anyone have the pylarify-psma pet scan? Question

OK, cutting to the chase: I have been fortunate to have had the latest scans. I have had the C11 scan at Mayo, 11/2014. I had the Ga-68 at Umich 11/2018. I am now scheduled to do the Pylarify PSMA late next month.

My question: is the procedure identical to the other scans (ie: inject me with the stuff and then do the scans?

If different, how so?

(I know due to the short half-life of Ga-68 there was an urgency to do the scan immediately after the infusion, and pylarify I think has a much longer half-life. Will that matter, procedurally?)

Mel

For those interested, I found this May 2022 coverage update document from BCBS of Mass.

____________________________________
"68Ga Prostate-specific membrane antigen (PSMA) PET/CT or 18F-DCFPyL (piflufolastat or Pylarify) PET/CT

Diagnostic Workup and Diagnosis: Not indicated

Management: Indicated when ALL of the following
criteria are met:

• Original clinical stage T1-T3 and NX or N0 treated with prostatectomy and/or radiation therapy, with biochemically recurrent/persistent disease

• Results of conventional imaging performed within the past 60 days are negative for metastasis

• Patient is a candidate for curative intent salvage therapy

• PSA level is > 1 ng/ml or PSA is rising

• PET/CT has not been performed within the past 3 months

Surveillance: Not indicated

Explanation of change • Addition of new prostate -specific membrane antigen (PSMA) PET/CT scenarios"
____________________________________

You can paste the URL; it isn't working as a link:
https://www.bluecrossma.org/medical-policies/sites/g/files/csphws2091/files/acquiadam-assets/999%20Medical%20Policy%20Updates%20prn.pdf

Post Edited (DjinTonic) : 5/22/2022 6:04:02 AM (GMT-6)

There is some indication that imaging at 120 min after injection picks up more than imaging after 60 min:

A Pilot Study of Dynamic 18F-DCFPyL PET/CT Imaging of Prostate Adenocarcinoma in High-Risk Primary Prostate Cancer Patients - Beyond the Abstract

"When is the optimal imaging time for 18F-DCFPyL? The package insert recommends imaging 60 minutes after radiotracer injection and furthermore, discourages imaging beyond 90 minutes, but validated evidence for this is lacking. What has been published is that imaging obtained 120 minutes after 18F-DCFPyL injection depicts more metastatic lesions than imaging at 60 minutes. Additionally, lesions at 120 minutes have better conspicuity and in one study, 9% of men were upstaged resulting in management changes due to findings on delayed images. Our dynamic data suggests later imaging results in higher tumor uptake.
..."

Post Edited (DjinTonic) : 5/21/2022 5:51:29 AM (GMT-6)

I had the Pylarify PSMA scan at the Cleveland Clinic several months ago. Procedure was similar to other scans I've had. They did give me the IV infusion first and then sent me to the waiting room for awhile and eventually called me back for the scan. Might have been a bit more than an hour between the time I got the IV infusion to the time I was in the PET machine but not too much more than that.

My memory is that my husband had the injection and then they took him for the scan about an hour later.

Really interesting info, Djin.

Djin,

Jerry had asked me about this, too. When I checked, it looked like my husband's scan was not full body. I think it was neck to knee. OTOH there were comments about the uptake by the salivary glands so the whole thing was confusing.

M

I would check the order…and I’m curious what others are seeing as well…the code for all of my f18 sodium flouride pet/cts were 78816 (Full Body)…I think for my PSMA it was 78815 (skull base to mid thigh)…

I did ask my doctor and the location where I got the scan…and they said 78815…

I’ve been trying to get one but my darn insurance company keeps denying the request. After first denial they told me I had to get a bone scan and CT scan first. Bone scan showed 3 suspicious spots which are surely cancer as the PSA IS 1.6 but hopefully coming down with Nubequa. I’ve offered to pay for it myself and dr doesn’t want me to do that. He’s trying to get me in a trial. We will see. Aggravating as hell.