Gallium-68 PSMA-11 PET

Hi Allen,
I have had wonderful meditative practice in the past and I know how healthy it is.
I try to meditate these days in my own shortened version and am somewhat, kind of, successful. I am often anxious though and know I could do better. I have several mediatators in my life and at least by proxy get within range of "presence" at times.
I try to "stop" whenever I remember to try but my life is a busy one and amongst the whirling activity it's hard to settle down into focusing on breathing and unfolding into static reflection. At least I know it's possible and that does help a bunch.
I am fairly good at thinking things into an alignment of sorts but often struggle with following my own conclusions during the day. :o)

I will rememeber what you said and focus on my breathing the next time I feel the anxiety train a comin' (which according to normal schedule comes every couple of hour or so these days and will be rolling into the station of my brain any minute now). Thanks.
It's amazing how you can forget to breathe. A week can go by and I realized I haven't been paying attention to my breathing. Like being dehydrated and not drinking enough water, we don't often breathe deep enough.
Allen, it's obvious you meditate by the clarity of your thought process. When you practice objectivity, dots naturally connect in easier to follow, unfolding patterns. It makes a difference to assess things centered and calmly. Good for you and all of us that read and follow your thoughts.
My mother died in January and my father died only three weeks ago. With my recent recurrence it's been a tough year for sure. Breathing helps.
I decided to go on some low dose Lexapro during this time. My PSA rose right after my mother died as did some digestive problems that started occurring. Thinking stress may have contributed to both I started the anti depressant. So far it does seem to be helping.

I have to say in some odd way my time on androgen deprevation therapy was rather profound for me in a perception altering way. The voyage into chemical castration was not an easy one but I did find the state of androgyny it produced was kind of oddly enlightening. When describing my state of non sexuality to some Buddhist friends of mine they were all ears as part of their practice was observing and ridding the mind of the slavery of sexual impulses (not an easy task...haha!).
Gender definition and division is so pervasive within us that I found it quite nice when the tendency was gone during ADT. I realized hormones dictate so much of our perception. To the point that if you ponder what age range people are most apt to commit suicide you'll soon realize it's the same age range that our hormones are most active. You don't hear of many suicides under 13 or over 60.

When you break down gender divisions you can go further into questioning all other divisions that you have been trained to believe and foster as truth. Along with gender androgyny so can you practice political androgyny, racial androgyny, wealth and status androgeny, removing good and bad-ism, on and on. We are in love with our divisionary thinking and it is nice to get some relief.
Now I am filled with testosterone and now again I am happily back where I was hormome wise...but I do remember and am better off because of it. Since my ADT I have to say I am more empathetic. It's always good to establish perception reference points.

Sorry, I get to scribbling my thoughts out loud. Not cool to take up non applicable space here. I'm such a darn blabbermouth.

Michael-

I am so sorry to hear about your losses. A mother and a father in the same year is more than anyone should have to bear. And then this disease on top of it all! Too much, my brother, way too much. I can actually see how ADT could help with that. I know men cry more easily while on ADT, and if ever there was a time to cry, this is certainly it.

I found that ritual was very helpful for me in creating the time and place to grieve. It is too easy to put it off and not feel the pain. When Jon Kabat Zinn introduced mindfulness, it was as a medical practice to help cancer patients deal with pain. He pointed out that one gets through pain faster by focussing on it rather than trying to put it out of mind. That's true whether the pain is psychic or physical.

Richard Wassersug, a well-known researcher on PC, has made a similar observation about the peace he found in "embracing his eunuch identity," and about the esteem ancient societies placed on it. You may be interested in these:

www.tikkun.org/nextgen/embracing-a-eunuch-identity
link.springer.com/article/10.1007/s10943-008-9231-9

Sorry, I drifted badly off topic. My mind goes off in strange directions at times I'm afraid. Especially these days.

Allen, I couldn't open that second link.

I made some inquiry over the last few days for the DCFPyl scan. There is one out of Yale I'm in contact with and trying to get into. In my search I spoke with a talkative guy connected with a study I didn't qualify for. He was pretty pretty enthusiastic about DCFPyl and says the limit they can usually detect lesions is of around 3 mm.

Allen or anybody else,

Can you direct me to the study that compared Gallium 68 and DCFPyL? I would like to show that to my oncologist.

Also, has there been any comparison between a Copper Cu 64 TP3805 and DCFPyl scan as far as sensitivity?

I am wondering, while I am pursuing scan options, which of the two I should be trying to attain?

Many thanks,

Michael

Michael-

I summarized all of that and gave links to the relevant studies in a single table that you may wish to pass along to him:

/pcnrv.blogspot.com/2016/12/pet-scans-for-prostate-cancer.html

Michael,

the Gallium PSMA scan will show if there is a local recurrence as well as mets in the pelvis and distant mets. You may see a few more of those with a DCFPyL scan but these may also be false positives, who knows.

Once you see where the lesions are you can plan the treatment. I don't think a local recurrence will cause the tumor to spread more than any mets will. Both can be the cause of spreading tumor.

All the PSMA scan studies grouped the results according to the PSA level and found the sensitivity to be higher when the PSA value was higher. The PSA value to some extend relates to the PSMA expression of the cells which is the basis for the PSMA scan. However, early studies show that you can increase the PSMA expression with antiandrogenes e.g. Bicalutamide. So its not just PSA as a parameter.

I recall a presentation by Dr. Kwon where he said it is easier to fight smaller legions than larger ones. This supports your thoughts.

I would say get your scan done now, it will result in a lot of additional questions.

George

Hi George,

Did you look at these images between the two scans?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493776/figure/Fig1/

It's a pretty convincing. I just wonder if these images are the norm of comparison or if they chose the most extreme variation? If it is the norm there is quite a profound difference between the two scans.

Michael

Michael,

I agree that if you do indeed have only a local recurrence, it makes sense to treat that with focal brachy or focal ablation. You are correct that most, but not all, distant metastases do come from the original source in the prostate. There is additional met-to-met spread afterwards, but that seems to be minor compared to the original prostate spread. If you have a local recurrence only it is certainly worth treating.

That is the value of the more sensitive DCFPyL scan for you. And you are right that it's a lot more sensitive at low PSAs. You have to rule out that there are no distant metastases. If there are distant metastases, it is questionable whether it's worth treating the local met. In that case, systemic therapy is your best bet.

You are also right that PSA is an indicator of larger mets rather than smaller more numerous ones. This has to do with blood supply. As tumors get bigger, they develop blood vessels to feed them. This accelerates their growth and also gives their PSA a way to leak out into the serum where it can be detected by a blood test. Healthy prostate cells have lots of PSA (but not PSMA) on their surface, but because there is no leaky blood supply around them (as there is in a tumor), the PSA stays in the prostate. The same is true for circulating tumor cells - without a blood supply, their PSA doesn't leak into the serum. A lot of people don't understand this. They think that if PSA is low there can't be micrometastases - they are wrong. It only means the tumors are small enough that they can't be detected by PSA blood tests.

Do not take bicalutamide without the advice of your doctor and the people doing the test. Bicalutamide may shrink tumors and make them undetectable. Don't turn yourself into a chemistry experiment.

UCSF is also experimenting with another novel PET scan that you can ask about:

/clinicaltrials.gov/ct2/show/NCT02916537

I know they have a PET/MRI there that I hope they will use with you.

Did they say what the cost is?