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Is a PSMA-PET scan of value if you have already started ADT treatment?
Prostate Cancer | Last Active: Oct 10 6:20pm | Replies (15)Comment receiving replies
A PSMA-PET scan is not the standard of care in Canada. I believe it was the oncologist that placed him on ADT but that raises the question why was a PSMA-Pet scan not recommended before starting ADT. Does the taking of hormone therapy negate the ability of the PET scan to detect the cancer?
Replies to "A PSMA-PET scan is not the standard of care in Canada. I believe it was the..."
Access to PSMA-PET in Canada would vary province-by-province, I'd think. I've added the criteria for getting a PSMA-PET scan in Ontario for prostate cancer to the end of this message (you can also make a special application even if you don't meet the criteria).
Note that the chemical markers for the scan weren't approved by Health Canada until 2022 (pharma companies always apply for approval in smaller markets like Canada later), so the scan wasn't available to me in 2021 when I was diagnosed. However, I did get MRI, CT, and bone scans, all of which showed only the one big metastasis on my spine. The fact that I've had no recurrence after 3 years and my PSA remains < 0.01 gives me a fair bit of confidence that there are no other metastases at this point, but of course, there could be (and likely are) individual dormant cancer cells that even a PSMA-PET scan wouldn't pick up. If my cancer comes back, it will start with them.
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Eligibility Criteria: Prostate Specific Membrane Antigen (PSMA) PET in the following patient populations:
Initial staging of patients with a new diagnosis of high-risk prostate cancer being considered for radical (curative) therapy
OR
Staging of patients with recurrent prostate cancer who fall into one of the following pre-defined cohorts:
Post-prostatectomy node positive disease or persistently detectable PSA
Biochemical failure post-prostatectomy
Biochemical failure following radical prostatectomy followed by adjuvant or salvage radiotherapy
Rising PSA post-prostatectomy despite salvage hormone therapy
Biochemical failure following treatment for oligometastatic disease
Biochemical failure following primary radiotherapy
Rising PSA and/or progression on conventional imaging despite prior second line hormone therapy or chemotherapy for castrate resistant prostate cancer
Where confirmation of site of disease and/or disease extent may impact clinical management over and above the information provided by conventional imaging (requires a case-by-case review)
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Source: https://www.ccohealth.ca/en/what-we-do/general-health/pet-scans-ontario/oncology-indications
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As I mentioned, if you have a large metastasis, it will show up even though you have a very low PSA.