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Psma pet scan

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User
Posted 25 Aug 2020 at 20:47

Hello all 

My PSA has more than doubled in the last six months to 0.3 I am thinking of getting a psma pet gallium scan. Have any of you found it useful at that PSA level? Where did you get it done? My oncologist doesn't think that the nhs would do more than a choline one. Have you found that such a scan can inform treatment successfully

Many thanks

Edited by member 25 Aug 2020 at 21:02  | Reason: Not specified

User
Posted 01 Sep 2020 at 20:01

Janus

It is often quoted on here that it can take 18 months for the PSA reach its nadir, hopefully you are still a long way off any further treatment and possibly never need it.

 Thanks Chris

 

User
Posted 01 Sep 2020 at 20:10

Originally Posted by: Online Community Member

Janus

It is often quoted on here that it can take 18 months for the PSA reach its nadir, hopefully you are still a long way off any further treatment and possibly never need it.

 Thanks Chris

Chris, thanks and I agree.  I'm the positive type,  but like they say "hope for the best and prepare for the worst".   So I asked in advance "what if".

Actually I did have a PSA test only 3.5 weeks after end of salvage radiation (just because I had an appointment to speak to the urologist).  The oncologist did tell me that so soon after SRT,  PSA could be actually higher, and it's not really until 3 months after SRT that you should expect to see lower PSA.

 6 weeks after surgery PSA was 0.09;   three months after that it was 0.33 and I went through all sorts of tests (CT scan, Bone Scan, and PSMA PET Scan), then Salvage Radiation.  And now 3.5 weeks after SRT, it's down to 0.08.     Early days yet, but good sign so far.   Hopefully even lower next PSA test.

 

 

 

 

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User
Posted 25 Aug 2020 at 21:36

Benjit

My PSA is now 0.47 following RARP and SRT, I am not due to get a scan until the PSA reaches 1.0. I am fortunate to have medical insurance. 

Thanks Chris

 

User
Posted 25 Aug 2020 at 21:47

A friend of mine had a Gallium 68 PSMA Pet scan with a PSA of 0.49 post RP but it didn't pick anything up

User
Posted 25 Aug 2020 at 21:56

Thanks Chris and Mike. Does that mean Chris that your oncologist is confident that waiting till it's 1.0 is still within a window for potential further radiotherapy?

User
Posted 25 Aug 2020 at 22:37

Benjit

It is just the protocol at our hospital that they prefer to wait until the PSA is at a level where there might be a better chance of detecting where the cancer is. Having already had SRT I wasn't anticipating having any more RT. I have recently seen where the scans have detected Cancer in lymph nodes, that have subsequently been removed. 

Thanks Chris

 

User
Posted 26 Aug 2020 at 05:46
You certainly seem to have cancer recurrence, so I would be looking at a G-68 PET-PSMA scan sooner or later to target radiotherapy to whatever metastases remain. Whether the scan will find anything to point a ray-gun at though is a gamble

There are men here who have had that test on the NHS (your oncologist could surely offer it if he wanted to, and his budget allowed it) and others who paid for it themselves or through insurance.

It costs £2600 here, or £400 in India...

Best of luck!

Cheers, John.

User
Posted 26 Aug 2020 at 10:23

The higher your PSA, the more likely it is to show up on a PET scan.

Rough guidelines for men without a prostate are:

Newest PSMA PET scans need at least 0.2 to have a reasonable chance of finding something.

Most PSMA PET scans need at least 0.5 to have a reasonable chance of finding something.

Choline PET scans (most common on NHS) need at least 2 to have a reasonable chance of finding something.

These are not absolute. You might be lucky and find something at much lower PSA, but equally, you might be unlucky and not find anything even with a higher PSA.

If you have a prostate, which will be producing PSA anyway from the non-cancerous parts, I don't know what thresholds they use.

User
Posted 26 Aug 2020 at 12:09

Thanks Andy that's very helpful. Do you happen to know who does the newest psma pet scans?

User
Posted 26 Aug 2020 at 19:51
Is there another PSMA diagnostic scan in the UK other than the 68 Gallium one which incidentally does not work for about 5-8% of men as they produce insufficient PSMA?
Barry
User
Posted 26 Aug 2020 at 20:42
https://www.stricklandscanner.org.uk/

Cheers, John.

User
Posted 26 Aug 2020 at 21:00

Originally Posted by: Online Community Member
Is there another PSMA diagnostic scan in the UK other than the 68 Gallium one which incidentally does not work for about 5-8% of men as they produce insufficient PSMA?

I don't think so, Barry. If the person can't get approval or doesn't produce PSMA, he could look for an Axumin (FACBC)  PET scan instead - that can also produce results at low levels. 

 

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

User
Posted 27 Aug 2020 at 00:17

I was just puzzled by this from Andy62 which can be read as the "Newest" being different from "Most"

"Newest PSMA PET scans need at least 0.2 to have a reasonable chance of finding something.

Most PSMA PET scans need at least 0.5 to have a reasonable chance of finding something".

The Axumin Pet scan is a good scan but does not work on PSMA. It is certainly worth considering getting this if it can be obtained on the NHS and the PSMA scan is not (for OP).

Update.

Well having looked further into this, something I have not done for quite some time, I find there is another PSMA scan.  It is termed 18F PSMA -1007 and is another small molocule that binds to fluorine rather than gallium.  This seems to give more defined results than the gallium tracer as detailed in this comparison.  I will have to look into this in greater detail. http://jnm.snmjournals.org/content/61/1/51.short

And more on scans here. https://www.hematologyandoncology.net/archives/july-2019/psma-pet-ct-for-staging-and-treatment-of-prostate-cancer/

 

Edited by member 27 Aug 2020 at 01:28  | Reason: Not specified

Barry
User
Posted 01 Sep 2020 at 15:33


Here's a paper from earlier this year that provides lots of detailed information on the latest F-labelled radiotracers for PSMA PET scans (including F18-DCFPyL and F18-1007). F18-1007 has not had as much testing as F18-DCFPyL, but early research suggests it may be better for detecting small lesions in the pelvis area, whereas DCFPyL may be better at detecting small lesions in the liver. 

The paper also mentions a few other even more recent F18-labelled radiotracers such as CTT1057 and PSMA-11 that are in even earlier testing stage than F18-1007, but they show promise.

Two links to same paper:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929634/
https://www.thno.org/v10p0001.htm

I had a F18-DCFPyL PSMA PET scan with PSA level of 0.33  four months after surgery, as part of clinical trial at the top cancer center in Canada.   The head of urology and research lead thought 0.33 was high enough for the F18-DCFPyL scan to have a good chance to pick up something.  Nothing was picked up by the scan, so I had regular prostate bed salvage radiation.    I don't think Ga68 is considered sensitive enough to use with PSA under 0.5, and even over 0.5,  and even from 0.5-3.5, it will not pick up as much as  DCFPyL.  

 

Edited by member 01 Sep 2020 at 16:04  | Reason: Not specified

User
Posted 01 Sep 2020 at 16:41
F18-FDG is already available in a small number of hospitals in the UK, as is 18F-FACBC - one looks at soft tissue and the other is better with small bone lesions.

The trouble is that different countries are starting to call these tracers different things. The US research papers call 18F-FACBC F18

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

User
Posted 01 Sep 2020 at 19:06

Originally Posted by: Online Community Member
F18-FDG is already available in a small number of hospitals in the UK, as is 18F-FACBC - one looks at soft tissue and the other is better with small bone lesions.

The trouble is that different countries are starting to call these tracers different things. The US research papers call 18F-FACBC F18

This blog article is a little old, but it doesn't rank 18F-FDG very high (behind Ga68).  Axumin (18F - FACBC) also included.   Ranking is just opinion of the writer.    18F-DCFPyL was ranked #1 (newest 18F tracers under testing not in the article), and Ga68 was behind but still #3.

https://www.prostatecancer.news/search/label/PET%2FMRI

 

Edited by member 01 Sep 2020 at 19:24  | Reason: clarify that new 18F tracers not mentioned in this older article.

User
Posted 01 Sep 2020 at 19:20

Originally Posted by: Online Community Member
It is just the protocol at our hospital that they prefer to wait until the PSA is at a level where there might be a better chance of detecting where the cancer is. Having already had SRT I wasn't anticipating having any more RT. I have recently seen where the scans have detected Cancer in lymph nodes, that have subsequently been removed. 

Thanks Chris

I just finished Salvage Radiation, and oncologist expects there is very good chance that this will be enough.  But to be prepared, I did ask what if PSA goes up again, what is next step.

Oncologist said that he would suggest waiting until PSA is a little higher, and then repeating the F18-DCFPyL PSMA PET scan.  Hopefully I don't need to go there, but that is also the recommendation from my center (top one in Canada).

User
Posted 01 Sep 2020 at 20:01

Janus

It is often quoted on here that it can take 18 months for the PSA reach its nadir, hopefully you are still a long way off any further treatment and possibly never need it.

 Thanks Chris

 

User
Posted 01 Sep 2020 at 20:10

Originally Posted by: Online Community Member

Janus

It is often quoted on here that it can take 18 months for the PSA reach its nadir, hopefully you are still a long way off any further treatment and possibly never need it.

 Thanks Chris

Chris, thanks and I agree.  I'm the positive type,  but like they say "hope for the best and prepare for the worst".   So I asked in advance "what if".

Actually I did have a PSA test only 3.5 weeks after end of salvage radiation (just because I had an appointment to speak to the urologist).  The oncologist did tell me that so soon after SRT,  PSA could be actually higher, and it's not really until 3 months after SRT that you should expect to see lower PSA.

 6 weeks after surgery PSA was 0.09;   three months after that it was 0.33 and I went through all sorts of tests (CT scan, Bone Scan, and PSMA PET Scan), then Salvage Radiation.  And now 3.5 weeks after SRT, it's down to 0.08.     Early days yet, but good sign so far.   Hopefully even lower next PSA test.

 

 

 

 

User
Posted 01 Sep 2020 at 21:51
Are you on HT to supplement the salvage RT? It isn't clear from your profile or recent posts.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 02 Sep 2020 at 14:42

Originally Posted by: Online Community Member
Are you on HT to supplement the salvage RT? It isn't clear from your profile or recent posts.

I did ask about HT.  Oncologist recommended salvage RT without HT for me based on my circumstances.  .

 
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