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Sodium NA Floride 18 (pet scan)

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Posted 2/9/2012 4:25 PM (GMT 0)

 My husband has had an unsuccessful RP and his PSA never was undectable post surgery and in fact keeps rising.

RP was Oct 13-2011 and his third PSA is now 3.5 starting at 1.2 post surgery.

We were referred to an oncologist who sugessted radiation.

We got a second opinion from another Oncologist at Stanford University who thought this test (SODIUM NA FLORIDE 18 PET SCAN) might be more accurate as she stated conventional Pet scans and Ct's are unrealiable.

She didn't think radiation would be a viable option for us.

We have started on casodex and lupon shot to follow this Fri.

I have also heard that starting HT this early in our journey  leaves us with little options when we really need it.

Any help is appreciated.

Thanks,

BOOGEE

Has anyone expeirenced this test?

Posted 2/9/2012 6:06 PM (GMT 0)
Boogee,

There are several schools of thought on early HT and you will probably hear from all camps. I opted to delay HT for three years after my unsuccessful RP and I already had bone involvement when my treatments began last September. My PSA was only about 3 when this was discovered so I didn't see it coming. (bone mets with a PSA under 10 are rare) Despite the skeletal involvement I am currently responding well to the HT. I did have a sodium f18 bone scan at Sand Lake Imaging in Florida and it did appear much more sensitive than a planar bone scan showing numerous lesions. Don't however compare my results with your case as I had positive nodes in my post op pathology. HT does not empty your arsenal should you become resistant. Second line HT, Chemo agents and new drugs just out of trial will be in your toolbox. The F18 scan seems a good place to start. Worse case scenario it identifies any targets early. Best case it puts your mind at ease.

Very best of luck.

Jim

Posted 2/9/2012 6:55 PM (GMT 0)
Boogee,

I personally have had the F18 Scans twice and am going for another one on the 21st.

My first scan in May 2010 was done because of my rising PSA. This one found a suspected met (suspected because it could not be definitively called yes or no) and I had it radiated.

The clarity and detail of F18 scan was far superior to the T99 scans I had previously done. These are the ones done most often on PCa patients because of their low cost as driven by Medicare and the Insurance industry.

Presently I am in a Clinical Trial at the National Institute of Health/National Cancer Institute in DC. It is a clinical trial of the F18 scan to prove the efficacy in finding the most minute changes in the bones of PCa patients. I had two scans in Sep 2011, and they found nothing. I will have the next on the 21st and the final scan of the trial in the August-September 2012 time frame.

As you can see from my signature, I continued to have a rising PSA despite surgery and SRT. My last test in September 2011 came back 9.64.

My oncologist and I will discuss the next step when we meet in March following this next scan.

I thought this information might be helpful,

Sonny
Posted 2/9/2012 7:00 PM (GMT 0)
Why does your Oncologist think radiation would not be an option. Unless he/she has reason to believe the cancer has spread outside of the prostate bed or local area, radiation should be a very good option. And the whole point of having such a sensitive scan is to find the small pockets of cancer that may be lurking so that they can be targeted with radiation. Dr. Myers even thinks many Pca patients can actually be cured with this approach. At the least, radiation can kill at least some of the remaining cancer cells that escaped and are still in the local area.
What am I missing?

What was your husband pre-surgery PSA and Gleason score?

Amy
Posted 2/9/2012 7:22 PM (GMT 0)
You might also look into the C11 Choline scans. They too are being tested and they may be superior to F11 though the jury is still out. But if you can't get one you may be able to get the other...

Tony
Posted 2/9/2012 7:42 PM (GMT 0)
I may be making a mistake here, but I was under the impression that C11 Choline scan was used to assess primarily lymph node involvement, and flouride 18 pet scan was used to more accurately assess the bone involvement. (?)
Posted 2/9/2012 7:49 PM (GMT 0)
Hi Jim,

Thanks for the advice of shared expeirences. Since we have started on casodex we will continue with the Lupron this Fri. and hope it works.
Dr Srinvas at Stanford was to talk to her radiologist to see if he,(she) thought my husband would be a good candidate for the floride 18 test.
I think because of his PSA never being undectable, Dr. thought is has or had escaped before the RP, and the test would be fruitless, however I want every option available.
Will keep posted his outcome and good luck to you.

BOOGEE
Posted 2/9/2012 8:05 PM (GMT 0)
Sonny,

Since I am new to this forum is a signature all ofmy husbands stats that I enter, and will follow each thread?
I am learning this a little at a time as I have found I get responses as I post a new thread and not usually when I add a quick reply to an existing thread.
What was your PSA post De Vinci and pre IMRT?????
It appears the IMRT didn't work for you. Because of my husbands rising PSA we were told the cancer cells aren't at the site but probably out there floating around.
I see others have suggested radiation but don't want to lessen my husbands quality of life, but want to all possible to live.
The Dr. stated she wasn't God and we may have a 15% chance of the cells still being at the site, but considering his rising PSA didn't believe it to be so.

Awaiting your response!

BOOGEE
Posted 2/9/2012 9:31 PM (GMT 0)
re: signature. If you click on MY PROFILE at the top of this page, then EDIT PROFILE in the window that opens, scroll to the bottom, then enter your stats (400 chars max)

You will have to save it and then when replying may have to choose to add the signature.

re: scans. With such a high PSA after surgery, there must have been some cancer left from the surgery OR it spread elsewhere before the surgery OR both. These scans might help to pinpoint the location. Then external radiation may be more likely to be successful.

Dr. Snuffy Myers is a big advocate of this approach. Previous commentors provided great info! He thinks there are a group of recurring patients where there are only a few locations of recurrence that if found, can actually cure it, and points to himself as an example.

Good Luck!
Posted 2/9/2012 9:44 PM (GMT 0)
Amy,

My husband had RP Oct 13-2011 and it was unsuccessful as his PSA never went to undectable levels.
In fact it was 1.2 6 weeks following RP and is now at 3.5.
We are due to start HT Fri.
Everything I have read seems to state for radiation to be successful one needs to do RT before the PSA reaches 1.0.
I know 2 of the Oncologist recommens RT but the Stanford Dr. made more sense when we talked with her yesterday.

If anyone out there has expeirenced postive results with radiation and PSA levels as high and climbing as ours, please let us hear from you.

Husband 53
5.7 PSA pre-RP
1.2 PSA Nov 29- 2011
1.8 Dec 30 2011
3.5 Jan 29 2012
No perineural invasion left side
Gleason 4+3 left side
Gleason 3=3 right side
Right lymph nodes 4 without Mets
Left lymph nodes 7 without mets.
Posted 2/9/2012 9:49 PM (GMT 0)
I would really question where the Oncologist got the estimation that there is only a 15% chance that the cells are still in the area. Pca doesn't typically go too far too fast. There could be some lesions in the prostate bed that are developing blood flow and producing PSA. Clearly I'm not an Oncologist but I would think there is a reasonable chance it is still localized. I would recommend having a consultation with an Onco that specializes in Pca if yours doesn't. Or getting another opinion from a top PC Oncologist.
Posted 2/9/2012 10:31 PM (GMT 0)
Piy,

We have seen 3 Oncologist that specialize in prostate cancer one at Stanford Dr. Sandhya Srinivas.

2 oncologist want to do radiation but the Stanford Dr. thinks not.
I want every possible chance for my husband, but as I read articles and posts, it seems that his PSA should have been lower to start after RP for there to be a good chance that radiation will work.

Still requesting for responses where radiation worked in a case such as ours.

Thanks

BOOGEE
Posted 2/10/2012 6:01 PM (GMT 0)
Sonny,

We just got a call from Stanford and they put my husband in a clinical study with the sodium floride 18 test, but our tests are all within 1 week 3 tests in all.
First test is Fri.with Sodium Floride, then Monday with sodium floride +FDG, and then that Fri. with FDG alone!

Please keep your results posted as I will.

Good Luck!
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