PSMA negative, Biopsy positive

Posted by undetectable @undetectable, Jul 19, 2023

My husband (71) has a Gleason 8, PSA 8 (4+4). His recent MRI-guided biopsy revealed 9/18 positive cores, four of those 4+4. PSMA showed no spread but the area of diagnosed malignancy didn't light up either. His urologist (at large well-regarded medical center) said he's clear, but the radiologist (at cancer center) who interpreted results said the scan could have 'reduced sensitivity.'

Husband's plan is to choose a surgeon who will decide whether to retest. (He has ruled out radiation because of the ADT.) Is anyone else familiar with this kind of PSMA PET result?

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sillyoyster | @sillyoyster | Feb 12 11:19am

From my understanding, not all pca cells light up with a psma scan. They can be found with an Axumin Pet scan.

heavyphil | @heavyphil | Feb 13 9:10am

In reply to @sillyoyster "From my understanding, not all pca cells light up with a psma scan. They can be..." + (show)

Hey Oyster, your post made me curious so I started digging. It seems that PSMA works better than Axumin at lower PSA levels .2 - .5 which is useful when screening for salvage treatment.
But at higher levels it seems that the Axumin shows clearer areas with less “noise” (grainy ghost images) than PSMA.
So I guess there are indications for both depending what your PSA levels are when you present for treatment.

shepper | @shepper | Feb 14 7:05am

You may be a person for whom PSMA doesn't light up. I think about 10% of cases won't light up. I know someone who had a few PSMAs with no lights. Continue to advocate for yourself and ask questions. Your Gleason is 4+4, which needs attention.