I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

Is there a shortage of PSMA radiotracer?

Email this conversation Print this conversation
User
Posted 04 Apr 2025 at 16:27

Just spoken with my uro-oncology nurse who said there was a shortage of the radiotracer. I know some trusts were looking for alternative suppliers at least according to BBC news articles last year and in 2023 but didn't know this was ongoing. I guess if you were private no shortage would exist.

After the prostatetectomy and bisopsy I was classed as high risk. Now nearly 22 months later it's looking like I'm going to hit the 0.2 PSA level and looking at the rate it's increasing I'll hit that in about 2-3 weeks. What's annoying is the push back I'm getting from my uro-oncology nurse to wait until my next appointment with the oncologist in 7 weeks time!! Wouldn't it make sense to schedule the scans now or as soon as I hit 0.2 which I believe will be in weeks. And I now find according to her there is a universal shortage of tracer!

 

User
Posted 04 Apr 2025 at 16:44
The 7 weeks wait won’t count for much in my opinion. I’ve had 2 PET scans over the years. The first was Choline and was cancelled 3 times , once actually on the 2 hr drive to the hospital. The second was Gallium and also cancelled once leaving me with an expensive journey and overnight stay in London. The problem isn’t as such the tracer but the availability of the machines that make it. Also the tracer has a very very short half-life , so if it isn’t made quite right or needs to travel far it can often be wasted. Hope that helps a bit
User
Posted 04 Apr 2025 at 17:10

Originally Posted by: Online Community Member
The 7 weeks wait won’t count for much in my opinion. I’ve had 2 PET scans over the years. The first was Choline and was cancelled 3 times , once actually on the 2 hr drive to the hospital. The second was Gallium and also cancelled once leaving me with an expensive journey and overnight stay in London. The problem isn’t as such the tracer but the availability of the machines that make it. Also the tracer has a very very short half-life , so if it isn’t made quite right or needs to travel far it can often be wasted. Hope that helps a bit

 

Hi Chris,

Yes I've read it's a fragile substance but your experience sounds very unlucky, was it shortage related or it's sensitivity/breakdown. It's knowing how loud one has to shout so you're not forgotten about in the NHS. I've found if you sit back and do nothing the wheels turn slower.

I don't see why at this point when my psa has climbed from 0.12 to 0.18 in 10 weeks that they can't pre-emptively just book the scans now to avoid delays in treatment. In the 22 months since my RP I've had ever increasing rises apart from the first 2 (undetectable) so we all know where this is going.

User
Posted 04 Apr 2025 at 17:25
User
Posted 04 Apr 2025 at 17:26
Sorry to hear this Gerry. In both cases I was given VERY short notice of cancellation. In London I had stayed the night and was having a pleasant walk from Buckingham Palace to UCLH in the morning when I was given 1 hrs notice. I’m guessing it’s more fragility of substance but I’m no expert.

Also worth saying that the higher the psa the better the scan can be. In my case both scans showed nothing but my psa was climbing very rapidly. Based on this I utterly rejected SRT even though asked 4 times. And I was right …… I had oligo-metastasis all through my lymphs. Nothing in prostate bed. So glad I didn’t put myself through that.

And yes as they say “ the squeakiest wheel gets the oil “. I’m never rude but all through my journey I’ve had to help steer it myself. I often wonder if I didn’t have my 4 monthly blood test how long it would take them to notice. Not complaining as they are overwhelmed we all know.

User
Posted 04 Apr 2025 at 17:54

Originally Posted by: Online Community Member
Sorry to hear this Gerry. In both cases I was given VERY short notice of cancellation. In London I had stayed the night and was having a pleasant walk from Buckingham Palace to UCLH in the morning when I was given 1 hrs notice. I’m guessing it’s more fragility of substance but I’m no expert.
Also worth saying that the higher the psa the better the scan can be. In my case both scans showed nothing but my psa was climbing very rapidly. Based on this I utterly rejected SRT even though asked 4 times. And I was right …… I had oligo-metastasis all through my lymphs. Nothing in prostate bed. So glad I didn’t put myself through that.
And yes as they say “ the squeakiest wheel gets the oil “. I’m never rude but all through my journey I’ve had to help steer it myself. I often wonder if I didn’t have my 4 monthly blood test how long it would take them to notice. Not complaining as they are overwhelmed we all know.

 

Thank you Chris you're a calming voice. 

Originally Posted by: Online Community Member
Also worth saying that the higher the psa the better the scan can be.
Thanks for pointing out the silver lining, love your outlook :)

 

Originally Posted by: Online Community Member
In my case both scans showed nothing but my psa was climbing very rapidly. Based on this I utterly rejected SRT even though asked 4 times. And I was right …… I had oligo-metastasis all through my lymphs. Nothing in prostate bed. 

Confused here Chris. The PET PSMA scan is a full body scan and from what I understand the most sensitive scan we have so wouldn't this have picked up oligo-metastasis?

Originally Posted by: Online Community Member
I had oligo-metastasis all through my lymphs. Nothing in prostate bed

That's nuts!!

Originally Posted by: Online Community Member
“ the squeakiest wheel gets the oil “
 

Not heard that one before but love it and unfortunately I completely agree. Self education, politeness combined with persistence is the key I believe.

 

Edited by member 04 Apr 2025 at 17:56  | Reason: Not specified

User
Posted 04 Apr 2025 at 19:26

Gerry, just to add my experience, my first PSMA f18 scan was cancelled about six hours before the scan. I was led to believe the tracer was made on site and the production of the tracer failed. If I understand it correctly it takes time to produce the stuff. I had another three or four scans at Genesis Oxford, the gallium tracer is produced at Windsor, they did say it was rare for it to fail. 

The extra wait will give a better chance of detecting something, so I wouldn't worry about the wait. I had a scan at 1.4 that picked up a tumor, and it was treated. At 6.2 another tumor was found and treated. At 1.4 another scan found nothing,six months later at 6.7 multiple sites of concern were found. 

You say it is a full body scan ,that may not be the case, I was told head to mid thighs. I did have the lower legs included because I had issues with my knees. I was told the top of skull does not show up well either.

We have seen on here where 0.023 can detect something and at 200 see nothing. It's not a 100 percent reliable test, but it's the best we have at the moment.

Hope all goes well.

Thanks Chris 

User
Posted 05 Apr 2025 at 12:05

Originally Posted by: Online Community Member

Gerry, just to add my experience, my first PSMA f18 scan was cancelled about six hours before the scan. I was led to believe the tracer was made on site and the production of the tracer failed. If I understand it correctly it takes time to produce the stuff. I had another three or four scans at Genesis Oxford, the gallium tracer is produced at Windsor, they did say it was rare for it to fail. 

The extra wait will give a better chance of detecting something, so I wouldn't worry about the wait. I had a scan at 1.4 that picked up a tumor, and it was treated. At 6.2 another tumor was found and treated. At 1.4 another scan found nothing,six months later at 6.7 multiple sites of concern were found. 

You say it is a full body scan ,that may not be the case, I was told head to mid thighs. I did have the lower legs included because I had issues with my knees. I was told the top of skull does not show up well either.

We have seen on here where 0.023 can detect something and at 200 see nothing. It's not a 100 percent reliable test, but it's the best we have at the moment.

Hope all goes well.

Thanks Chris 

Thank you Chris. May I ask why scans weren't actioned before your PSA got to those higher levels on those occasions. I know you said a 1.4 picked up nothing on one occasion which I didn't think could happen, how strange. Did they ever explain this? 

I've always believed a 0.2 was actionable and the first step would be MRI & PET scans. But I'm beginning to wonder if micro metastases is very common and in the less fortunate it flares up. Up to now I've had a more simplistic view of PC tumours.

User
Posted 05 Apr 2025 at 13:30

Gerry, I am guessing I am about 8 or 9 years in front of your current situation. At 0.2 they started to investigate and I had salvage RT without the benefit of PSMA scan in 2017 with a PSA of around 0.27. The scan at 1.4 was in about 2022, following relapse after SRT it was common to let the PSA rise to 2 ,4 or even as high as 10 before introducing HT, the advance of PSMA scans and pin point RT meant I had scans and treatment to lymph nodes tumours.

Thanks Chris 

Edited by member 05 Apr 2025 at 13:33  | Reason: Not specified

User
Posted 06 Apr 2025 at 12:04

There's always been a shortage of PSMA radiotracer.

Combined with this, the manufacture of it is an unreliable process and it can't be stored, so it's very common to be told your scan is canceled on the day of the scan, because it's only then that they know if they have any usable tracer.

There's now a shortage of many other radioisotope tracers, which wasn't the case some years ago, due to the relatively few nuclear reactors around the world which produce them, and their age and lack of reliability, and some being in countries which have become unfriendly. Molybdenum 99 was a big problem at the tail-end of last year. I think it's only produced in something like 3 reactors worldwide, and is the precursor to Technetium-99m used in nuclear bone scans. 2 of the 3 reactors went off-line, which meant it was having to be rationed between countries, and between patients. Wales was looking at building a reactor to produce Molybdenum 99, but I don't know where that's got to.

Edited by member 06 Apr 2025 at 12:15  | Reason: Not specified

User
Posted 06 Apr 2025 at 15:23

A second batch of Cholin tracer had to be made for me as the original did not meet the required standard. Also, my first PSMA scan was cancelled whilst I was on my way from Devon to the Paul Strickland Scanner Centre due to a problem with the 'Generator' that supllied the tracer for scans in the London area at the time. Since that time the PSMA scan has become far more widely used, particularly so with greater adoption by the NHS. (I had to pay for mine as my treating hospital would not provide it on the NHS, wrongly rellying on a Cholin scan whiich was misleading). *An Australian professor said that with the intrduction of the PSMA scan they soon switched to this from Cholin. However, approximately 8% of men do not exhibit sufficient PSMA to make the scan work for them..

Some say the 18F - DCFPyL scan is superior to the 68 Gallium PSMA scan but this does not seem to be widely available in the UK yet.

* https://www.youtube.com/watch?v=0H-g047os6c

This presentation was a few years ago and as the presenter forecast, the scans have since been refined so that snaller tumours can now be identified in many cases.  Also, Australia has gone on to extend it's use of the PSMA scan greatly in subsequent years.

Edited by member 06 Apr 2025 at 16:36  | Reason: For link and further comment

Barry
 
Forum Jump  
Email this conversation Print this conversation

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.




MenuTop ▲
©2025 Prostate Cancer UK