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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@fuzzyjeepster

My understanding is UCLA has the only two machines in the country. UC Berkley and UC Los Angeles.

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It's UCLA and UCSF that has the PSMA Pet scan machine.

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@cl81227

Hi Coleen,
Yes thats it.
Part 1 of 3 videos, which are all worth watching

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How do we get the other two videos?

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I think the question has to do not with “machines” but with having a site approved by the ?manufacturer of the gallium for the PSMA PET. I saw a press release suggesting more sites would be online in Oct 2022. I believe that Mayo Clinic in Rochester is doing these; Dr Kwon’s video (link above) confirms that.

Fuzzyjeepster, would you be willing to tell us what you paid out of pocket for the PSMA PET scan at UCLA? FWIW: On diagnosis of my PCa I asked at Mayo Rochester about the (older) choline scan. The radiation oncologist advised it was not approved for first level diagnostics, but I could pay for it out of pocket (only $18,000 in 2020). I opted not to do that.

Fuzzyjeepster could you clarify if the 7.5 weeks of radiation or the 5 treatments are both traditional (photon) radiation vs. proton beam radiation?

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@web265

I don't think I answered in this thread yet...but for the sake of more information...

PSA 11 at discovery 13 just prior to RP, Gleason 4/3, 8 of 12 cores, RP in Sept of 2021.
Margins clean, right pelvic lymph removed & tested clean (most cancer on that side of the prostate), minimal invasion in blood vessels and nerve tissue.
PSA 3 mos later <.2
PSA 3 mos later 0.039
PSA 3 mos later 0.091 off to the radiation oncologist.
PSMA PET CT ordered by urologist at that time.

PSMA PET CT showed nothing, which I guess is a good thing? Started 40 IMRT sessions (around #10 now) and orgovyx (Lupron substitute). It seems to have the same side effects they just don't seem as extreme as I see for Lupron, or, I'm just lucky enough to tolerate it better, who knows?

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Some things are still uncertain.

PSA = or < 0.1 -0.2
Depending how the RP is done, e.g. nerve sparing, could some prostate tissue be left behind? I recall a discussion amongst four urologists on what to do with someone with PSA levels like this. One replied: I always ask the pathologist if they saw the prostate capsule membrane in the prostate that was removed. The implication is if they don't see it, some tissue could remain which might account for the tiny amounts of PSA. The key is looking for rising levels. I don't have enough information to determine if the PSA is rising.

Next: What is the reproducibility of the laboratory's PSA method at such levels? Are 0.04 and 0.09 truly different? I suspect these levels are analytical challenges, You would have to run both specimens in the same assay to be more certain. If the lab runs a QC specimen in this range, the analytical range should be known.

PSMA PET. Mine showed all cancer confined to the prostate. I hope it is true. On the other hand, what do we know about the analytical detection level of a PSMA PET for prostate cells? Perhaps it has been studied; I don't know. This is very new technology. One thing I'm fairly certain of: a negative PSMA PET does not rule out extra capsular disease. It likely only gives you probabilities of disease/disease free, neither of which has likely been established yet.

BTW, I chose radiation rather than RP. That decision too is a bit of a crap shoot as far as disease is concerned.

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@jimcinak

I think the question has to do not with “machines” but with having a site approved by the ?manufacturer of the gallium for the PSMA PET. I saw a press release suggesting more sites would be online in Oct 2022. I believe that Mayo Clinic in Rochester is doing these; Dr Kwon’s video (link above) confirms that.

Fuzzyjeepster, would you be willing to tell us what you paid out of pocket for the PSMA PET scan at UCLA? FWIW: On diagnosis of my PCa I asked at Mayo Rochester about the (older) choline scan. The radiation oncologist advised it was not approved for first level diagnostics, but I could pay for it out of pocket (only $18,000 in 2020). I opted not to do that.

Fuzzyjeepster could you clarify if the 7.5 weeks of radiation or the 5 treatments are both traditional (photon) radiation vs. proton beam radiation?

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One limitation to broad adoption: the means to generate the radioactive positron-emitting Gallium 68 from its precursor Germanium 68, and likely some subsequent biochemistry. The Gallium 68 isotope has to be generated on site because its half-life is only 68 minutes. I'm uncertain if they use a Cyclotron or other means, and whether there is a purification step, and it must also be mixed with specialized proteins but the bottom line is, it's highly specialized and complicated. At UCLA, they delivered the Gallium 68 - labelled compound from its preparation site somewhere else on campus using a low tech vacuum delivery tube 🙂 all ready to be injected into a vein in my arm, which was already prepped and ported. As a biochemist who has used radioisotopes and antibodies extensively, I can tell you this is frontier stuff. Among the leaders in this: UCLA and UCSF. The technology has also being adapted to TREAT metastases (different isotopes of course) and just been approved in the US. Initial data are understandably small numbers, so we'll see.

You can learn more here (the PSMA/PET of interest starts around 10 minutes in): This is Dr. Reiter at UCLA

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@drj

One limitation to broad adoption: the means to generate the radioactive positron-emitting Gallium 68 from its precursor Germanium 68, and likely some subsequent biochemistry. The Gallium 68 isotope has to be generated on site because its half-life is only 68 minutes. I'm uncertain if they use a Cyclotron or other means, and whether there is a purification step, and it must also be mixed with specialized proteins but the bottom line is, it's highly specialized and complicated. At UCLA, they delivered the Gallium 68 - labelled compound from its preparation site somewhere else on campus using a low tech vacuum delivery tube 🙂 all ready to be injected into a vein in my arm, which was already prepped and ported. As a biochemist who has used radioisotopes and antibodies extensively, I can tell you this is frontier stuff. Among the leaders in this: UCLA and UCSF. The technology has also being adapted to TREAT metastases (different isotopes of course) and just been approved in the US. Initial data are understandably small numbers, so we'll see.

You can learn more here (the PSMA/PET of interest starts around 10 minutes in): This is Dr. Reiter at UCLA

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Very helpful information. Dr. Thomas Hope's video was especially

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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.

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Can you advise where these numbers for PSMA/PET sensitivity can be found?

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@drj

Can you advise where these numbers for PSMA/PET sensitivity can be found?

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I found this info by following The Prostate Cancer Research Institute on You Tube. They have an excellent question and answer service, semi-annual weekend conferences, and shorter videos covering various topics. I highly recommend it.

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My brother had PSMA/PET last week and yes it showed cancer in prostate and two lymph nodes in low abdomen. It also had uptake in soft tissue of his face by a frontal sinus. We are being told he needs MRI of face and sinuses too will out aberrant diagnosis of meets to sinus. Doing week with all this stuff.

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I had the scan when my PSA was 1.0. Four pelvic lymph nodes were shown to be cancerous. They were treated with radiation and I began taking Nubeqa. I was already on Lupron. My PSA is now undetectable. The new scan is the reason.

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