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Prostate cancer recurrence: RT advised concerned about quality of life

Prostate Cancer | Last Active: Sep 4 12:43pm | Replies (19)
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@heavyphil

Perhaps I am mistaken but isn"t the PSMA the most sensitive of all the scans? I had an Axumin a few years back and it was negative; but I was told the next step would bePSMA since it could detect smaller amounts of cancer cells. Don't get me wrong, most of these are still not a guarantee which is why they recommend pelvic lymph node radiation along with prostate bed.

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Replies to "Perhaps I am mistaken but isn"t the PSMA the most sensitive of all the scans? I..."
brianjarvis | @brianjarvis | Apr 8 7:23pm

Yes, the PSMA PET scan is the most sensitive of the previously developed scans under normal circumstances: F18-FDG —> F18-NaF —> Choline C11 —> Axumen —> PSMA (Illuccix; Pylarify; Posluma).

However, PSMA is not perfect. For example:
> Even at PSAs of 0.4 ng/mL, PET scans will miss prostate cancers about 50% of the time. (See attached chart.)

> Up to 15% of prostate cancers may be PSMA-negative (or PSMA-naive), and not express any (or much) PSMA, such that a PSMA PET scan won’t even see them - even though you know something is a problem due to the elevated PSA.

In those very unique cases, an earlier form of PET scan might work better than a PSMA PET scan. (I’ve heard that sometimes Mayo uses C11 Choline PET/CT in these unusual cases.)

So, depending on where the recurrence is eventually found, might require a different treatment.
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