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Prostate cancer recurrence: RT advised concerned about quality of life
Prostate Cancer | Last Active: Sep 4 12:43pm | Replies (19)Comment receiving replies
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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A choline C-11 PET can find active cancer that is not expressing PSMA and that would therefore not be seen by the PSMA PET, even though the PSMA PET is generally more sensitive. My husband is having PSMA PET scans during Pluvicto treatment at Mayo Rochester, but a choline C-11 PET scan will be used a few weeks after he has had the six Pluvicto infusions to see if any avid cancer still shows up.