After some Advice

[JVARA]

Hi all, I was hoping to get some advice. I have been on AS sonce December 2021 and am due for a PSA and MRI next month. Following this my urologist said that a follow up biopsy may be required.

My Question should I also ask for a PMSA, I have read that this type of imagining picks up smaller lesions plus by having this test it scans the whole body for any other type of disease

[Justfor_]

By all means, Yes.

[Tall_Allen]

No. There is no justification for PSMA PET/CT for men on AS. It is only for men with high risk PCa.

[JVARA in reply to Tall_Allen]

Thanks Tall Allen , that’s what ai thought but was curious to see what others thought

[Derf4223]

Randomly speaking, SoC for staging requires PSA high enough -> DRE (if positive) -> biopsy (if positive)->bone x-ray -> MRI -> PSMA PET/CT. You will be asked at each step if you want to continue. You will never be asked to request a speculative next step, and if you pushed you might find that they will not be authorized by your insurance and cost you thousands.

Know your relevant trials and cite them when speaking with your onco team.

[Justfor_ in reply to Derf4223]

Ah, you Americans, judging the world by looking out of your windows. The OP is Australian. Do you know how much is the cost of the PSMA PET scan down under? Do you know the current exchange rate of the AUD to the USD? You will get a big surprise, guaranteed!

[Derf4223 in reply to Justfor_]

Justfor_, I said _ almost* nothing_ about cost and finances which of course vary regionally. The American health care system is not cheap for anybody, let alone complex cancer cases. The costs arise in different ways. I had to, for instance, pay about US$1500 for a PSMA PET/CT scan. I also pay a lot for meds -- in some cases US$3K per month. Radiation == approximately US$10K. And on and on. The US also has sources of financial support for the needy. I can't speak for the AUS system, but isn't the HU audience more than any one country? Is discounting someone for not being an expert on a different country helpful?

* correction for the pendatically inclined

[Justfor_]

You wrote: "... and cost you thousands" which according to you: "... I said _nothing_ about cost...". Ok, let's have it your way.

[Murk]

I've had two of these to date and they found nothing even though after my RP my PSA is rising, thus there is something there not being found. IMO a PSMA scan is only valuable to determine that its metastasized majorly. You proabbaly had a biopsy before so getting another should show any increased changes.

[JVARA in reply to Murk]

Thanks Murk , yes i had a biopsy in December 21.. Last PSA was 2.0., next one is in November as well as mpMRI

[Gardenpests]

This is from NCCN guidelines for AS. There is much more. NCCN is not the only set of USA guidelines.

nccn.org/professionals/phys...

There is much more..