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PSMA frustrations

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User
Posted 29 Mar 2021 at 23:02

I have had a recent MRI scan and I am now waiting for a Ga-68 PSMA Pet scan before deciding on treatment with the ALLANTA trial. I’m not sure why but apparently this is needed before I see the Urologist so his consultation keeps being moved. Frustratingly I have had planned scans which three times have been cancelled at short notice (one when I was half way to the hospital which is a 200mile round trip for me).

 

Have any others faced this sort of problem at the moment? Also wonder if there is a centre nearer to me in Gloucestershire.

User
Posted 29 Mar 2021 at 23:54
Ga-68 tracer is very difficult to make and has a very short shelf life; I don't think it would matter where you booked an appointment as the tracer is only made in 2 places in the UK - if that morning's batch is spoilt, your scan will not go ahead.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 30 Mar 2021 at 03:19

Gallium-68 is a radioactive isotope with a very short half-life (so it decays to nothing after a few hours, so you don’t have radiation floating round your body. - in contrast, the half-life of Uranium 235 used in nuclear power stations is 700m years!)

A PET-PSMA scan using Ga-68 as a tracer is highly effective in picking up even tiny metastases around the body, so if any are found, the radiologist can point his beam directly at those sites only. You are lucky (if someone with cancer can be called that), to be offered such a scan, which costs £2600 privately in London.

Even private patients suffer the kinds of cancellations you have experienced, due to the inherent instability of the isotope.

I so grin and bear it, you will eventually get the scan, and your medics will have a fuller picture of your situation and the pathway forward.

Best of luck.

Cheers, John.

Edited by member 30 Mar 2021 at 03:21  | Reason: Not specified

User
Posted 30 Mar 2021 at 07:57

Thanks Lyn. I had not appreciated that there are only two production places for the tracer. I’ll try to be a bit more of a patient patient!

User
Posted 30 Mar 2021 at 08:05

Originally Posted by: Online Community Member

 

A PET-PSMA scan using Ga-68 as a tracer is highly effective in picking up even tiny metastases around the body, so if any are found, the radiologist can point his beam directly at those sites only. 

 

Thanks John

This is what I understand to be the reason for this scan: on the ATLANTA trial metastasis, if present,can be treated with SABR. I will ask the question of the team as to whether it is necessary to have it before the urologist can make a decision about a prostatectomy vs RT to the primary tumour.

User
Posted 30 Mar 2021 at 08:52
All sounds familiar to me and so frustrating. I had 2 Choline PET cancelled in Oxford on the day , again I was half there driving from Southampton. Also had 2 Ga68 cancelled at UCLH , one of which was on my wife’s 50th birthday.

Southampton now have their own scanners and I believe the cyclotron that can make tracers

Good luck

User
Posted 30 Mar 2021 at 14:25
Choline tracer is produced using a Cyclotron whereas for the 68 Gallium PSMA scan it requires a 'Generator'. As Chris will attest, from experience, not all men express sufficient PSMA for the scan to be of any use. This applies to about 8% of men. However, where it does work, it is a better scan than the Choline one. Interestingly, an Australian Professor stated in a lecture that they only used the Choline scan for about 6 months in Australia before generally replacing it with the PSMA one.

Barry
User
Posted 30 Mar 2021 at 15:55

Perhaps someone could enlighten me about the different tracers used for PET/CT scans.

Gallium 68 seems to be the tracer most associated with PSMA PETR/CT scans. I have an appointment in early May for a PSMA PET/CT scan at the Royal Marsden but I have been provided with a leaflet for a PET/CT scan using FDG (fluorodeoxyglucose) as the tracer. I am now wondering if this will be a PSMA scan or a scan similar to the choline PET/CT scan I had about 2 years ago.

Edited by member 30 Mar 2021 at 15:56  | Reason: Not specified

User
Posted 30 Mar 2021 at 16:19

The full reference for FDG is F18 FDG - the research data says that at low PSA numbers it is slightly better than an F18 choline tracer but not as good as Ga-68. There is also 11C choline and 18F-FACBC.

Worth checking with the hospital what they are actually planning to do - I think some of the main cancer centres have been trying Ga-68 and FDG at the same scanning session because they pick up slightly different tumour patterns.

Edited by member 30 Mar 2021 at 16:22  | Reason: Not specified

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

User
Posted 31 Mar 2021 at 04:18

https://community.prostatecanceruk.org/posts/t16522-F-18-PSMA-scans?gclid=Cj0KCQjwmIuDBhDXARIsAFITC_55G5nlh6cohDs8HFhPtsZxKo9a0607QtUl6VAUpl69rLuCcVArSssaAizUEALw_wcB

There are many addvanced scans now, by no means all of them being available in the UK, including one of the leading contenders the Fluorine18F DCFPyl, I believe. This compliation of studies compares 13 of them if you have the time to read through. https://link.springer.com/article/10.1007%2Fs00259-021-05210-9

 

Edited by member 31 Mar 2021 at 04:38  | Reason: to highlight link

Barry
 
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