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PSMA -PET Scans

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User
Posted 02 Apr 2023 at 00:13

An ongoing niggle of mine, can i ask why i wasn't ever offered a PSMA-PET scan at any point from PC diagnosis to


Post RALP Histology?   I was diagnosed with PC December 2020   PSA 9.7  Gleeson 3+4  7


I had my RALP 4 months after referral, Post op Histology  PSA 0.1 Gleeson 3+4.  7. and stage T3a 


with 10mm positive margin. i am now on 12 monthly PSA testing following  a  2 year 0.1  PSA Test which is great 


But what i have noticed is that a lot of members joining  the forum have been offered a PSMA- PET scans with


lower Gleeson/Staging  and PSA  scores than me.


Any ideas please


Thanks Van

User
Posted 10 Apr 2023 at 00:51

There are different kinds of PET scans. Choline is not a PSMA one It just shows areas that show uptake of Choline denoting cancer. It has it's uses but is not so highly regarded as a PSMA one. An Australian Professor said they largely abandoned the Choline scan in OZ in favour of PSMA very quickly* but they do have much better coverage with the PSMA scans there. This is anecdotal but from a Choline scan ULCH told me that I had cancer in an Iliac Lymph Node and wouldn't offer any further focal treatment. They declined to give me a 68 Gallium PSMA scan so I paid to have this at Paul Strickland Scanner Centre. This did not show cancer in the suspect node and subsequently UCLH gave me a second HIFU to a small tumour in the Prostate as noted from MRI scan. So in my case the PSMA scan changed my treatment plan.


*About 26:30 in this very interesting lecture largely about scans, https://www.youtube.com/watch?v=0H-g047os6c


 

Edited by member 10 Apr 2023 at 00:58  | Reason: Not specified

Barry
User
Posted 02 Apr 2023 at 16:23

Van, I would say it is just progress. Five years ago some guys on here were having PSMA scans before salvage RT, I was refused and was told that is something for the future. More recently PSMA scans before SRT is being used more.


Thanks Chris 

User
Posted 02 Apr 2023 at 16:29
PSMA scans are expensive, not widely available, and I believe there was and maybe still is a problem in obtaining at least the ligand used with 68 Gallium. Not long ago it was very restricted on the NHS and I had to pay for mine. In the circumstances, I think its use is restricted to those where it is thought that it would be most beneficial. Although figures are a consideration, it is significant how these move and the histology of the individual. You seem to be doing well and great that you are annual checks now.
Barry
User
Posted 02 Apr 2023 at 18:38

I think the Paul Strickland Scanner Centre (at Mount Vernon) was the first centre to offer PSMA PET scans on the NHS, around the middle of 2019. PSMA scanners only existed at a small number of the main NHS centres of excellence, and in private hospitals at that time. In the first years, they were only used on the NHS for men who had recurrence after curative treatment. That's still the main use, but occasionally someone will have one during initial diagnosis if there's a suspicion of mets which haven't been found, but certainly not routine at initial diagnosis.

Looking hard for tiny mets initially is a potential double-edged sward.

User
Posted 03 Apr 2023 at 01:41
Is that a less than 0.1? After RP it should be. If it isn't you could soon be a candidate for a PSMA scan!
User
Posted 03 Apr 2023 at 10:31
Sounds like a result and you can stop worrying about PSMA...
User
Posted 03 Apr 2023 at 12:13
Yes, enjoy life and keep your annual appointments and now you know why you were not offered a PSMA scan.!
Barry
User
Posted 04 Apr 2023 at 16:55

I had the "Radical +" treatment along the lines Chipper is suggesting. Removing lymph nodes came at a cost. There are many lymph nodes in the pelvic area. The surgeon removed all he could see (36 in total) during the prostatectomy. It's a bit of a lucky dip approach but the histology confirmed one of the nodes was positive. I suppose you can count that as a success but the price was a lymphocele post op which required further procedure to install a second drain. Further details of my post operative complications are in my profile. I also have Lymphoedema in my abdomen and right leg, requiring me to wear a compression stocking (probably for life).


I didn't have adjunct RT but SRT and HT seven months after surgery with the accompanying side effects. It was a pretty rubbish twelve months all in all. As always complications and side effects are going to different for everyone but Francij1 comments are certainly valid.

User
Posted 09 Apr 2023 at 23:01
No, not the same thing. All PET scans are the same general thing but they use different tracers - choline is a tracer. PSMA scans use a tracer such as Gallium 68 or F18. There is also axumin which is more sensitive than choline but not quite as sensitive as PSMA.

The different tracers have their own strengths and limitations; your dad needs a PET scan to clarify the results of his bone scan and choline is ideal for this. Gallium 68, F18 and axumin are better at identifying recurrence at very low PSA levels.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 02 Apr 2023 at 16:23

Van, I would say it is just progress. Five years ago some guys on here were having PSMA scans before salvage RT, I was refused and was told that is something for the future. More recently PSMA scans before SRT is being used more.


Thanks Chris 

User
Posted 02 Apr 2023 at 16:29
PSMA scans are expensive, not widely available, and I believe there was and maybe still is a problem in obtaining at least the ligand used with 68 Gallium. Not long ago it was very restricted on the NHS and I had to pay for mine. In the circumstances, I think its use is restricted to those where it is thought that it would be most beneficial. Although figures are a consideration, it is significant how these move and the histology of the individual. You seem to be doing well and great that you are annual checks now.
Barry
User
Posted 02 Apr 2023 at 18:38

I think the Paul Strickland Scanner Centre (at Mount Vernon) was the first centre to offer PSMA PET scans on the NHS, around the middle of 2019. PSMA scanners only existed at a small number of the main NHS centres of excellence, and in private hospitals at that time. In the first years, they were only used on the NHS for men who had recurrence after curative treatment. That's still the main use, but occasionally someone will have one during initial diagnosis if there's a suspicion of mets which haven't been found, but certainly not routine at initial diagnosis.

Looking hard for tiny mets initially is a potential double-edged sward.

User
Posted 03 Apr 2023 at 01:41
Is that a less than 0.1? After RP it should be. If it isn't you could soon be a candidate for a PSMA scan!
User
Posted 03 Apr 2023 at 09:40

Post RALP March 2021   my PSA Readings have all  been 0.1 Unrecordable. 


I am now 2 years post RALP maintaining a 0.1 PSA Reading  and have now been switched to yearly PSA Monitoring


Thanks Van.


 

User
Posted 03 Apr 2023 at 10:31
Sounds like a result and you can stop worrying about PSMA...
User
Posted 03 Apr 2023 at 12:13
Yes, enjoy life and keep your annual appointments and now you know why you were not offered a PSMA scan.!
Barry
User
Posted 04 Apr 2023 at 09:51

Have just been offered/suggested PSMA PET before starting SRT. Have also been pondering a little bit. When surgeons cannot categorically ensure negative margins, why don’t they remove lymphs routinely as part of surgery (even if assuming contained PC) and immediately bombard the bed after recovery? Seems at every treatment step there’s always a chance of recurrence. Surely it would be more cost effective and efficient to do the “preventative maintenance”.  I am now in the position of slowly rising PSA after 12m post op undetectable period… awaiting a conclusion of whether there are mets. Given my lymph system is intact, surely I have an increased risk of spread from the bed area. Its not a good place to be, even if that outcome is considered ‘unlikely’ by experts and stats.

User
Posted 04 Apr 2023 at 10:38
Because all of those steps come at a significant cost to your quality of life... No point being cured if you can't walk, piss, s*** and screw...
User
Posted 04 Apr 2023 at 10:44
Seriously going undetectable after RP is good, rising PSA later means more work is required but at least your body has had time to heal, adjuvant RT tends to "set" any impact from the surgery so no further recovery is possible.

A PSMA scan is your best shot at proving it's still localised and hence treatable with RT. If nothing shows up it's probably still worth a shot at salvage RT as you had a positive margin.
User
Posted 04 Apr 2023 at 12:34

Originally Posted by: Online Community Member
When surgeons cannot categorically ensure negative margins, why don’t they remove lymphs routinely as part of surgery (even if assuming contained PC) and immediately bombard the bed after recovery?


 


Removing lymph nodes has the potential side effect of lymphoedema which can be difficult to manage and reduces mobility significantly as well as putting pressure on soft organs.


Regarding adjuvant (immediate / planned) RT following RP - a) it introduces further side effects and b) costs money. There has been a national trial going for about 5 years, offering aRT to all suitable men post-RP but they have struggled to secure enough participants. John's onco is involved in  the trial

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 04 Apr 2023 at 16:55

I had the "Radical +" treatment along the lines Chipper is suggesting. Removing lymph nodes came at a cost. There are many lymph nodes in the pelvic area. The surgeon removed all he could see (36 in total) during the prostatectomy. It's a bit of a lucky dip approach but the histology confirmed one of the nodes was positive. I suppose you can count that as a success but the price was a lymphocele post op which required further procedure to install a second drain. Further details of my post operative complications are in my profile. I also have Lymphoedema in my abdomen and right leg, requiring me to wear a compression stocking (probably for life).


I didn't have adjunct RT but SRT and HT seven months after surgery with the accompanying side effects. It was a pretty rubbish twelve months all in all. As always complications and side effects are going to different for everyone but Francij1 comments are certainly valid.

User
Posted 04 Apr 2023 at 19:02

There's so much bad stuff I don't know - Lymphoedema!  LynEyre and ChrisBromsgrove.  Sounds like another pro for RT.

Edited by member 04 Apr 2023 at 19:36  | Reason: Not specified

User
Posted 04 Apr 2023 at 19:47

Most surgeons won't do a prostatectomy if they think in advance it will require extensive lymph node removal (Pelvic Lymph Node Dissection - PLND). The side effects are potentially debilitating and in most cases there is no effective management. I think even if they only discover the need during the op, they should perhaps leave alone a go straight in to adjuvant radiotherapy.

User
Posted 09 Apr 2023 at 20:55

My dad is currently waiting for a Choline CT scan - searching for this online says it is a PET scan.


Is this the same as a PSMA PET scan? I'm trying to get my head round all the acronyms!

User
Posted 09 Apr 2023 at 23:01
No, not the same thing. All PET scans are the same general thing but they use different tracers - choline is a tracer. PSMA scans use a tracer such as Gallium 68 or F18. There is also axumin which is more sensitive than choline but not quite as sensitive as PSMA.

The different tracers have their own strengths and limitations; your dad needs a PET scan to clarify the results of his bone scan and choline is ideal for this. Gallium 68, F18 and axumin are better at identifying recurrence at very low PSA levels.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 10 Apr 2023 at 00:51

There are different kinds of PET scans. Choline is not a PSMA one It just shows areas that show uptake of Choline denoting cancer. It has it's uses but is not so highly regarded as a PSMA one. An Australian Professor said they largely abandoned the Choline scan in OZ in favour of PSMA very quickly* but they do have much better coverage with the PSMA scans there. This is anecdotal but from a Choline scan ULCH told me that I had cancer in an Iliac Lymph Node and wouldn't offer any further focal treatment. They declined to give me a 68 Gallium PSMA scan so I paid to have this at Paul Strickland Scanner Centre. This did not show cancer in the suspect node and subsequently UCLH gave me a second HIFU to a small tumour in the Prostate as noted from MRI scan. So in my case the PSMA scan changed my treatment plan.


*About 26:30 in this very interesting lecture largely about scans, https://www.youtube.com/watch?v=0H-g047os6c


 

Edited by member 10 Apr 2023 at 00:58  | Reason: Not specified

Barry
 
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