PSMA PET Scan

Posted by WingNut @ucfron, 2 days ago

Does anyone know if the PSMA PET Scan will also find any non-prostate cancer cells as well, or is it specific to PSA? I had a PSMA PET Scan due to a high elevated PSA test, and confirming MRI and Biopsy, and the PSMA PET Scan should no spread outside of the prostate. Just wanted to find out if other cancers are seen on this prostate specific type of scan?

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No, it is specific to prostate cancer since the tracker binds to the psma protein. Also, it is used to determine if the cancer has metastasized (lymph node, bones, or even farther). but not very accuate in determining extracapsular extension or seminal vesicle invasion.

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The PSMA pet scan also can’t see prostate cancer that doesn’t produce PSMA. That’s about 10% of prostate cancer cases.

They do have FDG PET scans at many places and a plain old style Pet scans and they can see other kinds of cancers.

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A CT contrast scan can't see quite as tiny micro-metastases as PSMA PET, but it can see other types of cancer (and non-cancer as well: it lights up where my spine is still healing itself after the surgery in 2021).

In Ontario, they reserve PSMA PET scans for special circumstances, because (as my oncologist told me), it's not clear how to respond to tiny spots of lucency in many cases, especially since PSMA PET can throw up false positives so easily. CT + contrast is still routine standard of care.

That said, if/when my PSA starts rising again, I probably will ask for a PSMA PET scan; we just don't use it for routine screening surveillance.

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Thank you all for the comments. I have had a PSMA PET Scan and it showed nothing outside the prostate. I have also had a CT with contrast that also showed nothing other then the prostate (except for an old neck injury I had in 2012 where they noted it was degenerative and not cancer). My concern was that I have several indicators that I have read could happen when the cancer spreads outside of the prostate. These being on and off pains in my lower abdomen (both dull and at times sharp which started just recently), with lower back and upper thigh pain and stiffness (which I have had for several years now). Certainly both the PSMA PET Scan and the CT with contrast couldn't both be wrong. I guess this is my life now since the diagnosis back in April. Thankfully I think it was caught early enough and now I just need to get some treatment. Elevated PSA (4.5) found in December 2024, MRI found PIRAD5 area on prostate in February 2025, all metabolic tests normal in March, 12 core biopsy in April showed 70% of one core at area of concern was 3+4=7 with 4 making up only 5% of the core, and found one additional core having 3+3=6 with only 5% of core being 3, all other cores good. Since then I have had CT with contrast and PSMA PET Scan both showing no signs of spread outside the prostate. I was told by Moffitt in June that I am not a good candidate for focal therapy due to the size of my lesion which was estimated at 2 cm on the MRI (1.8 cm on the PET). This was disappointing. I am waiting on the ARTERA-AI test results to finalize my decision between radiation of removal. I have met with both a Radiologist and Surgeon at AdventHealth in Orlando (where it was found and all tests were done), and at Moffitt, and I have an appointment at the Mayo in Jacksonville next week. Interestingly that the surgeon at Moffitt suggested I do radiation.?? I thought that was odd since Drs usually advocate for what they practice. Not sure what to do, but I feel I need to do something. Obviously I don't like the side affects of removal, but I also want this out of my body before I miss the window of opportunity I have.

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Sometimes prostate cancer doesn’t produce PSMA. The PSMA pet scan cannot see metastasis smaller than 2.7 mm and according to one surgeon at an webinar even under 5 mm can be difficult. An FDG scan does see non PSMA prostate cancer.

It is unusual to have pain from prostate cancer if it is isolated to the prostate. I know it can happen but people I know that had pain, had it in bones or a vital organ. Any treatment you pick should take care of that Since the prostate has to go.

Getting all these opinions is a great idea.

If a surgeon recommends radiation, it could be he thinks that the cancer has gotten out of the prostate. The location of the pains you are having may be what is causing him to make that decision.

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What is your age? That might be the reason that the surgeon recommended radiation. Did you talk to Dr. Rodrigues?
I opted for surgery at Advent with Dr. Patel, but would have chosen Dr. Torres at Moffit if I had chosen radiation. Mayo Jax also made a goid impression on me for surgery.

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@ucfron

Thank you all for the comments. I have had a PSMA PET Scan and it showed nothing outside the prostate. I have also had a CT with contrast that also showed nothing other then the prostate (except for an old neck injury I had in 2012 where they noted it was degenerative and not cancer). My concern was that I have several indicators that I have read could happen when the cancer spreads outside of the prostate. These being on and off pains in my lower abdomen (both dull and at times sharp which started just recently), with lower back and upper thigh pain and stiffness (which I have had for several years now). Certainly both the PSMA PET Scan and the CT with contrast couldn't both be wrong. I guess this is my life now since the diagnosis back in April. Thankfully I think it was caught early enough and now I just need to get some treatment. Elevated PSA (4.5) found in December 2024, MRI found PIRAD5 area on prostate in February 2025, all metabolic tests normal in March, 12 core biopsy in April showed 70% of one core at area of concern was 3+4=7 with 4 making up only 5% of the core, and found one additional core having 3+3=6 with only 5% of core being 3, all other cores good. Since then I have had CT with contrast and PSMA PET Scan both showing no signs of spread outside the prostate. I was told by Moffitt in June that I am not a good candidate for focal therapy due to the size of my lesion which was estimated at 2 cm on the MRI (1.8 cm on the PET). This was disappointing. I am waiting on the ARTERA-AI test results to finalize my decision between radiation of removal. I have met with both a Radiologist and Surgeon at AdventHealth in Orlando (where it was found and all tests were done), and at Moffitt, and I have an appointment at the Mayo in Jacksonville next week. Interestingly that the surgeon at Moffitt suggested I do radiation.?? I thought that was odd since Drs usually advocate for what they practice. Not sure what to do, but I feel I need to do something. Obviously I don't like the side affects of removal, but I also want this out of my body before I miss the window of opportunity I have.

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❝ My concern was that I have several indicators❞

That's a very normal and understandable situation. After a cancer diagnosis, we can become hypersensitized to little aches and pains that we would have ignored or downplayed before. ❤️

You've had all the best tests done, and while there's never a 100% guarantee, it's probably safe to trust them for a while, at least to to the same extent you trust that a bridge won't fall on you when you drive under it

When I apologized to my family doctor for worrying about so many aches and pains early on (to the extent she was booking double appointments for me), she told me two things

1. It's a normal reaction to a new cancer diagnosis.

2. If I were still doing that in 5 years, then she'd be concerned.

In fact, after about two years I stopped worrying. I still mention anything new to my oncologist, but as I approach the 4-year mark, I no longer feel that sense of panic: listing them is just routine due diligence now.

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@topf

What is your age? That might be the reason that the surgeon recommended radiation. Did you talk to Dr. Rodrigues?
I opted for surgery at Advent with Dr. Patel, but would have chosen Dr. Torres at Moffit if I had chosen radiation. Mayo Jax also made a goid impression on me for surgery.

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62 year old and very healthy, fit and active otherwise. I too met with Torres at Moffit and the surgeon was Yu. The surgeon at AdventHealth was Dr Zachery Smith. Meeting with Albert Attia who is a Radiologist Oncologist at Mayo Jax next Thursday.

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@topf

What is your age? That might be the reason that the surgeon recommended radiation. Did you talk to Dr. Rodrigues?
I opted for surgery at Advent with Dr. Patel, but would have chosen Dr. Torres at Moffit if I had chosen radiation. Mayo Jax also made a goid impression on me for surgery.

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How long ago did you have surgery and what was your age? Are you experiencing any side affects. Are you happy you did? I know second guessing isn't good, just curious. I really don't know what to do.

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@ucfron

How long ago did you have surgery and what was your age? Are you experiencing any side affects. Are you happy you did? I know second guessing isn't good, just curious. I really don't know what to do.

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I am 52. I had my RARP with Dr. Patel at Advent only five weeks ago. He was able to do good nerve sparing, over 75% on each dide, and margins were negative. I was Gleason 4+4 on biopsy. I have more incontinence than I had hoped/expected, but within what seems to be still a normal range. To soon to evaluate boners.

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