Has anyone had the PSMA-PET scan? Was cancer found?

Posted by hector13 @hector13, May 12, 2022

My prostate was removed 5 years ago. Two months ago, my PSA went from 0.00 to 0.09, and this month the PSA increased to 0.2. My urologist believes I am a candidate for the new PSMA-PET scan approved in 2020 that is more sensitive than previous scans in detecting small tumors. Has anyone had this scan? If so, what was your PSA at the time and was the cancer found?

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Hi @hector13, welcome. I believe @bandit11 @kujhawk1978 @natem @scullrower @bburg and @olanordman have experience with the newer PSMA-PET scan and can share more about what to expect.

Hector, I assume that your prostate was removed 5 years ago due to cancer. Is the scan being recommended to monitor for recurrence?

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Yes I have and no it wasn't.

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Watching this thread with great interest. I had RP Sept of 2021.
Post op labs indicated clean "margins" but some very minor indication of invasion of blood vessels and nerve tissue. I also has the right lymph node removed, it was clean as well. No further treatment was recommended at the time.
3 month scans so far are;
<.2 (not ultra sensitive)
.039
.091
My Gleason scores were 7. Given the combination the surgeon is referring me to a radiation oncologist but has also ordered the PSMA PET CT. My insurance company has denied it as "medically unnecessary". I'm considering going "out of pocket" for it. Is it really thought to be that much better than a standard scan?

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Indeed, I have had the scan and it just may have helped killed my cancer for good. My PSA was rising fast. By the time I got the PSMA PET scan with gallium 68 at UCLA the PSA was 1.0. The scan showed four pelvic lymph nodes had cancer but nowhere else. I came back home to WV and got 5 SBRT radiation treatments. A month later the PSA was .5. Two months after that it was undetectable. I’m also taking Lupron and Nubeqa. All of this after being treated for this cancer for more than 20 years. I had surgery, then follow up radiation, then Lupron, and now this, three recurrences. Time will tell if the cancer is truly gone but I’m hopeful. The PSMA scan is a life changer and the folks at UCLA couldn’t have been kinder or more helpful. Best of luck.

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Had PSMA pet scan after MRI and bone scan. No cancer indicated outside prostate confirming previous tests.

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Hi Bandit11 – I am curious as to why your physician ordered a PSMA-PET scan after previous MRI and bone scan showed no cancer present?

To Everyone Else – After having prostate removed, radiation therapy and 4 years of 0.00 PSA, I have a PSA that has risen to 0.2. This is supposed to be the lowest figure that the new PSMA-PET scan can locate, but I wonder if this newly approved scan will find it at this level. Can anyone comment on whether they had this scan at around 0.2 , and what was the result? Was the cancer located? Hector13

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@web265

Watching this thread with great interest. I had RP Sept of 2021.
Post op labs indicated clean "margins" but some very minor indication of invasion of blood vessels and nerve tissue. I also has the right lymph node removed, it was clean as well. No further treatment was recommended at the time.
3 month scans so far are;
<.2 (not ultra sensitive)
.039
.091
My Gleason scores were 7. Given the combination the surgeon is referring me to a radiation oncologist but has also ordered the PSMA PET CT. My insurance company has denied it as "medically unnecessary". I'm considering going "out of pocket" for it. Is it really thought to be that much better than a standard scan?

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The newer scans are indeed worth it. In my case, and using Gallium 68 tracer, four cancerous pelvic lymph nodes were found at PSA 1.0. These newer scans are sensitive as low as PSA .2 but the sweet spot seems to be .5 or .6.

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I have not had the newer PSMA scans., mainly because I have not needed them. Still, should I need them, my medical team and I have decision criteria as to when to image. One of those criteria is a continuous rise in PSA that goes above .5. These scans can detect at lower PSAs but .5-1.0 is where statistically higher probability of locating sites of recurrence comes into the decision making process.

The question you want to ask is does waiting to image at a PSA of .5 or higher change the treatment decision and outcome versus imaging at a lower PSA and a decreased probability of it locating any sites of recurrence. A part of that decision is micro-metastatic disease, sites too small for the scans to identify. As an example, of the imaging locates several sites, would you decide on radiation treatment only to those sites or would you add short term systemic therapy such as ADT to deal with micro-metastatic disease?

As to your insurance company, they may very well be hiding behind old NCCN guidelines that required you to use conventional imaging first before using the PSMA ones, after all, they are cheaper and that's what insurance companies do.

I would consider appealing and cite NCCN guidelines
https://www.urotoday.com/video-lectures/nccn-prostate-cancer-guidelines-review/video/2365-nccn-guidelines-staging-evaluation-and-imaging-approaches-in-prostate-cancer-christopher-wallis-and-zachary-klaassen.amp.html
https://www.urologytimes.com/view/psma-pet-imaging-modalities-added-to-nccn-guidelines-for-prostate-cancer

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@hector13

Hi Bandit11 – I am curious as to why your physician ordered a PSMA-PET scan after previous MRI and bone scan showed no cancer present?

To Everyone Else – After having prostate removed, radiation therapy and 4 years of 0.00 PSA, I have a PSA that has risen to 0.2. This is supposed to be the lowest figure that the new PSMA-PET scan can locate, but I wonder if this newly approved scan will find it at this level. Can anyone comment on whether they had this scan at around 0.2 , and what was the result? Was the cancer located? Hector13

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PSMA Pet is much more accurate in detecting cancer outside the prostate than Bone or MRI. I had done extensive research before I saw oncologist or radiologist and knew I wanted PSMA. Because wait time to obtain Pet was 2+ months, went ahead with bone and MRI since those could be scheduled quickly. Radiologist indicated that bone and MRI would not have been necessary had PET been available quickly. Happy I did all! Also, had Decipher genetic test which I would highly recommend if your insurance will cover. Best to you!

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@scullrower

The newer scans are indeed worth it. In my case, and using Gallium 68 tracer, four cancerous pelvic lymph nodes were found at PSA 1.0. These newer scans are sensitive as low as PSA .2 but the sweet spot seems to be .5 or .6.

Jump to this post

To continue, after the cancer was found to be isolated in the pelvis, I was treated with five rounds of SBRT. Three months later my PSA was undetectable. This is after 21 years since diagnosis, surgery, then first recurrence treated with radiation, second recurrence treated with Lupron, third recurrence scanned then radiation. Rule of thumb: get scanned, then treated. If you can see cancer, you know better how to treat it. Any recurrence should be seen as an opportunity to kill it. Get second opinions and seek curative treatment, if possible. Don’t settle for palliative treatment except as last resort. Finally, if you aren’t satisfied with your local doctors, got to a center of excellence. I had better communication with docs at UCLA than I did at home.

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