Pirads 3, going for PSMA PET scan instead of biopsy

These scans a super expensive, double or triple what a good MRI costs and then some. Then if done in a hospital setting which they usually are, even more. It is about insurance. I mean if you pay of of pocket I am sure somebody would do it. You might look into these liquid biopsy, no experience but search around for info, insurance might pay for that but not sure.

Lay person here. I’ve now had 2 PSMA-PET scans. My care team explained to me that having them would not take the place of a biopsy, only alert us to the presence of PCa within the prostate and any metastasis outside of the prostate. Neither a PET scan or an MRI can determine how aggressive cancer might be, and all the medical advisors I spoke to expressed their belief that once cancer is identified on an MRI or PET scan, it was imperative that there be a biopsy for the purpose of determining the aggressiveness of the cancer.

As others said, the PET does not take the place of a biopsy, and no insurance will pay for it prior to a biopsy. My PSMA PET was $12,887.00 and was paid for by Medicare and my supplement.......after....my biopsy and diagnosis was done.

Get PSMA PET Scan, then biopsy the lesion or lesions to make sure how aggressive it is. It seems Dr. Scholz or Dr. Kwon are quite inclined to do the PSMA without biopsy.

I insisted on a PET 5 yrs ago before surgery to see if there was any spread BEFORE going under the knife. Why bother if it had - just go right to radiation and hormones, right?
Ins co said ‘no way’ so I paid about $8K for Axumin - which was the only game in town. It was negative but meant nothing since I am now facing recurrence after the surgery.
IMO, get the transperineal biopsy (Only!!) and then take it from there. Even PSMA is not foolproof!

Just to clarify. Pyrads 3 is approx 20% risk of a significant prostate cancer. My plan is to go for a PSMA pet scan, if no cancer is detected, no more test are required and I saved going through a biopsy. If a cancer is detected, than of course I need a biopsy to determine the cancer grade.

How you get treated and diagnosed is your business and your choice and I respect that. I held off getting my first biopsy until there was compelling evidence that a biopsy was necessary. Before you go through the expense of a PET-PSMA test you might consider getting a 4K test test done. It’s low cost in comparison to PET-PSMA and has a good track record of identifying aggressive PCa. My 4K test came back with a high likelihood of PCa which turned out to be unfortunately true. If a 4k test comes back with a low probability of aggressive PCa you can factor that into your decision whatever that is. https://4kscore.com/

thanks Robert, good suggestion, I will look into it

More reading. Here is some other links since you are on hunt for something you can do lots of reading and let us all know what you think is the best out there. I had two biopsy, one trans-rectal and other transperineal at Mayo, transperineal is the way to go when/if you get a biopsy. I had PSMA pet/ct then Tulsa Pro after second biopsy.

MyProstateScore 2.0
https://www.lynxdx.com/my-prostate-score/patients/

ExoDX
https://www.exosomedx.com/patients/understanding-psa-levels

Journal articles on some, probably out of date the minute they are published if not before since it takes awhile to publish things:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350244/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765473/
https://jamanetwork.com/journals/jama/fullarticle/2819078

Retired Radiologist here just offering my opinion. I have had 2 PSMA PET scans, a trans rectal US guide biopsy, 2 prostate MRIs, RP and radiation. I interpreted those tests for years prior to retirement.

There is no imaging test that can definitively identify cancer. I have been virtually certain many times reading CTs. MRIs, PET scans etc, but a biopsy with a pathology reading is required to definitely identify cancer. A caveat is in the setting of a known, biopsy proven cancer, follow up tests that show a typical appearance of cancer can be presumed to be so without additional biopsy.

PSMA PET is not 100% accurate in identifying prostate cancer. If a MRI shows a PIRADS 3 focus, biopsy of that focus can be performed for definitive diagnosis. Of course, the decisions are always the patients.