PSMA PET CT question

Hi and welcome. Is his PSA high?

Thanks! PSA fluctuated between 2.1 and 3.5, but mostly hovers 2.6 last couple years.

Sounds like a proactive/thorough urologist. Oncology is probably going to want to see one anyway.

There is no downside to getting a PSMA pet scan.

Surgery should not be the only thing you look at.

You should speak to Dr. Roach at UCSF to see if SBRT radiation would be appropriate. Since it’s isolated to the prostate, that can work quite well.

@mjp0512 If he was GG3/unfavorable intermediate risk, for sure. GG2 on the other hand seems to be too low for private carriers, suggesting medical necessity is always accepted as justified. Medicare seems to be more lenient.

@jeffmarc thanks. active surveillance is also a good option at this grade group, true? Or too risky?

@chocchip I meant “… medical necessity is NOT always accepted as justified”.

Sorry for the typo.

@chocchip A 3+4 case with 20% 4 is too risky for AS. As another said, radiation is a good option for this case. See my bio for more details.

@wwsmith granted 20% pattern four isn’t 5%. But his PSA and Decipher score are notably lower, no cribriform subtype was noted, and biopsy positive core count = 1. All other cores were clean. This all stemmed from a routine DRE (first one in eight years), not from an elevated PSA.
Do you still think AS is too risky given that? Can you elaborate a bit?

Agreed with @jeffmarc. While it is unlikely that the PSMA PET scan will detect any PCa outside of the prostate, a biopsy does not necessarily detect all PCa in the prostate. Having this additional data will be helpful for determining treatment options. I can’t think of any downside, given the information you provided.