Connect
← Return to Widespread Skeletal Metastatic
Discussion
Widespread Skeletal Metastatic
Prostate Cancer | Last Active: Mar 7 11:37am | Replies (27)Comment receiving replies
@northoftheborder The use of PSA for screening is widespread in the US and catches many cases. One I know of is 42 yo. The USPSTF recommendation was rescinded years ago. The OP must have gone years without PSA testing and now he has widespread mets in his bones. And as seen elsewhere, Canada has not made the PSMA PET scan readily available in the Provinces. Looking at grayscale bone scans is signficantly inferior to a PSMA PET scan image.
Replies to "@northoftheborder The use of PSA for screening is widespread in the US and catches many cases...."
Connect
@ctsenior The U.S. recommendation against routine PSA screening was loosened but not rescinded. Unfortunately, many U.S. men (both here in the forum and in touch with me privately) still do not get routine PSA screening offered to them, or were talked out of it when they asked. As here in Canada, it really depends on your doctor.
And the variety of prostate cancer that spreads aggressively to bones can move *very* fast. It's not like the slow-moving kind that affects mainly elderly men and takes years or decades to spread. You can have PSA in normal range, then suddenly have bone metastases 1–2 years later.
As for PSMA-PET, it's available in Canada, but not used as first-line imaging because there's no significant evidence (yet) that its higher-resolution imaging actually leads to improved survival or delayed progression.
Still, I would support making PSMA-PET more widely available here in Canada, with the following caveats
1. It's not very effective for those of us already on ADT and/or ARSIs (like the lutamides), because they inhibit PSMA uptake.
2. It's a very "noisy" scan that produces lots of false positives: your bones, lungs, lymph nodes etc might light up like a Christmas tree on a PSMA-PET scan when there's little or no actual cancer there, which is why they need to confirm with other indicators (PSA, biopsies, alternative imaging methods, etc).
Cheers!