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Is hormone therapy necessary with radiation?
Prostate Cancer | Last Active: 3 days ago | Replies (99)Comment receiving replies
@brianjarvis
The vast majority of people with prostate cancer will produce PSMA. As a result, a PSMA pet scan will find it unless it is too small to see, Or there is nothing there yet.
In those cases, neither of the other scans will be any good.
That’s why they usually do salvage radiation, even if it might be somewhere else it is likely to also be in the prostate bed or the lymph nodes near it.
People can wait for metastasis to show up. I suspect that could cause some anxiety
Replies to "@brianjarvis The vast majority of people with prostate cancer will produce PSMA. As a result, a..."
@jeffmarc They estimate that about 15% of prostate cancers are PSMA-negative (or PSMA-naive). In fact, that can even occur within a patient - some of the prostate cancers may be PSMA-positive others may be PSMA-negative/naive. If recurrence is suspected (i.e., PSA rising) but, PSMA is negative, it’s important to look further.
Yes, PSMA PET scans are superior to all the earlier scans (Axumin, C11 Choline, F18-NaF, & F18-FDG). However, when there is no PSMA expression (& PSMA PET scans become blind), those older PET CT scans rise back to the top.
@jeffmarc
Can doctors use MRI scans or 'bone scans' to detect non-PSMA producing prostate cancer? If they suspect that is the case?
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@jeffmarc Yes having recently been in this exact situation I find these lines to be really ambiguous. I was at .23 when radiation started but PSMA was negative. I got radiation to pelvis and bed. As the stats would show there is in the low 30 percent probability that the recurrence is ONLY in the bed. I am getting four months ADT with what must be a corresponding 60 odd percent chance that the radiation did not get my recurrence. Now we know I have a recurrence somewhere. But because it didn't show on PSMA I am getting 4 months whereas if it showed on my spine etc I would probably get years of ADT and doublet therapy. It seems an odd dichotomy based solely on a scan result when the PSA tells the tale. Also in addition to the confounding variables others have mentioned, I would like to see an analysis when time to recurrence and doubling time are considered in addition to the initial staging. Finally, I have not read the article yet, but Jeff with regard to the studies saying start before .25 regardless of PSMS, didn't they also show benefit to combined radiation and ADT? That is my recollection.