Is there a procedure for detecting micrometastic PCa ?

There is no scan that can detect cancer with psa levels less than .01
The best scan, The Combidex MRI can detect lymph node infection at 2mm and C11 PET scan can detect at 4mm, but at these levels psa would be generated. Try researching the circulating tumor test which is a blood test.

JT

I'm in the same boat and really have found nothing more than what John has mentioned. My post PSA was significantly higher than yours with confirmed mets but I still wonder about the micro mets hence the HT rather than any type of local treatment. The systemic approach should knock down the micros along with my lesions until I become refractory. That's the bummer though isn't it? You seem to be doing fine though.

Cheers, Doug

I faced the same dilemma that as a G9 (4+5) Lupron since 3-28-13 was likely masking some bone mets and/or lymph node involvement.

I had the F18 sodium scan that showed no bony mets but suspicion of Lymph node involement.

Then I had the C-11 Acetate test (not covered by insurance except if you do the similar C-11 Choline test at Mayo clinic).

Either of the C-11's is deemed most accurate at PSA >=2, but I did not want to wean off Lupron including its half life to reach PSA >=2 as that might also cause my mets visible or invisible at the time to increase in quantity and severity, a risk I was unwilling to take.

I signed off on the warning that results at PSA = 0.23 may not be optimal but the C-11 Acetate did show I had 3 micro LN's all contained within the pelvic area.

I elected to have Provenge concurrent with SBRT radiaiton to leverage the abscopal effect

prostate-cancer.org/abscopal-effect/

My rationale was that even though there were likely more mets, the SBRT would zap anything in its path (and perhaps more due to abscopal) whether they were visible on the advanced scans or not visible because of Lupron masking.

The SBRT was to the prostate, to what we would call the prostate bed had it been removed and to the entire pelvic girdle, not just to the 3 micro LN's identified on C-11. Many RO's felt that would be too toxic by my RO recommended by Tall Allen, Dr. Chris King at UCLA is one of 3 RO's I know of who does SBRT for G9's, the others being Dr Allen Katz in NY and a group of doctors in Toronto.

Due to a perfect storm of favorable anatomy and visceral fat, the dose volume histogram showed a minimal amount of radiaiton to my rectum.

My PSA has risen from <0.01 to =0.01 and I will take that rate of increase for as many years as I can.

My medical oncologist Dr Jeffrey Turner and I agreed to a bogey of 1.0 rather than the customary nadir +2 rule of thumb since PSA has never been a very relaible indicator for me.

First things first though if I remain undetecible until Memorial Day the 9-month mark since I started Zytiga I will go onto IHT and try to rediscover my long lost libido.

One my PSA eventually rises to 1.0, we will do another set of F-18 and C-11, and decide next steps but hopefully that is a long time away.

LupronJim

CellSearch is really problematic - many men have low CTCs despite widespread metastatic disease. And high levels of CTCs may arise because the CTC count includes shed tumor cells incapable of forming mets, cells from leaky vasculature, and even normal epithelial cells that have entered the bloodstream after disruptive or invasive procedures, such as injury or surgery.

I agree with John T that there are no known imaging techniques that can detect anything while PSA is undetectable, unless there are already large mets present.

- Allen

Jerry,
I don't know. The Ra+2 ions get attached to sites of active bone overgrowth (osteoblasts) where the Ca+2 ions normally would. I don't know enough about the natural history of bone mets to say when in its lifecycle the osteoblastic phase starts. It's possible that micromets in bone stimulate osteoclasts (osteolysis) for a while before the osteoblastic phase kicks in as a reaction. But this is just conjecture.

- Allen