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Posted 5/17/2014 4:12 PM (GMT 0)
John you can easily post that chart at PCAF and link it for everyone.
Posted 5/17/2014 6:21 PM (GMT 0)
Baptista,

You are fortunate to live in Europe where some of the more interesting development of met detection is happening. If cost and high PSA requirements are impediments, I have a couple of suggestions for you. There are a couple of new radiotracers for PET scans that do not require the high PSA that the C11 PETs do. Also, they will detect both lymph node and bone mets too.

At the University of Bologna, they are working with the FACBC PET scan that improves detection over the C11 Choline PET.

The latest developments are radiotracers where they attach a positron emitter to a prostate cancer antigen ligand, rather than a metabolically active molecule. At the University of Heidelberg, they have developed one - (68)Ga-labelled PSMA ligand - that is better than F18 Choline, especially at low PSAs. The University of Lausanne is currently recruiting men for a clinical trial. Often these are free of charge, so you'd have only a short vacation in Switzerland to pay for.

Please keep in touch.

- Allen
Posted 5/18/2014 3:41 AM (GMT 0)
Thanks John, I received your very informative mail.

Just curious about the scope of each technique. I believe that the C11 PET/CT examination includes bone and soft tissue in the whole body. Combidex has high marks in regards to locate cancer in soft tissues (the lymph nodes) at the lower abdomen. Is it correct?

Best.
Posted 5/18/2014 4:27 AM (GMT 0)
Both the lower and upper lymph nodes. It can't do bones.
The lymph nodes absorb the iron nano particles. Lymph nodes that have cancer won't let the nano particles in so all the good nodes show up clearly because they are filled with iron. All of the lymph nodes in the body are scanned and reviewed independently by Barantz and one other experienced RO, any discrepancies between the two reviews are reconciled.
Posted 5/18/2014 5:00 AM (GMT 0)
John; Thanks for the added info.

Allen;

Thanks for the links. Your last year guidance regarding the newer examinations took me to research about those European locations, but in Europe things work differently. Nobody will attend you if you go on your own. It is like bumping on a concrete wall. We need a referral or a MD behind us.
It wasn’t easy to receive replies from those institutions, even if addressing the mail directly to the researchers. The names we find in the trial studies.

These papers in your links are newer to me but it seems they refer to results from the traditional PET and CT machines. In some other European research facilities/universities they are doing the trials in the newer combi PET/MRI +α (and turbo) machines. The synthetic amino acid 18F-FACBC is a good try because it doesn’t require special facilities such as the C11. Probably an unstable C11 is not the right choice in future testing.

I would like to try Lausanne. Can you give me a referral through your researching lines?
In any case, thanks for the trial link. I will take a copy to my next uro-oncologist meeting on the 20th and see what he suggest.

Best.
Posted 5/18/2014 4:51 PM (GMT 0)
I agree that in an ideal world, PET would be combined with MRI instead of CT, but that application is hard to find because of the expense. I've only read about it in Germany.

I'm sorry to hear that the doctors don't return your calls. Maybe some of the others on this site have some suggestions for getting a response from European doctors. I know that it used to be the case in the US that it required a referral to see a specialist, but that seems to be changing over the last several years. Many specialists at university hospitals and in private practice have websites with numbers to call for an appointment. Can't your primary care physician make the referrals?

But I agree with you that your best bet might be the Lausanne study because they are actively recruiting patients for their clinical trial. There is a section on the page titled "Contacts and locations" under which it gives the phone number and email for John Prior, MD, PhD, The Principal Investigator.
www.clinicaltrials.gov/ct2/show/NCT02111954
Posted 5/19/2014 12:41 PM (GMT 0)

John T,

I agree with Gunfighter's post.  You have helped me a great deal with your analysis on this and all other aspects dealing with prostate cancer.  We are very fortunate to have you informing us.

If it is true that it is much better at identifying nodes of 2mm to 6mm than the C11 it seems criminal that we don't have it available to us.

PhilC

Posted 5/19/2014 6:17 PM (GMT 0)
FWIW, NIH is now recruiting for a clinical trial of ferumoxytol (Feraheme) for lymph node detection. This defers the high cost of Feraheme (about $2000). The catch is that there has to be a suspicion of mets to the lymph nodes from an imaging study.
Posted 5/19/2014 10:24 PM (GMT 0)
John T helped me in my decision on treatment 2.5 years ago. Thanks, John, for all you have done for a lot of us here and on other forums!!

Robert
Posted 5/25/2014 3:29 PM (GMT 0)
May I echo the praise for the research that both John T and Tall Allen have graciously donated to all of us on this site.
Just met with Dr. Myers. He has more faith in Dr. Bravo and his work with Fereheme at Sand Lake than with Dr. Barentsz and his Combidex scan (note his Office’s latest interview with Dr. Barentsz where the latter is critical of the work of Dr. Bravo).
I am concerned with my slow progression of PSA readings. Since I am on Zytiga, Dr. Myers deemphasizes reliance on the PSA reading, preferring instead focus on the bone-specific alkaline phosphase together with MRIs and Bone Scans.
John T and Tall Allen - I plan to be in Europe this Fall. Based on your immense research, would you suggest I explore the Clinical Trial at the University of Lausanne or instead pursue the Combidex scan? You will note that so far, my nodes have not indicated any tumours; rather, the metastases have all been to my pelvic bones.
Houseboy
Posted 5/25/2014 4:53 PM (GMT 0)
Houseboy, I don't know anything about Lausanne trials so I can't comment.
JT
Posted 5/25/2014 9:21 PM (GMT 0)
houseboy,

Since your mets have all been to bone, neither the Combidex nor the Feraheme MRI are applicable to your situation.

The C11 scans (choline and acetate) do require a higher PSA level to show anything. Some of the other PET tracers may be better at detecting mets at lower PSA. FACBC seems to be the best so far and is under active investigation at Emory U in Atlanta and at the U of Bologna (see above).

This is an area of very active investigation and by the time you leave for Europe, I'm sure there will be more PET tracers being studied. If you search clinicaltrials.gov for the following PET tracers (enter "prostate cancer" "PET" "tracer name here"), you will get info on clinical trials recruiting for them: 89Zr, DCFBC, 124I, 64Cu, 68Ga.

- Allen
Posted 5/26/2014 12:05 AM (GMT 0)
Very helpful, Tall Allen. Thanks.

Houseboy
Posted 6/28/2014 6:44 AM (GMT 0)
John T, I am planning to travel for the Combidex but its cost is now 4000 EU ($5495) My PSA 15 years after RP has gone up gradually to 9. Which insurance company coverage paid for yours? I am on Medicare and will have to tap my savings. Also, could you describe how you got to the university, where did you stay and how long, etc., It would help with my planning. Thank you in advance for your reply
Posted 6/28/2014 4:09 PM (GMT 0)
Please email me, my email is in my profile if you click on my name. I can give you details. Niemeigan is a lovely city and since you will already be there plan to spend a few days and make it a vacation; it will make the trip and the money you spend much more enjoyable. I've spent a lot of time in Holland and you can't find a nicer people in all the world.
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