2.5 Yrs After Proton Rad PSA reached 1.05

The data for those patients were retrospectively analyzed. They used 68Ga-PSMA PET/CT and considered factors such as androgen deprivation therapy, PSA doubling time, PSA before PET/CT, T−/N-category and Gleason score. So, they accounted for the status of the cancer.

You’ll find regular mention of PSMA PET being most useful at PSAs above 0.2 ng/mL (like here: https://www.petimagingflorida.com/helpie_faq/at-what-psa-level-should-i-get-a-psma-pet-scan/#:~:text=Generally%20speaking%2C%20PSMA%20PET%20Scans,levels%20above%200.2ng%2FmL.), which is why you’ll often see doctors wait until PSA of 0.2 before using PSMA PET.

The more aggressive the prostate cancer, the more PSMA avid uptake of the radiotracer there is. Also, the more aggressive the cancer, the more effective Pluvicto (Lutetium-177) is at treating it.

Castration sensitive or castration resistant, was wondering if there is a difference?

Hi Jeff is Medicare covering the PSMA scans every 3-months I’m not sure they would?

I’m not sure how old this guy was. The thing is if a doctor says it is required they will usually pay. May take some justification.

Right he may have had private insurance I’m on original Medicare they cover all my oral cancer meds, which is a true blessing.

Hey brianjarvis, is that also the case for the most aggressive cancers which exhibit very low PSA? Is the numerical value consistent with uptake? I would think not…
Then the older Axumin or choline PET would be more useful. BUT, how would an RO know this? You could be riddled with metastasis and show little or no uptake on PSMA, couldn’t you?
It almost takes the breath away not knowing what you don’t know!!😖

This is the reason I attend in-person, virtual, and FB forums like this. I realize that my doctor can’t know everything. But if I see/hear what 10 other guys’ doctors told them, I’m that much wiser.

I’ve read that when Mayo Clinic uses PSMA PET scans that show nothing (even though they know something’s wrong due to rising PSA), that they fall back to C11 Choline PET/CT. Other centers go back to Axumin (F18-Fluciclovine) PET/CT, while others use the much older F18-FDG (Fluoro-2-Deoxyglucose) PET/CT (if they think the cancer is aggressive enough).

What Dr. Johnson from Mayo Clinic says is that (usually) the more aggressive the cancer, the more avid the uptake of the PSMA radiotracer (https://youtu.be/JoJomACA5UM). In that video he goes so far as to say that the more aggressive the prostate cancer, the better Pluvicto (Lutetium-177) works.

When I was in discussions with my RO, there were a number of things I told him that either he had never done or had never heard of. (This always led to fantastic patent-doctor discussions between us.)

Yes, one could be “…riddled with metastasis and show little or no uptake on PSMA.” But, we have so many tools in the toolkit available to us, that one of then would have given some indication of potential spread.

Use all the tools available (that insurance will pay for).