PSMA PET CT question

@chocchip I'll tell you what. My first PSMA PET was done after a biopsy showed Gleason 9 (5+4) GG5 with 10 of 12 cores at 100%. Sure wish I had a time machine to go back and have it done at (3+4).

No downside. I had 3+4 and caught things early and was treated with a built in MRI radiation machine. No regrets and feel luckier than most.

If it were me, I’d be glad to get a PSMA PET/CT scan at this stage. It can serve as a baseline, reveal any hidden areas of concern…. I see no downside to knowing more facts. (Wish it would have been available earlier.)

@chocchip
PSA is within normal limits.
My suggestions from my own personal experience is Decipher test. I got the same intermediate risk from Gleason Score and was to have radiation and hormone treatment. My Decipher came back low risk not intermediate. So no hormone treatments recommended.

PSMA test yes. I had it also and mine was negative. Can add evidence that cancer is still in prostate. But remember that a lot of the prostate cancers are still at the cellular level and hard to detect. But the PSMA test is excellent to help with diagnosis and treatment plans. I also had bone scan and it was also negative.

He is seeing both a urologist and oncologist/urologist. That is good. Going to get a lot of recommendations for treatment. Make sure you discuss all with his doctors to include radiations and surgeries not just one but both. I had 30 rounds of proton radiation.

Good luck and if in double about diagnosis or treatment plans suggest second opinion. That really helps you decide and I had 3 separate medical professionals opinions done before I made final decision with final consultation with my PCP.

It appears you have an experienced urologist and will be seeing a oncologist/urologist. Just know many urologist lean (just a comment not a fact) surgery. So ensure your husband gets briefed on all the pros and cons of all PC treatments so can make informed decision of what is best for him and you.

I believe the lower PSA range may guide in the selection of diagnostic ligands. There are more than one PSMA PET CTs not just the lutetium-177 (?) which may be best in the higher range of PSAs

@thmssllvn he’d go to UCSD or UCSF for the PSMA PET, because we are presuming their radiologists to be notably most experienced in this arena, compared with our local community hospital. I assume there is not much reason to make a location choice based on which tracer is used at which center but LMK if this is not necessarily the case.

All these comments are very helpful! So appreciative of this service and all of you!

@jc76 did they discuss any of the focal therapies with you? We know the research is still limited so not sure if they reduce risk versus more routine vanilla AS.

I think it is a great diagnostic tool for the doctors. Because there are so many unknowns in prostate cancer, this will fall into the “known” category for them and both of you. Best to both of you while on this journey…

@chocchip
As others have said, 20% of four is a little high. It could mean there is more cancer there, but wasn’t found in the 1% of the prostate that was examined.

@jeffmarc jeff, when it comes to stratification and pondering AS, how much weight do you see docs tending to give to the subtype / histology of the pattern 4: Cribriform / IDC varieties vs fused and ill-formed.
Have you seen a lot of AS regret, from initially low volume 3+4 guys? For sure life span outweighs the side effects of RP for us. But AS can also mean improved techniques and medicine in five years.