Outside of PSMA scans what tests are important to new patients?

There are additional tests & calculations that help provide more information on the possible aggressiveness of the cancer:
> PSA Doubling Time – the number of months it takes for PSA to double. If the PSADT
is < 10 months, that’s a sign of possible aggressiveness. If it’s < 3 months, that’s serious.

> PSA Velocity – the change in PSA levels over time. A rapid rise in PSA may indicate
the presence of aggressive cancer.

> % Free PSA – PSA circulates in the blood in two forms – either attached to certain
blood proteins or unattached (“free”). If the PSA is high, but the % of Free PSA is low, it may be an indicator.

> Biomarker (genomic) test: Looks for genes, proteins, and tumor markers that tell
more about the prostate cancer. (Not the same as genetic testing.) These tests
include Decipher, Prolaris, OncotypeDX, and more.

> Genetic (germline & somatic) test:
—> Germline: Tells you which genes have been inherited by your parents. (Also, not only for other males in the family, but have the female relatives been tested for the same gene mutations related to breast cancer? They say that either gender can pass the gene mutations to the other.
—> Somatic: Tells you which genes you have acquired (mutated variants) caused by
cell mutations or environmental factors.

—> Additional Bone/CT/PSMA PET scans results.

With this additional information, along with the PSA, PIRADS, and Gleason, you’ll have a full picture of the status of his disease.

(Also, look in the MRI and biopsy results to see if the phrases cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma mentioned? If not, that’s good. Those are often indicators of more aggressive cancer.)

PSMA shows where advanced prostate cancer is located. Subsequent treatments available are Pluvicto & Docetaxel (chemo)

Speaking as a newbie (everything's happened since 3/2024) whose PSA spiked from 2.89 to 3.62 over a 15 month period, I was really glad my urologist recommended an MRI and a PSA retest. The PSA retest dropped to a 3.26 (false signal), but the 3T MRI showed an 8 mm lesion with a PI-RADS 4. Then I was really glad my urologist recommended I go out of town to get an MRI Fusion biopsy (which I was ignorant of at the time), with the idea being the MRI fusion biopsy gives the best chance of the biopsy actually sampling the lesion. I went to Mayo Phoenix for the biopsy, but they first gave me a 2nd opinion from both a urologist and a 2nd reading of the MRI from their radiologist who also classified it as PI-RADS 4. At that point Mayo also agreed an MRI fusion biopsy was needed. The reason I really wanted the MRI fusion biopsy was because if the biopsy came back as non-cancerous, I really wanted confidence they had sampled the lesion. However, the biopsy came back with multiple 3+3 = 6 and 3 + 4 = 7 samples, so I elected nerve sparing RALP in late June at Mayo Phoenix. The prostate biopsy after surgery found both Cribiform and IDC, indicating likelihood of aggressive treatment resistant cancer in prostate, but the margins were clear. So 4 months into this foray, I'm pretty glad I had access to a 3-T MRI (and not some older MRI which might or might not have imaged the lesion) and that I didn't delay getting the MRI or the MRI fusion biopsy. I'm also glad my medical insurance and financial situation afforded me an opportunity to go out of town to a recognized cancer center of excellence for the MRI fusion biopsy and the nerve sparing RALP. I'm coming up on 4 weeks after surgery and I'm virtually 100% continent. No idea on ED yet.

There are additional tests & calculations that help provide more information on the possible aggressiveness of the cancer:
> PSA Doubling Time – the number of months it takes for PSA to double. If the PSADT
is < 10 months, that’s a sign of possible aggressiveness. If it’s < 3 months, that’s serious.

> PSA Velocity – the change in PSA levels over time. A rapid rise in PSA may indicate
the presence of aggressive cancer.

> % Free PSA – PSA circulates in the blood in two forms – either attached to certain
blood proteins or unattached (“free”). If the PSA is high, but the % of Free PSA is low, it may be an indicator.

> Biomarker (genomic) test: Looks for genes, proteins, and tumor markers that tell
more about the prostate cancer. (Not the same as genetic testing.) These tests
include Decipher, Prolaris, OncotypeDX, and more.

> Genetic (germline & somatic) test:
—> Germline: Tells you which genes have been inherited by your parents. (Also, not only for other males in the family, but have the female relatives been tested for the same gene mutations related to breast cancer? They say that either gender can pass the gene mutations to the other.
—> Somatic: Tells you which genes you have acquired (mutated variants) caused by
cell mutations or environmental factors.

—> Additional Bone/CT/PSMA PET scans results.

With this additional information, along with the PSA, PIRADS, and Gleason, you’ll have a full picture of the status of his disease.

(Also, look in the MRI and biopsy results to see if the phrases cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma mentioned? If not, that’s good. Those are often indicators of more aggressive cancer.)

@gently
Not a problem at all. I sometimes hit reply to comment on something regarding a discussion. I should be careful to do it at end of discussions.

MCC is a great source of information. I have been through it all and hope I can help by providing what I learned and went through. I have posted many times I was not aware of MCC until attended a prostrate cancer seminar at Mayo Jacksonville.. What a disapointment not knowing about MCC before then. I could have really used all that experience of others.

However my PCP was, and is, outstanding. He was the one who advised about proton verus photon and provide me a lot of research and pros and cons of each treatments. He still a active involvement with my recovery and hopefully cure. He is the one who did not like my continued PSA rising numbers even though I was still below the norm of 4 and ordered the urologist referral.
Take care!!

Yes, PSMA can show where advanced prostate cancer is located. However, at lower PSAs, PSMA PET scans are less sensitive to prostate cancer (see attached chart).

Also, about 15% of prostate cancers are PSMA negative (or PSMA naive) such that PSMA PET will often miss them even though you know something is wrong due to the increasing PSA.

That’s where other types of PET scans that aren’t reliant on PSMA (like Axumin PET scans) may be helpful. Always consider the full set of tests/calculations that are available.

I am living this. Will not post in the future.