Article: Imaging scans detect prostate cancer progression, stable PSA

Unfortunately, you put the link in the subject line and they only allowed so many characters so the link doesn’t work at all. You could post an update and put the link you wanted just to see in it.

Insurance is not going to approve a PET scan every couple of years unless a biopsy shows something pretty serious like Gleason Eight or higher. The standard for active surveillance is regular PSA tests and occasional, probably annual, Biopsies.

Looks like he was trying to link to this:
https://www.news-medical.net/news/20260701/Imaging-scans-detect-prostate-cancer-progression-despite-stable-PSA-levels.aspx
It's more coverage of a study that was previously reported on this forum. It's talking about patients with advanced, previously treated PC, not about pre-Tx patients. So the question about insurance coverage may be a bit different.

Imaging scans detect prostate cancer progression despite stable PSA levels
"The ARCHES trial included patients whose prostate cancer had metastasized but still responded to hormone therapy, which lowers testosterone levels or blocks the cancer's ability to use testosterone signals to grow. Of these patients receiving enzalutamide, a subset experienced cancer progression on imaging despite stable, low, or minimally changing PSA levels.

The researchers found similar results in the PROSPER trial, which enrolled patients with non-metastatic castration-resistant prostate cancer, meaning their prostate cancer no longer responded to hormone therapy, but their cancer had not spread to other organs based on conventional imaging.

Patients taking enzalutamide whose cancer progressed on imaging had worse overall survival than those whose cancer had not, regardless of PSA changes. The study also found that patients often felt well without new symptoms, despite the cancer advancing. Since the findings in both groups were similar, this may be a broad issue across advanced prostate cancer."

@jeffmarc https://www.news-medical.net/news/20260701/Imaging-scans-detect-prostate-cancer-progression-despite-stable-PSA-levels.aspx

sorry..try this..PSA readings can be only semi reliable it seems...

@xahnegrey40 They do say it is mostly for cases of advanced PCa, which kind of makes sense.
Some of these variants do not even exhibit high PSA markets to begin with, so small rises might be interpreted as ‘normal’.
Phil

PET scans (especially PSMA PET scans) are expensive.

In both of the studies referenced (ARCHES and PROSPER), imaging was assessed using CT, MRI, x-ray, and bone scintigraphy, “…as newer PET radiotracers (PSMA PET) were not available at the time that these studies were conducted.”

They also mention the concern regarding the “….economic cost of frequent PSMA PET scans.”

> https://ascopubs.org/doi/10.1200/JCO-24-02829

@heavyphil The study also involved a cohort of men who had recieved hormone therapy (both the ARCHES and PROSPER trials). So, the conclusions apply only to a specific subset of men with prostate cancer.

I have undergone both a RARP (2015) and salvage IMRT (2025), but no hormone therapy. My PSA is low (0.097 average post radiation) and stable. I wouldn’t bother with another PET scan unless my PSA started trending upward. That said, I know that PSA is not a perfect indicator, but in my case, it is probably the best indicator of disease progression/remission.