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Is a PSMA-PET scan of value if you have already started ADT treatment?
An acquaintance had a RP in mid July and while the pathology report had some positives his Gleason score increased from a 7 to an 8 (5+3). The urologist commented that if his PSA was to rise above .4 they would order a PSMA-Pet scan. However, because his Gleason score was 8, his urologist suggested that a PSA test should be performed earlier rather than waiting the normal 3 months. Unfortunately, his 1st PSA reading was a 4.7 and a second follow up was 5.2. He has started taking a bicalutamide tablet for 28 days and has had his first ADT injection. Is there any benefit in having a PSMA-PET scan as presumably the ADT will bring his PSA level down and the scan might not identify any cancer cells.
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GKM - sounds like testing is going on - thats a good thing. This is such a technical question and there are so many versions of the PSMA-Pet scanners , here's what I would do . First I would bring this question to your Urologist( Uro) and the Radiation Oncologist ( RO) . Its a great Question and depends on many factors . Also , then I would contact the radiology guys who do the actual PSMA-PET scanner . Get them to re-explain the process and the issue of taking that particular ADT before the scan - does it modify results of any sorts ? I 'think' taking ADT will modify the PSA for sure , but the PMSA-Pet operates differently and need about a PSA of 0.2 or higher ( depending on machine ) . But check it out through the Urologist , RO and Tech who does PSMA PET scan itself ! I sure wish you and your friend the best ! God Bless ! James on Vancouver Island .
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4 ReactionsDr. Kwon's team at Mayo recently told me that 10-22% of men can have undetectable PSA's, while cancer continues to show up on a scan and potentially keep growing/spreading. So his team has patients do a lot more frequent PET scans that someone like my local oncologists would (which is one of the many reasons I fly to MN). This gives more options to radiate spots, start treatment earlier, etc. before things get worse.
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3 ReactionsI went to a major cancer center and this scan was never even mentioned before I started treatment. I'm very surprised to see that it's such a standard thing.
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1 ReactionEven more on that topic
About 10% of men do not produce PSMA and don’t show anything on the PSMA PET test
In that case, they need to do an FDG PET test to see if they have any metastasis.
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2 ReactionsThanks for sharing that.
I'm aware of this 2007 lit review concluding that some people still had prostate-cancer progression with PSA of 0.1–0.2. Have there been more recent studies showing people still progressing when their PSA is undetectable on the newer ultrasensitive PSA tests (e.g. < 0.01)?
https://pubmed.ncbi.nlm.nih.gov/17171704/
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