Does a PMSA scan detect prostate cancer at the prostate bed?

Posted by oskarpr @oskarpr, Jun 22 6:20pm

Does a PMSA scan detect prostate cancer at the prostate bed , before prostate surgery?

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It might but it’s not guaranteed. What is your PSA number?

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PSMA PET is the gold standard for scans. Having said that, while it is quite sensitive and specific there is no guarantee that clear scan means not cancer.

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In reply to @oskarpr "5.13ng" + (show)
@oskarpr

Thanks for sharing your number. To be clear, I am a two-time PCA patient currently undergoing salvage radiation and ADT. I can’t give true medical advice, just my personal opinion which includes my recommendation that you always seek the best pair care possible at a center of excellence.

I have had 2 PSMA PET scans at two different centers of excellence. I have been told by two separate oncologist that the scan does not have the resolution to detect microscopic disease. The lesion or lesions need to be about 1 cubic centimeter in volume to be reliably detected using the scan. In certain circumstances, it may be able to detect PCA with smaller volume disease, but that is not guaranteed.

You did not mention whether or not you had any other diagnostic tests. If that’s the case, I would suggest you consider having either a PSA 4K test or a PSAISO test as your next course of action. That can help you understand your risk of PCa in light of your current PSA number. If either of those tests come back with a significant risk of prostate cancer next reasonable test prior to having a biopsy would be a 3 Tesla MRI with and without contrast. If the MRI shows likelihood of an extraocular extension in the area of the prostate bed, then it is more likely that the prostate bed is involved.

If the MRI shows areas of suspicion and results in a PIRADS score of 4 or more, an MRI guided fusion biopsy would be the next logical step.

The PET-PSMA test is a great tool and probably the best tool currently available to diagnose prostate cancer and determine whether or not it has spread. It’s also an expensive test with a typical list price of $10,000-$11,000. As one can imagine, Insurance doesn’t want to pay for this test unless there is convincing evidence that the risk of spread beyond the prostate is highly likely.

Good luck on your journey and don’t hesitate to ask more questions if any of us can help you

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"As one can imagine, Insurance doesn’t want to pay for this test unless there is convincing evidence that the risk of spread beyond the prostate is highly likely."

Indeed that is the case. In my situation my insurance required that we take a sequential set of steps, starting with Bone Scan, then MRI Scan, then CT Scan, then PSMA PET. I had wanted to skip the other tests, but all said and done it was nice to have lots of data!

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@robertmizek

Thanks for sharing your number. To be clear, I am a two-time PCA patient currently undergoing salvage radiation and ADT. I can’t give true medical advice, just my personal opinion which includes my recommendation that you always seek the best pair care possible at a center of excellence.

I have had 2 PSMA PET scans at two different centers of excellence. I have been told by two separate oncologist that the scan does not have the resolution to detect microscopic disease. The lesion or lesions need to be about 1 cubic centimeter in volume to be reliably detected using the scan. In certain circumstances, it may be able to detect PCA with smaller volume disease, but that is not guaranteed.

You did not mention whether or not you had any other diagnostic tests. If that’s the case, I would suggest you consider having either a PSA 4K test or a PSAISO test as your next course of action. That can help you understand your risk of PCa in light of your current PSA number. If either of those tests come back with a significant risk of prostate cancer next reasonable test prior to having a biopsy would be a 3 Tesla MRI with and without contrast. If the MRI shows likelihood of an extraocular extension in the area of the prostate bed, then it is more likely that the prostate bed is involved.

If the MRI shows areas of suspicion and results in a PIRADS score of 4 or more, an MRI guided fusion biopsy would be the next logical step.

The PET-PSMA test is a great tool and probably the best tool currently available to diagnose prostate cancer and determine whether or not it has spread. It’s also an expensive test with a typical list price of $10,000-$11,000. As one can imagine, Insurance doesn’t want to pay for this test unless there is convincing evidence that the risk of spread beyond the prostate is highly likely.

Good luck on your journey and don’t hesitate to ask more questions if any of us can help you

Jump to this post

I’ve had 4 scans
The first 2 were $3000
Now most insurance companies including Medicare cover 100%
Last one showed one perimeter lymph node involvement to small to radiate according to UCLA
Precious 5 SBRT resolved 3 previous lymph nodes

Now being treated with
Orgovyx and xtandi
After 3 months psa undetectable and testosterone 4
Mild fatigue, loss of libido weight loss
10 yrs post RP
Gleason 3+4 nmiv

REPLY
@robertmizek

Thanks for sharing your number. To be clear, I am a two-time PCA patient currently undergoing salvage radiation and ADT. I can’t give true medical advice, just my personal opinion which includes my recommendation that you always seek the best pair care possible at a center of excellence.

I have had 2 PSMA PET scans at two different centers of excellence. I have been told by two separate oncologist that the scan does not have the resolution to detect microscopic disease. The lesion or lesions need to be about 1 cubic centimeter in volume to be reliably detected using the scan. In certain circumstances, it may be able to detect PCA with smaller volume disease, but that is not guaranteed.

You did not mention whether or not you had any other diagnostic tests. If that’s the case, I would suggest you consider having either a PSA 4K test or a PSAISO test as your next course of action. That can help you understand your risk of PCa in light of your current PSA number. If either of those tests come back with a significant risk of prostate cancer next reasonable test prior to having a biopsy would be a 3 Tesla MRI with and without contrast. If the MRI shows likelihood of an extraocular extension in the area of the prostate bed, then it is more likely that the prostate bed is involved.

If the MRI shows areas of suspicion and results in a PIRADS score of 4 or more, an MRI guided fusion biopsy would be the next logical step.

The PET-PSMA test is a great tool and probably the best tool currently available to diagnose prostate cancer and determine whether or not it has spread. It’s also an expensive test with a typical list price of $10,000-$11,000. As one can imagine, Insurance doesn’t want to pay for this test unless there is convincing evidence that the risk of spread beyond the prostate is highly likely.

Good luck on your journey and don’t hesitate to ask more questions if any of us can help you

Jump to this post

I had a PSMA , covered by the insurance. Results = no signs of metastatic disease.
Also prior to a Decipher test of the one lesson
On the middle of the right side of the prostate, Results =low risk.

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@oskarpr

I had a PSMA , covered by the insurance. Results = no signs of metastatic disease.
Also prior to a Decipher test of the one lesson
On the middle of the right side of the prostate, Results =low risk.

Jump to this post

Having a Decipher test is an excellent idea!

REPLY
@robertmizek

Thanks for sharing your number. To be clear, I am a two-time PCA patient currently undergoing salvage radiation and ADT. I can’t give true medical advice, just my personal opinion which includes my recommendation that you always seek the best pair care possible at a center of excellence.

I have had 2 PSMA PET scans at two different centers of excellence. I have been told by two separate oncologist that the scan does not have the resolution to detect microscopic disease. The lesion or lesions need to be about 1 cubic centimeter in volume to be reliably detected using the scan. In certain circumstances, it may be able to detect PCA with smaller volume disease, but that is not guaranteed.

You did not mention whether or not you had any other diagnostic tests. If that’s the case, I would suggest you consider having either a PSA 4K test or a PSAISO test as your next course of action. That can help you understand your risk of PCa in light of your current PSA number. If either of those tests come back with a significant risk of prostate cancer next reasonable test prior to having a biopsy would be a 3 Tesla MRI with and without contrast. If the MRI shows likelihood of an extraocular extension in the area of the prostate bed, then it is more likely that the prostate bed is involved.

If the MRI shows areas of suspicion and results in a PIRADS score of 4 or more, an MRI guided fusion biopsy would be the next logical step.

The PET-PSMA test is a great tool and probably the best tool currently available to diagnose prostate cancer and determine whether or not it has spread. It’s also an expensive test with a typical list price of $10,000-$11,000. As one can imagine, Insurance doesn’t want to pay for this test unless there is convincing evidence that the risk of spread beyond the prostate is highly likely.

Good luck on your journey and don’t hesitate to ask more questions if any of us can help you

Jump to this post

Well said! Especially the "microscopic disease" concept. Very important to understand both the capabilities and limitations of the wonderful PSMA-PET scan.

I had a PSMA-PET imaging scan which, to my surprise, failed to detect the known GG2-(3+4=7) tumor within my prostate! That caused me to doubt the efficacy of the entire scan and whether it had somehow been botched. It put my mind at ease, once I understood the micro vs macro disease concept.

Here is the link to my previous post about that experience.
https://connect.mayoclinic.org/discussion/69-years-old-recent-mri-dce-positive-pr4/?pg=3#comment-1088129

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