Choline PET scan availability in Europe?

My husband had RP in January. But unfortunately the margin was 3mm positive and there is still some cancer. PSA is behaving strangely jumping around (up and down) between 0.1 to 0.4, so the likelihood is that he will need radiotherapy.

Our specialist has advised a choline PET scan for which we have been waiting for an appointment for 6 weeks. I understand that UCL is the only hospital in the UK to perform this scan for prostate cancer patients, but they are unable to source the stuff they need to inject into you and are not making any new appointments. It could be months until he is seen.

Does anyone know if there is a hospital or specialist we could be referred to in Germany or Switzerland (or elsewhere in Europe)? It would presumably be fairly easy to do a day trip to get this part done sooner. With Gleason 8, I feel the longer we wait, the more likely the cancer is to spread out of the prostate bed. So we are keen to move this on, even if it costs us more.

Any help gratefully received.

 

Age 46
PSA c 3 for 2 years
PSA 6.3 in September 2012
Biopsy 2/11/12 - 12 cores
Pre-op Gleason 8 (3+5) 4 present left and right
Radical Prostatectomy 24/1/12
Catheter in for 58 days following anastomotic leak
Post-op Gleason 6 T2C
3mm positive margin
PSA at 8 weeks 0.269
PSA at 12 weeks 0.1
PSA at 20 weeks 0.4 RT recommended

 

(Added a subject - 142)

Post Edited By Moderator (142) : 8/21/2012 3:41:34 PM (GMT-6)

Thanks SpecialLady

I have made contact with the Dusseldorff hospital and will keep you posted.

It may be worth just starting radiotherapy now without even waiting for the scan. I am terrified that the longer we leave it, the more likely it is for the cancer to spread out of the prostate bed.

janem123,
hi! Cholin-PET/CT is widely available in Germany. Some uses C11-Cholin, some F18-Cholin. C11-Cholin have a half-life on about 30 minutes, it must be processed in the clinic or nearby. F18-Cholin have half-life of 2 and ½ hour, transportation over moderate distance is possible.
As a non German resident and not a member of one of the German health insurance companies, you have to pay this by yourself, wich is called “IGeL” in Germany (Individuelle-Gesundheits Leistung aka. Individual-health services). Please calculate with 1500€ to 2000€ for PET-CT.

Some radiological clinics in Germany do have the brand new PET/MRI from Siemens, called Biograph-mMR, combining a 3T-MRI with a highly sensitive PET scanner in one machine. I have done this a week ago in Leipzig. It has some advantages over the PET-CT procedure, because you add some MRI specific scannings like DCE (dynamic contrast enhanced) or DW-MRI (diffusion-weighted-MRI). The advantage in my case was, that the Leipzig Docs can correlate the MRI Data with the whole-body MRI from preliminary investigations… 2150€, not too much over PET-CT. From registration to the procedure you have to wait max. 2 weeks.

Post Edited (LowRoad) : 8/23/2012 2:13:50 AM (GMT-6)

Hi SpecialLady,
Yes, PET-MRI is a established procedure in PCA recurrence state! In Tübingen a comparison study is in progress, you get both PET-CT and PET-MRI. If interesting call Dr. Nina Schwenzer.
BTW. PET-MRI comes with only 1/3 of the radiation dose of PET-CT, not bad at all!

Thanks so much Lowroad. Can you advise whether it is worth having the PET/MRI scan with PSA up and down between 0.1 and 0.4? Some people have suggested the usual choline 11 PET scan doesn't detect cancer below PSA 0.5.

But then my husband had a gleason 8 (80% of prostate affected) with a PSA of only 3.5 for 2 years!

I doubt it's clearcut so think on balance it's worth a shot!

I will call Nina Schwenzer and wil also ask the other German clinics I'm in contact with if they can do this new test too.

Janem123,
with a PSA of less than 0.5ng/ml PET scan would be a waste of money!!!  PSA must be at least 4ng/ml, a bit lower if PSADT is less than 3 month. Some basics:

http://www.isrn.com/journals/oncology/2011/219064/
http://www.ncbi.nlm.nih.gov/pubmed/19690023

The Biopsy Gleason-Score was 3+5=8 but the post RPE score was 3+3=6?! Perhaps it’s time for a 2nd pathological opinion?

With a rising PSA after RPE a salvage RT is the standard-of-care, but cure comes only for about 1/3 of the pts. Discuss the option of including SRT to the pelvic lymph node area with your radio-oncologist.