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Brother considering carbon acetate PET in Arizona?

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Prostate Cancer
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Posted 12/29/2015 2:57 PM (GMT -5)
My brother is 64 and had a radical prostraectomy in August.
His first post op PSA was 3.07 in November December it was 3.55
December bone scan was ok.......as was cat scan

He had positive margins and had a Gleason score of 9( I know :( )
My dad also had prostrate cancer.

Have any of you gone to the clinic in Arizona vs Mayo?

I live in Utah but my brother is in Canada. Everything done in the USA is out of pocket.
Posted 12/29/2015 4:12 PM (GMT -5)
With Gleason 9, he probably should have had other therapy, i.e. hormone, Casodex during or after. That should have knocked his PSA down for a while.

When the PSA comes back, consider the acetate scan. In fact, Dr. Almeida will require certain treatment history before doing the scan, which cost around $3,000 out of pocket. The idea is to find a few mets that can be spot treated. Call his office. I had the scan.

==================================

Age 64 in 2015
12/02 PSA 2.9 age 51
9/03 BX/DX, Gleason 6, 4 of 12 cores
9/03 Low dose brachytherapy
5/08 PSA nadir 1.1
12/08 PSA 1.8
2/09 BX/DX, Gleason 8, 1 of 12 cores
6/09 Hyperthermic Radiation, Hormone (short term), IMRT (10 fractions) spring 2009
10/09 PSA nadir < 0.1 10/09 through 01/12
4/12 PSA 0.2
3/14 PSA 2.9
5/14 C11 Acetate PT/CT, found 2.0 cm lymph node
5/14 Lupron/Casodex (9 months)
8/14 nadir <0.01
2/15 SBRT to node, at UCSD
3/15 PSA 0.02,T=0
6/15 PSA<0.015,T=105
9/15 PSA<0.1,T=278 Quest Lab
Posted 12/29/2015 4:47 PM (GMT -5)
So what he's trying to do is to determine whether salvage radiation might work for him? i.e. - he is trying to rule out distant mets? The reason I ask is because the advanced PET scans are pretty good at telling you if it is not worth treating but are not very good at telling you if it is worth treating. There are none that detect micrometastases.

That said, he can probably get a more accurate PET scan than a C-11 Acetate right there in Canada, if he can get in on a clinical trial. In Toronto, he might be able to get a PET/MRI which is more accurate than a PET/CT.

/clinicaltrials.gov/ct2/show/NCT02131649

In BC, they are testing a NaF18 PET, which is not as accurate as the C-11 PETs but may be good enough:

/clinicaltrials.gov/ct2/show/NCT01930812

In the US, there are several clinical trials that may be more accurate and les expensive than Fabio's C-11 Acetate. I don't know how your brother's citizenship may affect eligibility, but you can call and ask. Here are a few of my favorites:

/clinicaltrials.gov/ct2/show/NCT02523924
/clinicaltrials.gov/ct2/show/NCT02151760
/clinicaltrials.gov/ct2/show/NCT02624518
/clinicaltrials.gov/ct2/show/NCT02559115
/clinicaltrials.gov/ct2/show/NCT01666808
/clinicaltrials.gov/ct2/show/NCT02397408
/clinicaltrials.gov/ct2/show/NCT02190279

- Allen
Posted 12/29/2015 7:58 PM (GMT -5)
You guys are a great help.

He will be going on hormones and has the option for a clinical trial,he has had several bone and CT scans.

He is considering salvage radiation if the PSA is coming from the prostrate bed.

His uroligist is in Halifax NS and there are a few clinical trial options.

I live in Utah and will go meet him in Arizona.

He has been to Sloane Kettering in NYC for consultation as well.

Thanks to all of you. All of this is overwhelming and getting support and learning the ins and outs are so helpful.

Lost my dad.............sure do not want to lose my brother.

 

Posted 12/29/2015 9:13 PM (GMT -5)
The cancer is almost always coming from (at least) the prostate bed. An advanced scan may show any large macroscopic tumor growing there, but none can show micrometastases growing there. And they are almost always growing there first. That's why they don't bother with PET scans before doing salvage radiation - it really doesn't make a difference what it shows or doesn't show in the prostate bed. The presumption, and it's a good one, is that there is cancer there regardless. The only value of a PET scan in a case like this is to rule out distant metastases.

BTW - if he has started hormone therapy already, any PET scans will be particularly useless. HT shrinks early metastases rendering them undetectable.

- Allen
Posted 12/29/2015 9:21 PM (GMT -5)
He has not started hormone therapy yet.
Poor guy has had a miserable time. He had a fall just before his biopsy and had to have screws placed in hip. So he was on crutches during surgery. He then had a blood clot in his lung from the hip surgery.

I think he is deciding on salvage radiation. Thus, the reason to go to Arizona.

If it has spread he will not have salvage radiation.

I appreciate hearing from all of you. My brother is scared. My dad died in 1991. The memory of his passing and pain I think affects his spirits.
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