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PSMA scan and surgery Trial

User
Posted 05 Apr 2018 at 21:12

4 centres throughout the UK are enrolling men who meet the entry criteria for a PSMA scan and surgery.  Might be of interest to some but one of the requirements is that no previous treatment has been given including HT. http://www.isrctn.com/ISRCTN56584901


 

Barry
User
Posted 09 Aug 2018 at 22:59

The PSMA scan has been used earlier and to a greater extent in some other countries where it has also been found that it does not work for about 8 or so % of men (like Chris) who do not express sufficiently for the ligand to bind to cause a detectable result. Heidelberg DKFZ and University Hospital, who introduced the scan suggested as a guide men with a PSA of 0.7 as a suitable start point for it. As would be expected, it is increasingly more likely to show cancer where PSA is higher.


We know that a number of UK Hospitals want to be able to provide this scan because it can greatly influence or change the way quite a sizable number of men are treated. Maybe the fairly small study covering men in 3 kinds of situations now being done is to check the comparative advantage and perhaps longer term effects of this nuclear based scan. The UK often requires more confirmation than others on efficacy before widely adopting new innovations.


My first appointment for the PSMA scan was aborted because the machine that generates the tracer broke down just before the event. I was told that all the London Hospitals that provide the scan use tracer from this one supplier so would have been affected. It needs to be produced fairly close to the Hospitals involved due to it's short half life.

Edited by member 09 Aug 2018 at 23:01  | Reason: Not specified

Barry
User
Posted 11 Aug 2018 at 00:46

John,


Maybe because there seems to be a monopoly situation in the supply of the tracer, the cost of the PSMA scan seems to be going up rather than down in the UK. In Australia, as correctly forecast by the Professor in this video, there has been a considerable increase in the availability of the PSMA test there and they have kept costs down. The Professor said that they only used the Choline scan for about six months before going over to the much superior 68 Gallium PSMA one. This is a far ranging video, not only about this scan but how it can help change treatment plans and it also covers other aspects of PCa in the presentation and the Q&A session that followed. It's quite long and I have previously posted the link but recommend it for those who have not seen it. https://www.youtube.com/watch?v=0H-g047os6c


I did consider having my PSMA scan and a short holiday in OZ for the price of the scan in the UK but had to reject the idea for family reasons.


Incidentally, my treating hospital for HIFU, UCLH, believed that the uptake of Choline in an iliac lymph node indicated it was affected by cancer and recommended I start HT. They would not give me the PSMA scan on the NHS. However, other Hospitals I sent the Choline scan to for an opinion were not convinced. I therefore had a PSMA scan done privately and there was no indication of cancer in the suspect node or anywhere else outside the Prostate, so further focal treatment is now being considered without the need for HT, at least if/until the cancer spreads.


 

Edited by member 11 Aug 2018 at 00:50  | Reason: Not specified

Barry
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User
Posted 05 Apr 2018 at 22:49

And must be high risk but with no mets, and about to have RP with lymph node removal ... it’s a good job they are only looking for 60 participants!

I find it interesting that they feel the need to run a trial to see whether PSMA is reliable for lymph nodes.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 05 Apr 2018 at 23:47
Originally Posted by: Online Community Member

And must be high risk but with no mets, and about to have RP with lymph node removal ... it’s a good job they are only looking for 60 participants!

I find it interesting that they feel the need to run a trial to see whether PSMA is reliable for lymph nodes.



Why is it interesting Lynn??
User
Posted 06 Apr 2018 at 00:17

Because papers in 2016 stated that PSMA was producing better results than all other tracers including choline 11 / choline 18 in all areas and the researchers went on to say that it was proving particularly effective at identifying biochemical recurrence in lymph nodes. So a decision to trial it now for lymph nodes at diagnostic stage rather than at the point of recurrence sounds to me like an attempt to prove value for money for wider application. In other words, the hoop jumping politics of NHS funding.

I will be happy when they get round to publishing the results of the FACBC trials as we know we will be able to get that in Leeds if / when John needs it, and Mr B tells us that it is picking up tiny traces.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 09 Aug 2018 at 19:53
You might be right on the proving value for money point LynEyre.

New PSMA trial in London with 3 different patient groups has come online this week:: https://clinicaltrials.gov/ct2/show/NCT03617588?lupd_s=07%2F10%2F2018&lupd_d=30 may be of interest to those who have not been able to get the scan

User
Posted 09 Aug 2018 at 20:25
Just wanted to add that my PET scans were in Oxford then London. When I was last at my local Southampton General they had a mobile PET scan lorry in the car park and I enquired about it. They are taking PSMA much more seriously. It is so accurate but can fail in 8% of patients to find anything. This may be the case with me as I am known N1 with rapidly rising psa yet it’s not found anything in me. Ulsterman had a ridiculously low psa and it picked up something !! I’m still not sure I’m trusting of the tracer reliability re the production and transportation and half-life , having had only 2 scans out of 6 attempts. I wonder if other areas have access to this scanner or is it the tracer production areas that are the problem ?

If life gives you lemons , then make lemonade
User
Posted 09 Aug 2018 at 21:17

Good find, Berks.


Here is the link on active for others


https://clinicaltrials.gov/ct2/show/NCT03617588?lupd_s=07%2F10%2F2018&lupd_d=30


 

Edited by member 09 Aug 2018 at 21:21  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 09 Aug 2018 at 22:59

The PSMA scan has been used earlier and to a greater extent in some other countries where it has also been found that it does not work for about 8 or so % of men (like Chris) who do not express sufficiently for the ligand to bind to cause a detectable result. Heidelberg DKFZ and University Hospital, who introduced the scan suggested as a guide men with a PSA of 0.7 as a suitable start point for it. As would be expected, it is increasingly more likely to show cancer where PSA is higher.


We know that a number of UK Hospitals want to be able to provide this scan because it can greatly influence or change the way quite a sizable number of men are treated. Maybe the fairly small study covering men in 3 kinds of situations now being done is to check the comparative advantage and perhaps longer term effects of this nuclear based scan. The UK often requires more confirmation than others on efficacy before widely adopting new innovations.


My first appointment for the PSMA scan was aborted because the machine that generates the tracer broke down just before the event. I was told that all the London Hospitals that provide the scan use tracer from this one supplier so would have been affected. It needs to be produced fairly close to the Hospitals involved due to it's short half life.

Edited by member 09 Aug 2018 at 23:01  | Reason: Not specified

Barry
User
Posted 10 Aug 2018 at 05:14

I enquired at the Paul Strickland Centre about a Gallium PSMA scan, and they said it cost £2600. It is not available on the NHS, but on occasion the NHS does pay for the cheaper choline scan at around £1100.


And then I read in Australia they are available for AUD $800!


https://www.huffingtonpost.com/larry-diller/fly-to-australia-for-to-s_b_12807018.html


And I have just found in India you can have one for £236 - don’t think that’s the Gallium one though. I’ll see what my oncologist says - he’s Indian.

Edited by member 10 Aug 2018 at 05:31  | Reason: Not specified

User
Posted 11 Aug 2018 at 00:46

John,


Maybe because there seems to be a monopoly situation in the supply of the tracer, the cost of the PSMA scan seems to be going up rather than down in the UK. In Australia, as correctly forecast by the Professor in this video, there has been a considerable increase in the availability of the PSMA test there and they have kept costs down. The Professor said that they only used the Choline scan for about six months before going over to the much superior 68 Gallium PSMA one. This is a far ranging video, not only about this scan but how it can help change treatment plans and it also covers other aspects of PCa in the presentation and the Q&A session that followed. It's quite long and I have previously posted the link but recommend it for those who have not seen it. https://www.youtube.com/watch?v=0H-g047os6c


I did consider having my PSMA scan and a short holiday in OZ for the price of the scan in the UK but had to reject the idea for family reasons.


Incidentally, my treating hospital for HIFU, UCLH, believed that the uptake of Choline in an iliac lymph node indicated it was affected by cancer and recommended I start HT. They would not give me the PSMA scan on the NHS. However, other Hospitals I sent the Choline scan to for an opinion were not convinced. I therefore had a PSMA scan done privately and there was no indication of cancer in the suspect node or anywhere else outside the Prostate, so further focal treatment is now being considered without the need for HT, at least if/until the cancer spreads.


 

Edited by member 11 Aug 2018 at 00:50  | Reason: Not specified

Barry
 
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