First Scan PSMA-PET or PET Gleason 8

[Vortex12]

I am scheduled for a PSMA-PET as explained below this is the correct procedure. Thanks to all who helped.

[Tall_Allen]

Unless you have reason to believe otherwise, a PSMA PET is fine. MD Anderson will know.

[Vortex12 in reply to Tall_Allen]

Thank you for your reply. They currently have me set for a PET scan at my request. Really have no idea if I should go for a PSMA PET. I am at MD Anderson, and they tend to push you toward what they have available. Really not sure if the PSMA PET scan machine is different than the PET scan equipment. Trying to search, google and read as much as I can.

[Murk in reply to Vortex12]

I would be stunned if they didn't interpret your request as a PSMA test but to be 100% sure just phone the scheduler / front desk and confirm.

[Vortex12 in reply to Murk]

You are correct, the appointment only indicated PET, but I sent a MyChart message and they confirmed what you said. Thanks for the reply

[dhccpa in reply to Vortex12]

My understanding is the PET machine is the same as the Axumin PET (and maybe others), but that the radiotracer injected into you is different. That's what my local imaging center told me.

[Derf4223]

The full name of the scan is PSMA PET/CT. It is way different than a PET scan or CT scan. Google it. It combines both in one machine that overlays the imagery. Very cool stuff.

[Starr15]

All prostate PET scans now are done with CT (or MRI).

PSMA refers to prostate specific membrane antigen, which is a type of radioactive tracer that shows prostate cancer (and other things).

[maley2711]

I am confused. Your Docs at such a highly regarded place didn't simply advise a PSMA PET for your Gleason 8 high risk ????....that is now SOC for high risk!!!

[janebob99]

I get my first PSMA-PET scan on Feb. 6. We should compare the results!

I'm thinking of going to MD Anderson. How do you like it there?

[janebob99 in reply to janebob99]

While you're reading about PSMA-PET scans, you should also read up on "Lutetium-177" therapy, which is basically a high-dose PSMA-PET scan. They inject high doses of the same radionuclide (radioligand) as the low-dose PSMA-PET scan and then they use the high-dose radiation to attack individual prostate cancer cells, wherever they may be located. This works because the radioligand attaches to the PSMA molecule on individual PCa cells. So, it's a highly-targeted therapy.

It's very exciting, and it produces excellent results for men with metastatic cancer. It's also called "Pluvicto" (brand name). The general name of the treatment method is called "theranostics". It does have side effects, though, because the PSMA molecule is expressed elsewhere in the body (e.g., salivary glands, kidneys, etc.).

us.pluvicto.com

[Vortex12 in reply to janebob99]

Will do

[Vortex12 in reply to janebob99]

Sounds like a plan. They are very efficient at setting appointments and keeping things moving. However, do your research. I needed a peritoneal biopsy (I am antibiotic resistant) and had to be firm. I suggest if you go, insist on peritoneal biopsy. They are very dependant on Nurse Practitioners. The Doctor who did the peritoneal biopsy was outstanding (Gregg) but met him 5 minutes before the procedure. He had an assistant call and tell me I had cancer. They had a center in the Woodlands that is in a great location. However, the most experienced Doctors are downtown in the Medical Center. I am meeting with the RO on 12th

[janebob99 in reply to Vortex12]

I hada transrectal biopsy and it went reasonably well. I asked them to add a shot of Rocephin antibiotic to their standard Cipro (which they did), and I had no infection. Do you mind if I ask what antibiotics you are resistant to, and how did you determine that? Rectal swab culture and sensitivity test? Did you have a MRI? What's your PIRADS score?

[Vortex12 in reply to janebob99]

Yes, MRI which led to the biopsy and the Gleason 8 pathology. I have no idea what PIRADS is but am researching that now. Is it important? Antibiotic resistance is based on history and prior experience.

[janebob99 in reply to Vortex12]

The PIRADS score is a way of standardizing MRI reports across different radiologists. PIRADS 1 is the smallest tumor, while the max, PIRADS 5, indicates a large tumor. It's useful for staging. What was your "T" score? (e.g., I'm a T3a, because the tumor is larger than 1 cm and has extra capsular extension (ECE)), but no lymph node enlargement.

[Vortex12 in reply to janebob99]

Prostate gland, ROI #1 vol. 0.65 cc, right base peripheral zone, PIRADS 5, biopsy:

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 7 (4+3), WITH 80% PATTERN 4, GRADE GROUP 3, THREE FOCI (9 MM, 8 MM AND 7 MM) INVOLVING SEPARATE TISSUE CORES.

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 8 (4+4), GRADE GROUP 4, 7 MM FOCUS.

Prostate gland, right medial mid, biopsy:

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 8 (4+4), GRADE GROUP 4, 6 MM FOCUS.

INTRADUCTAL CARCINOMA IDENTIFIED.

PROSTATIC ADENOCARCINOMA, GLEASON SCORE 7 (4+3), WITH 70% GLEASON PATTERN 4, GRADE GROUP 3, 17 MM FOCUS.

Mean anything to you?

[janebob99 in reply to Vortex12]

I suspect Tall-Allen will want to comment, but here goes. Remember, we're not doctor of medicine.

PIRADS = 5 means that there are confirmed tumors > 1 cm in size. PIRADS=5 is the highest (worst) score possible. It also means a very high risk of cancer from the MRI images. (Later confirmed by biopsy). The volume of your prostate is 65 cc, which is large-ish. "Three Foci" means that there are three different spots of cancer in your prostate. The high Gleason scores point to a more aggressive form of cancer; one that could easily spread outside of the Prostate.

I'm concerned about the MRI finding: "Intraductal Carcinoma". This is an aggressive form of prostate cancer. The good news is that the MRI report didn't find any enlarged lymph nodes. Also, it didn't find extra capsular extension (ECE).

It's great that you're getting a PSMA-PET scan today! My PSMA-SCAN yesterday was easy-peasy. You'll have to wait 1 hour after they inject the radionuclide, so that it can travel through the body and attach to prostate cancer calls, wherever they may be located. The actual scan lasted about 20 minutes.

You definitely need treatment. Have you decided which kind of treatment to get, RP or RT?

[Vortex12 in reply to janebob99]

You will never know how much I appreciated your kind response. Not what I was hoping for. But at least I know what I am facing. Waiting on the PSMA-PET and Decipher and hoping for the best. The first radiologist at MD Anderson I talked to seemed to be pushing me towards surgery because of prior BPH symptoms, frequent urination etc. I meet with the Proton Radiologist on the 12th. I will try and get the name of the Surgeon with the best track record at MD Anderson, and if I get the name I will post here.

Really at this point I am scared to death, like a deer in the headlights. Nightmares every night, etc. I have lived a charmed life, and the last time I had nightmares was when I was 4 or 5 years old.

The Radiologist I see on the 12th is SEUNGTAEK CHOI, he seems to be highly rated. My thought is to do what he tells me to do.

Thanks again for taking the time to explain what the biopsy showed. Truthfully, I got more information from your post than from the 2 Doctors I have already seen.

Please let me know if I can be of any help to you.

If you do come to MD Anderson, there is reduced cost housing available thru the Kingwood Church of Christ as well as other local Churches.

[janebob99 in reply to Vortex12]

Hi, Vortex12. Than you for your kind words of support. It's been helpful that I enjoy doing research.

Getting prostate cancer was a big wake up call for me, as I'm sure it was for you. I appreciate that you are scared. But, one thing I learned is that most prostate cancers grow slowly, so you have time to research all of your options and make informed decisions. Probably a medical oncologist (MO) is the least biased doctor, because they don't do surgery or radiation therapy themselves. It would be worth establishing with a MO at some point.

One retired urologist advised me that prostate cancer is a "marathon, not a sprint." Take your time creating the team that you want to work with, and are comfortable with. Definitely get 2nd and 3rd opinions before you proceed.

I'm thinking seriously of going to MD Anderson in Houston (are you located in Houston?), because they have a state-of-the-art X-ray machine called Elekta Unity. It's an X-ray machine that rotates 360 degrees around your body that is combined with an MRI scanner. It uses the MRI scanner to provide real-time tracking of the location of the prostate during irradiation with high-energy X-rays. Dr. Kishan at UCLA found (in the MIRAGE trial) that the rates of bad urinary side effects were cut in 1/2 when using a MRI-guided irradiation (he used a different machine, called MRIdian, though). This because the beam automatically shuts off when the prostate moves out of the targeted area (e.g., from a gas bubble in the colon). I expect the same results from the MIRAGE trial will apply to MD Anderson's machine (Elekta Unity). You might ask your radiologist (RO) about the Unity machine as an alternative to proton therapy. There's a lot of marketing hype about the great benefits of proton therapy, but results show not much difference from regular X-ray therapy.

Let me know what your PSMA-PET scan report says. I hope to get my report soon, also.

Bob

[Vortex12 in reply to janebob99]

The PSMA-PET shows localized no spread.

If you come to MD Anderson start with this guy

faculty.mdanderson.org/prof...

He is a Proton guy, and the science is unproven on the possible benefits, but start here. He is the janebob99 of Doctors, with clear explanations and wants to put together what works for you. Very patient focused.

MD Anderson currently only has 1 pencil Proton machine (the type you would want if you go proton) However, there are 4 more coming later this year. Even if you know you want some other form of radiation start here, and let him make the referral to someone he trust. In this manner, you avoid potluck on what radiologist you get.

I would also try and get the PSMA-PET and Decipher before the consult. I was able to do this by making a request over MD Anderson MYChart

He is the second MD Anderson Radiologist that has suggested I have surgery. I have an appointment with this Surgeon faculty.mdanderson.org/prof...

I have BPH and the only other option is to go to this guy houstonmethodist.org/doctor... and have GreenLight laser vaporization of the prostate with a 3 month recovery necessary before they can start radaition. The Radiologist would immediately start ADT.

[Starr15 in reply to janebob99]

PIRADS scoring of MRI of the prostate:

PI-RADS 1—Very low (clinically significant cancer is highly unlikely to be present);

PI-RADS 2—Low (clinically significant cancer is unlikely to be present);

PI-RADS 3—Intermediate (the presence of clinically significant cancer is equivocal);

PI-RADS 4—High (clinically significant cancer is likely to be present);

PI-RADS 5—Very high (clinically significant cancer is highly likely to be present).

[Starr15]

For PSMA PET, one wants any one of the following isotopes used:

Plarify

Illuccix

Newer one- Posluma

Any of these are excellent. There has been no head to head steady comparing one of these to the other to have a data driven preference. The most important thing is to have an experienced radiologist read your scan that has experience using the isotope they prefer. I am confident MD Anderson will select the correct isotope for your scan.

Axumin is another isotope PET scan for prostate cancer however, they three previously mentioned ones are probably better.I don’t know anyone using Axumin anymore.