My post-RP BCR has creeped up to 0.56, so after discussing this with my oncologist, I decided to get a PSMA PET/CT scan before deciding on a treatment plan. My local radiology center uses the Pylarify (18F PSMA-DCFPyL) tracer, but I'm thinking I might get a better result with the newer Illuccix (68Ga PSMA-11) tracer.
Anyone have any recent experience with this?
My RP stats: post surgery Gleason 3+3, negative margins, PSA undetectable from post surgery 2009 to 2013, then slow rise to above 0.20 in 2017, steady in mid-0.30's in 2020-21, now relatively steady in mid-0.50's. Doubling time from 2 to 9 years depending on sample data used.
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KeyboardGuy
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The results are not mixed. That link was for an F18 Choline PET scan, which isn't at all relevant. To my knowledge, there has been only one trial using both kinds of PSMA PET scans in the same patients. Pylarify had an advantage:
The PyL scan "MAY" have an advantage, but it is clearly defined in the study that the larger amount of contrast agent used, and the longer dwell time used in the study "may" have contributed to it's slightly better efficacy. The study clearly identified this, not sure why we keep presenting Pyl as "superior" in results. If we get be additional G68 and let it sit as long, twice as long, then the results would be the same... Read the results, but also the conclusion of the study. When I discussed the newly approved PyL with my MO, he was pretty adamant about using G68-HBED-CC over other tests. Whatever that is worth...
The G68 contrast agent is still the one by which all others are compared to, and there's a reason. But each (test) has it's place for specific reasoning too. Big Advantage goes to the PyL because it's half life is longer and batch processing creates more (2x) the agent to be used. So it's availability is increased making it a better choice for those who cannot access G68. Ultimately I don't think, and yes that's an opinion, that either would be a wrong choice!
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PET/CT PSMA Scans
Medicare did not pay for the Pylarify used in PSMA PET/CT Scan
18F-DCFPyL PET/CT at NiH
18F-DCFPyL PSMA PET/CT for Lu-177 eligibility evaluation
PSMA PET CT versus PSMA PET MRI
