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At what PSA Level to have PSMA PET-CT Scan

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User
Posted 28 Jan 2023 at 05:54

HI I am trying to understand at what point (PSA level) I should have a scan to determine progression of cancer History below.  I understand its a balance between too soon and inaccurate and too late to take action.  Grateful for thoughts.

Prostate removed May 13

PSA rising so Radiation Apr 15

PSA slowly rising since Jan 18

PSA now 0.25 (Jan 23)

User
Posted 28 Jan 2023 at 08:46

Hi there

I think it's all a bit of a minefield when it comes to PSA,a few months ago I was down to 0.428 I asked the question at what number do alarm bells ring,I was told there's no definitive number but on how quick the numbers rise.

At my next meeting (which was Thursday) my psa was 0.876 but they said they weren't worried with that jump but I said well it's doubled in less than 3 months it fell on deaf ears,I asked about scans to back up PSA readings they said they won't scan for the sake of scanning only if they feel there's a need for it,I'm at the mercy of my oncology team and I hope they know best.

Regards Phil 

User
Posted 28 Jan 2023 at 13:08

I think they get really worried when they see a PSA doubling rate of a month or less.  I was at 1.2 months but now around 3 weeks, thus the change of approach for me. 

Michael 

User
Posted 28 Jan 2023 at 17:20
So your doubling time calculates at about 14 months - by that rate, your PSA will be sufficient for a detailed scan in summer 2024 although it still may not show anything.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jan 2023 at 18:20

It does seem a bit of a lottery which type of PSMA scan you can get (if at all) but also a lottery as to whether you get a result. My PSA was 0.28 immediately after RP. Interpolating between readings it would have been around 0.4 by the time I had my F18 PSMA scan but it didn't show anything up. Despite the blank result my PSA was roughly doubling very three months . The Onco thought it would be risky to wait to do another scan so I ended up having best guess RT to the prostate bed. 

User
Posted 29 Jan 2023 at 11:26

Hi 

This is my PSA journey to date

May 22....2104!!

June 22....3.58

Early Aug 22....2.6

Late Aug 22....1.9

Sept 22....0.502

Oct 22....0.5

Nov 22....0.478

Jan 23....0.826.......story to be continued.

Regards Phil 

 

User
Posted 29 Jan 2023 at 12:06

From a personal point , I started this journey with the thought to they could eradicate my cancer but leave me with some side effects.  My big disappointment was that RARP did not eradicate my cancer, then another disappointment that my Salvage RT didn't eradicate the cancer.  The failed vaccine trial was also a disappointment. 

By the time I be was faced with a life time of HT, and with the benefit of knowledge gained from the members on here , I was aware that PSMA testing had no guarantees of detecting anything treatable, but it did give me a possible alternative option other than HT.

Hopefully we will at some point get better detection and treatment.

Thanks Chris 

 

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User
Posted 28 Jan 2023 at 08:46

Hi there

I think it's all a bit of a minefield when it comes to PSA,a few months ago I was down to 0.428 I asked the question at what number do alarm bells ring,I was told there's no definitive number but on how quick the numbers rise.

At my next meeting (which was Thursday) my psa was 0.876 but they said they weren't worried with that jump but I said well it's doubled in less than 3 months it fell on deaf ears,I asked about scans to back up PSA readings they said they won't scan for the sake of scanning only if they feel there's a need for it,I'm at the mercy of my oncology team and I hope they know best.

Regards Phil 

User
Posted 28 Jan 2023 at 13:08

I think they get really worried when they see a PSA doubling rate of a month or less.  I was at 1.2 months but now around 3 weeks, thus the change of approach for me. 

Michael 

User
Posted 28 Jan 2023 at 13:28
I do worry that you much is being made of PSMA scans, potentially setting men up for a big disappointment. It is important to know a) PSMA isn't available to everyone b) may not be the right choice for some men and c) doesn't work for about 10% of prostate cancers. The important questions for your onco are

"at what PSA will you start to be concerned?"

"At what PSA would you restart or change the treatment plan?"

"At what PSA would you recommend I have a scan?"

"What scans are available to me at this hospital?"

"If only choline PET scan is available here, can I be referred to another hospital for a PSMA or axumin scan?"

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jan 2023 at 17:07

Thanks for your replies.  My last psa scores below.  My consultant in Liverpool indicated 0.5 was the point when a scan had a decent chance of helping pin point where a cancer may be.

 

Jan-18

<0.01

Sep-18

0.03

Nov-18

0.02

May-19

0.08

Nov-19

0.09

Sep-20

0.12

Mar-21

0.18

Sep-21

0.2

Mar-22

0.24

Oct-22

0.26

User
Posted 28 Jan 2023 at 17:20
So your doubling time calculates at about 14 months - by that rate, your PSA will be sufficient for a detailed scan in summer 2024 although it still may not show anything.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jan 2023 at 18:20

It does seem a bit of a lottery which type of PSMA scan you can get (if at all) but also a lottery as to whether you get a result. My PSA was 0.28 immediately after RP. Interpolating between readings it would have been around 0.4 by the time I had my F18 PSMA scan but it didn't show anything up. Despite the blank result my PSA was roughly doubling very three months . The Onco thought it would be risky to wait to do another scan so I ended up having best guess RT to the prostate bed. 

User
Posted 29 Jan 2023 at 11:26

Hi 

This is my PSA journey to date

May 22....2104!!

June 22....3.58

Early Aug 22....2.6

Late Aug 22....1.9

Sept 22....0.502

Oct 22....0.5

Nov 22....0.478

Jan 23....0.826.......story to be continued.

Regards Phil 

 

User
Posted 29 Jan 2023 at 12:06

From a personal point , I started this journey with the thought to they could eradicate my cancer but leave me with some side effects.  My big disappointment was that RARP did not eradicate my cancer, then another disappointment that my Salvage RT didn't eradicate the cancer.  The failed vaccine trial was also a disappointment. 

By the time I be was faced with a life time of HT, and with the benefit of knowledge gained from the members on here , I was aware that PSMA testing had no guarantees of detecting anything treatable, but it did give me a possible alternative option other than HT.

Hopefully we will at some point get better detection and treatment.

Thanks Chris 

 

User
Posted 29 Jan 2023 at 12:56

Good luck Phil

 

User
Posted 29 Jan 2023 at 13:23
Phil, I think the difference for you is that you are already known to have metastatic PCa so a scan would make no difference to your treatment plan.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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