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When do I do my next PSMA Scan?

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Posted 1/8/2020 3:34 PM (GMT 0)
I need some guidance on next steps to deal with my recurrent prostate cancer. [Surgery for Gleason 4+3 March 2013, IGRT radiation concluding May 2016 with concurrent 6 months ADT)

In April 2018 I had a 18F-DCFPyl-PET/CT PSMA PET/MRI scan at NIH when my PSA was 0.5 and no cancer was detected. PSA continued to climb with doubling time around 10-11 months and I then had an Axumin PET/CT scan Nov 2019 at PSA 2.1 which did not find any cancer.

I would like to do another PSMA scan to determine where the prostate cancer is located and if possible treat with spot radiation. If treatment is not possible, then I will at some point progress to ADT.

Assuming I can get into a clinical trial in the metro NY area (there are 3 for which I think I would qualify for), should I wait until PSA is around 3 or even a bit higher before having the scan or does it make sense to do it as soon as I can get into a trial?

Should I care which tracer is used assuming the choice is 18F-DCFPyl or 68Ga-HBED? I read Tall Allen's summary of ratings of these and it appears the 18F-DCFPyl is somewhat better but perhaps not significantly better for my situation.

Is there any other next step that is preferable to what I have outlined? I am seeing my MO next week and will get his opinion and may seek a few other opinions as well. Does anyone know if Medicare will pay for multiple MO consultations within a short frame for the same condition?

Thanks for your thoughts.

Teddy
Posted 1/8/2020 3:41 PM (GMT 0)
I can't be specific about the scan timing -- but your docs probably can be. One point about the excellent 68Ga scan is that the radionuclide is eliminated via the kidneys, so the entire bladder "lights up" on the scan. This can make it hard to discern lesions at the bladder neck. 18F is eliminated via the liver, so there isn't this concern.

I assume you were tested to check that your cells do produce PSMA? Some men do not.
I would think that your PSA is high enough that either PSMA scan should find the PSA sources, whether leftover tissue in the fossa or mets.

Regarding the clinical trials, you can call an open Site near you and inquire about their scan results vis-à-vis PSA levels. You may get some helpful info for your specific situation.

Keep us posted, please, and good luck!

Djin
Posted 1/8/2020 3:42 PM (GMT 0)
DjinTonic - Did you mean to say my PSA is high enough so either tracer would work? I did not have PSMA assay to my knowledge.

Teddy
Posted 1/8/2020 3:54 PM (GMT 0)
For 68Ga and PSA levels, see

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034726/

For Auxim and PSA leveld, there is info at the company's website:

https://www.axumin.com/about/efficacy

Given you negative scans, I would definitely ask if your were tested for PSMA production. That is another question you can pose to a Site near you for any study you are interested in. (It may be that you were, indeed, tested for PSMA production, but weren't made aware of it, if you do produce it. Like PSA, it is not produced only by prostate cells).

Djin

Post Edited (DjinTonic) : 1/8/2020 9:10:05 AM (GMT-7)

Posted 1/8/2020 4:02 PM (GMT 0)
DjinTonic - thanks for the reference.
Teddy
Posted 1/8/2020 4:21 PM (GMT 0)
I am part of a clinical 18f Pet scan program. Scan identified 2 presacral LN with small lesions at PSA=1.17 on 8/18. I am allowed one more scan within 3 years of the first one. Hope that RT has killed the cancer but if not, will monitor PSA levels until over 1 if still within this 3 year time period.

Dave
Posted 1/8/2020 5:15 PM (GMT 0)
Just noting that I corrected a typo in my first reply. I meant to say that your current PSA seems high enough for either scan to be good.

Djin
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