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68 Ga PSMA Scan booked

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Posted 6/22/2016 8:14 PM (GMT 0)
If anyone is interested in this scan see the study information.

I booked it today for later July -

Your insurance may cover the scan and Ga-68-HBED-CC-PSMA ??

From the study info:
"This compound has been shown to be superior to choline based PET agents for the staging of prostate cancer, both Carbon-11 and Fluorine-18 compounds."

https://clinicaltrials.gov/ct2/show/NCT02611882?term=thomas+hope&rank=1

Bobby Mac
Posted 6/22/2016 11:46 PM (GMT 0)
Glad you didn't have to go to Germany!

- Allen
Posted 6/23/2016 12:02 AM (GMT 0)
Although, the Deutschland Wienerschnitze will be missed - :)

Bobby Mac
Posted 6/23/2016 3:17 AM (GMT 0)
sorry about the wienerschnitze but good about the scan.

Andrew
Posted 6/24/2016 2:59 PM (GMT 0)
I am very surprised there is not more interest in this PSMA scan. It is the Cadillac of all current scans, picking up cancer locations at very low levels.

PRE-TREATMENT:
I wish I had this scan before being operated on - if the PSMA detected positive lymph nodes or distant MET's my treatment choice may have been impacted. The 3T MRI, bone scan and CT all pale, compared to this 68 Ga PSMA Pet scan.

POST-TREATMENT:
I don't know about anyone else, but since my post op PSA is 2.6, and even if it was .1, I want to find out where the cancer is to guide me in selecting secondary treatment. Again, the PSMA picks up the cancer at very low levels --

Bobby Mac
Posted 6/24/2016 4:12 PM (GMT 0)
Pardon me for asking but will your insurance cover it and if not, what's it going to cost you? Where will the scan be performed?
Posted 6/24/2016 4:32 PM (GMT 0)
Insurance may cover it, but not sure. Request to insurance was submitted yesterday - Total would be $4,000 w/o any insurance - if insurance covers scan and not injectable - about $1,600.

Scan is in San Francisco - there is another in Houston, but not sure of details on that one---
Posted 6/24/2016 5:32 PM (GMT 0)
Isn't this a study and therefore should be no cost to the patient?
Posted 6/24/2016 6:07 PM (GMT 0)
Jerry -

It is my understanding, there isn't a patent on this PSMA agent - so no corporate sponsor-

Some teaching universities, are doing the trials to get FDA approval for this great scan, on their own --

Germany has had it for years and so has Australia.

Bobby Mac
Posted 6/24/2016 7:01 PM (GMT 0)
I'm pretty sure the inventors at the U of Heidelberg hold the patent on HBED-CC (aka PSMA-11). I don't know what arrangements they've made with UCSF and others who use it. The PET scan is investigational, so the insurance company has a lot of discretion over whether to cover it. There is a cost for both the radio-indicator and the PET scan. The other wrinkle in the cost is whether they use a PET/CT or a PET/MRI (which is probably more expensive and more accurate).

NIH doesn't charge. Its entry in the PSMA PET scan challenge is the F18-DCFBC PET. Johns Hopkins, which had previously tested that one, is now testing F18-DCFPyL. They believe it is more sensitive, and in head-to-head trials against the Ga-68-PSMA-HBED-CC, the DCFPyL was significantly better:

Comparison of [18F]DCFPyL and [68Ga]Ga-PSMA-HBED-CC for PSMA-PET Imaging in Patients with Relapsed Prostate Cancer

The other major entry in the PET challenge is F18-FACBC (fluciclovine). It just went into expanded trials in the US (NY, NJ, LA & San Diego), UK & Norway. It had been tested at Emory and in Italy for about a decade. The hope is that it is more specific than the PSMA-based PETs.

There are several more in clinical trials, all using different ligands. We'll have to see which one rises to the top.

- Allen
Posted 6/24/2016 7:28 PM (GMT 0)
Allen -

I spoke with a German MD who told me the 68 Ga PSMA is not officially approved there, but they, unlike the US, have the authority to us it commercially anyway. So, apparently it is not patented -

This is a blurb from the California study-

"This compound has been shown to be superior to choline based PET agents for the staging of prostate cancer, both Carbon-11 and Fluorine-18 compounds. But this compound was not patented and therefore no company or private entity will make the investment required to bring HBED-CC PSMA to market. In the vacuum of availability, academic groups must take the lead in order to collect the necessary data for future FDA approval."

Seems like a difference of opinion exists in the academic community.

Bobby Mac
Posted 6/24/2016 8:20 PM (GMT 0)
When I spoke to Houston last year they are doing a comparison and wanted me to have new staging scans at there office. Then they would do the scan to compare. My PSA was to low at the time and I didn't think it would pick up anything. Did you have to provide your scans for the the 68 Ga?
Posted 6/24/2016 8:25 PM (GMT 0)
Note the list of inventors - they are the doctors at U of Heidelberg:

www.google.com/patents/WO2015055318A1?cl=en

Did you check out what Johns Hopkins and Cedars Sinai are charging?

- Allen
Posted 6/24/2016 9:10 PM (GMT 0)
Frank,

California were only sent the CT and bone scan reports, from March, not the CD's - Of course, other items were required too.

Allen,

I did not check costs at those hospitals ---

Bobby Mac
Posted 6/24/2016 10:41 PM (GMT 0)
Here is what the PSMA scan in Houston asked for - about the same as California

1) Most recent office visit notes from your physician with history/physical information
2) Most recent MRI, CT and Bone Scan results
3) Most recent lab results that include, CBC, CMP and PSA (send more than one PSA result to prove PSA is rising)
4) Biopsy/Pathology report (if any)
5) Signed Physician order from physician wanting you to have the PSMA GA-68 Pet/CT Scan along with reason for the test (if any)

Bobby Mac
Posted 6/25/2016 3:10 PM (GMT 0)

Bobby Mac said...
I wish I had this scan before being operated on - if the PSMA detected positive lymph nodes or distant MET's my treatment choice may have been impacted.

Removing the primary tumor plus an extended LND if there are positive nodes is the right choice even if there are a few distant mets. That's what I learned from the studies I read.

If the PSMA PET/CT shows a few mets that have not yet been removed you will ask yourself if you can get rid of these one way or another. I suggest SBRT:
/prostatecancerinfolink.net/2015/09/26/sbrt-for-oligometastatic-recurrence/

George
Posted 6/25/2016 3:59 PM (GMT 0)
Bobby:

I gather they will provide you with the results of the scan, including a disk that you can take elsewhere for follow-up tx. if needed?

Be sure to check on that. I seem to recall checking on some other trials where you would NOT be given the results .

Mel
Posted 6/25/2016 4:26 PM (GMT 0)
George -

That may well be, but all I'm saying is knowing the full extent may have altered my decision. Yes, surgery may be a good option, but if someone knew they had positive lymph nod, then maybe radiation could knock it all out.

In my case, because of a pre-treatment voiding problem, surgery was my best option. No case is the same as another.

Bobby Mac
Posted 6/25/2016 4:29 PM (GMT 0)
Compiler-

Yes, I made sure, in the California Study, I would get the report and CD.

I was the one who identified on study that required you pay, but would not receive the results.

Kind of ridiculous, I thought.

Bobby Mac
Posted 6/26/2016 3:49 PM (GMT 0)
Bobby Mac,

yes, a PSMA PET/CT often changes the decision regarding the therapy. See this study:
Effect of PSMA PET on the decision-making of radiation oncologists

I believe an extended LND is also very effective regarding positive lymph nodes. For that you do not need radiation.

George
Posted 6/26/2016 5:02 PM (GMT 0)
George -

Good find!

I agree, if only LN's, then extended LND could do the trick.

In my case, knowing I have positive margins, EPE, and depending on PSMA scan results, possibly an oligometastatic disease, the LND, in my opinion, would be fruitless.

Bobby Mac
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