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Recent PSMA PET does not detect cancer, what’s next?
I had a prostatectomy in May of 2016. Gleason of 7 = 4+3, psa of 10.5 . First post op psa was .01 and remained there until February 2018. In August of 2018 went to .018. From there psa would go up and down finally reaching .23 in December of 2024. Psa one month later also was .23. Had PSMA Pet CT last week, and got report today saying: No evidence of radiotracer avid nodal or distant metastatic disease. & No aggressive or PSMA-positive osseous lesions. & No enlarged or PSMA-positive abdominal or pelvic lymph nodes.
Have appointment tomorrow to discuss results and probably treatment options. Not looking forward to ADT, but may be the way to go. Also leery of abdominal radiation without any evidence of cancer there. I am interested in hearing any
Suggestions .
Thanks
Steve
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The FDG and Choline scans are the alternatives I am familiar with, to find metastasis that are not producing PSMA. The Axumin scan was not mentioned as beneficial for this but i’ve seen reports that say it can find cancer that can’t be found in the PSMA pet and can also find smaller lesions than the PSMA pet scan.
Then there is the other option mentioned at the PCRI conference. When PSA rises but can’t be found in the PSMA Pet scan, do an MRI, it will be found in Retroperitoneum or lung with high frequency
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2 ReactionsThanks for that information Jeff. Just watched a Dr. Scholz YouTube video that pretty much said the same thing, I Certainly like the idea of finding it and hitting it with SBRT. It’s the waiting that’s killing me and how long should you wait. How high do you let the PSA climb before giving up on PSMA PET.
Right above your message I replied with information that’s identical to what I would tell you right now about looking for it, if the PSMA Pet doesn’t Show anything.
Hopefully you have a doctor that can gauge how high your PSA is and what could be causing the lack of anything showing in the image. Once PSA hits 1 you should have anything with PSMA visibly showing up in the PET scan. Of course if it’s not bigger than 2.7 mm it doesn’t show up, yet. I would not like to see the PSA going above three or four. A few weeks ago somebody was talking about their PSA being in the 120s 30 year after surgery. They can’t find anything in the PET. Sound familiar?
OK, Jeff, thanks so much!
Phil