A PSMA-based PET scan can change salvage radiation treatment decisions

This study only applies to those with recurrent or persistent PSA ≥0.2 after prostatectomy.

A PSMA-based PET scan can help a patient decide to:
• rule out SRT if there are distant mets (in 12%)
• expand from prostate bed-only to whole pelvic (in 11%)
• expand from standard whole pelvic to a widened field (in 7%)

It can also identify mets for metastasis-directed therapy (in 8%), but that is of unknown significance. I guess one can argue that for the vast majority of recurrent/persistent men, it changes the treatment plan none or little (sometimes identifying tumors for a boost dose). But if they can keep the price reasonable, it's probably worth it. It is never a good idea to wait for PSA to rise just so mets can be detected -- a self-fulfilling prophesy.

https://pcnrv.blogspot.com/2018/02/a-psma-based-pet-scan-can-change.html

Interesting that the study referred to by George didn't see much benefits from ADT until PSA >0.5 - 0.7 (see Table 2). Not even for G8-10 and negative SM. Then very few men who monitors their PSA values after RP need to combine SRT with ADT. Who would wait until PSA >0.5 before starting SRT? Most would trigger SRT in the 0.1 - 0.3 range, or even at lower values if you are anxious.

Quote:
These data combined suggest that men with pre-SRT PSAs of <0.5–0.7 ng/ml do not appear to derive improvements in distant metastasis.

Gemlin,

I agree that the use of spot radiation (SBRT) on detected distant metastases is of uncertain benefit. That's why the authors categorized the impact as minor. The 17 patient study George cited is deceptive and has to be interpreted with caution. Of course radiation will provide local control - we've been doing that for palliative purposes for years - and it will temporarily reduce PSA - but we want to treat the disease, not the PSA. There is as yet no evidence that such therapy increases survival. The latest RCT had equivocal results:

https://pcnrv.blogspot.com/2017/12/metastasis-directed-therapy-for.html

My opinion is to do it only if safe.

I just finished up my 35th srt two weeks ago, my RO at ctca started me on srt when my psa went to .30.on Nov 1st he started me on a 30 day shot of adt and these pills bica,on Dec 1st he gave me another hormone shot that was good for three months but without the Bica pills, I started srt 2 weeks later ,,I had two pets,one with a contrash that showed psa in body, they found none, but did show a large piece of prostate left behind and a full and partial SV, he radiated starting at the base of penis and the prostate bed and the SV. NOW ON WAITING ON MYfirst psa rest in three months,, my psa was persistent after rp, we talked before TA.. what's your thoughts now.. You have to check my previous thread to see my situation.

Seems to be a lot of persistent PSA going around these days. May be a limitation of robotic surgery, or the Davinci equipment. Who knows?

Is the 'ctca' you mentioned, Joker, the Cancer Treatment Center of America in Boca Ration, per chance?

I had persistent PSA >2 after da Vinci surgery.

Went to UCSF for 68 Gallium scan to determine if mets outside of pelvic region.

Found 2 pelvic lymph nodes on left with uptake - had SRT done for potential cure ---

If uptake outside of pelvic area no sense to have SRT---

Bobby Mac

It's in Georgia..