) prostate cancer. The scans found psma in 2 ribs which were ultimately not determined to be cancer but which gave me a lot of worry. For this reason, I think this should only be used if you are pretty sure you have metastatic rather than at the start of your journey.
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