Update and question on Scans

Every insurance is different. Many insurances require a preauthorization before they will do the scan.

I went the surgery route and it seems I was getting access to psma pets once/year and cat scans as often as i needed once something was found.

There are alot of guys here who had radiation as primary treatment and there is something about that treatment method that leads to a psa rise some years down the road before a steady decrease sets in. They can shed some light.

I would ask for psa tests every 3 months instead of 6 to catch much faster rises than you have seen, or perhaps to see the drop that might happen.

https://pubmed.ncbi.nlm.nih.gov/27363387/

This study may give you some idea of PSMA sensitivity vs. PSA

Insurance coverage is a different animal as that can revolve around BCR classification. It is a brave new frontier with PSMA scans being very helpful in the original diagnosis and classification process as well so SOP is not well defined for all cases. Your RO should be up on these things and be able to tell you where the process is at and when it can get approved. I would assume it might be PSA testing until you get to >1.0 or if the PSA doubling takes off.

Just guessing on my part...

Hi

I will ask about a recomenndation on a MO in case this is a recurrance.

I will ask about a scan, and at what PSA level is has a reasonable probability of showing something.


Just not sure at what PSA most docs will order one.

Looking at https://www.prostatecancer.news/search?q=PET+Scans ,

there is a Table showing results of sensitivity in the article. Note this was written in 2016

Seems above 0.5 ng/ml there is a more likely chance of the scan finding the cancer, but 1.0 seems to be better.

Anyone who has had a Pylarify F18-DCFPyL PSMA PET scan, what was your PSA level at the time of the test and what did the test detect? Also whom were you working at the time of the scan, Urologist, RO or medical Oncologist?

Doing some reading about these scans, the quality and interpretation are important too.

I guess I will know more once I discuss with him next weeks as to the direction on this.

Anyone else who has gone down this situation please comment, curious how folks with primary radiation treatment who had recurrance or mets handled it after their PSA started rising after treatment.

With imaging a lot will depend on whether any cancer expressing PSA is concentrated to a tumor or diffused among many widespread micromets. The first will be found much earlier than the latter.

I can't speak to the sensitivity of PET scans. However in my case with PSA at 50, they showed no cancer except localized in the prostate. MRI showed nodules in my lungs. My urologist blew them off, so I changed doctors, had a biopsy and found the nodules in my lungs were in fact Prostate cancer.
So I have little faith in PET scan.

As JNF pointed out, the ASTRO definition of BCF after primary radiation is 2.0 over nadir. Many doctors dont support having PSMA until that level is reached. I know in my case my RO and Urologist did not despite my expressed concerns for several years as I watched my PSA slowly increase. My advice is to push as hard you you can for the scan and a mpMRI.
I dont know about involving a MO at this point. He/she usually prescribe medicines for treatment and you wont know if thats needed until you've had a thorough workup. Your Urologist can order the PSMA. You dont need a MO for that. On my first visit to my MO 2 weeks after the PSMA showed local involvement he asked why I was seeing him. Do you want ADT he asked. No I said, do I need it? I don't think so he said, at least not now. I treat PCa with medicines. If you dont want or need medicines I cant really help you. I'll be glad to refer you to a RO or Urologist if you like.

Turboz, yes, my PSMA did show only local involvement and the mpMRI showed the same tumor location classified as PI-RADS 5 and local involvement.

I'm not receiving any treatment at present, but my hope is to qualify for salvage treatment and have either cryotherapy or brachytherapy later this year. I'm having PSMA on October 4, PSA tested October 7, and a transperineal targeted biopsy plus 12 random cores and seminal vesicles on October 8. I think the PSMA is the key to getting approval for salvage treatment. I don't really think it matters too much what my PSA is or the Gleason from the biopsy. Is the cancer still confined to the prostate I think is the main question.

I have an appointment scheduled with my MO for October 17. If the PSMA shows spread beyond the prostate that'll probably mean I'm not a candidate for salvage and the MO will be my main doctor. If the PSMA still shows local involvement only but my PSA and/or Gleason is high the MO might still want to start meds for a period before and after salvage but that'll be a discussion with both the urologist who would do the cryotherapy and the RO who would do the brachytherapy as to whether that would affect the salvage treatments.

It looks like you reached your nadir 5 years out at .22. Your subsequent increases do not look like bounces to me. They're beyond the period when bounces usually occur and are not large enough to qualify as a bounce. I think you're right to be concerned but your PSA is still very low and there may be a benign explanation for the increases.
You're wise to watch this carefully and have frank discussions with your doctor about having a PSMA if you continue to have consecutive increases. Having future PSA tests every 3 months might be a good idea. If your next test is up that'll be 3 consecutive increases, enough to order a PSMA in my opinion but, as you know, PSA <1.0 might be iffy in finding cancer. If it's down, that'll be a good sign. PSA doesn't usually fall if cancer is present.

Don't let your doctor talk you out of having the PSMA. I let mine talk me out of it and you see what happened to me.

Post Edited (hrpufnstuf) : 10/3/2024 1:24:45 PM (GMT-4)

HI

had my F18 Pylarify PET scan this afternoon,

was able to look at the verbiage in Mychart

There is moderate uptake within a very small presacral lymph node concerning for nodal metastatic disease. No convincing evidence of recurrent disease within the prostate gland itself.

so looks like will be following up with my RO once he sees the results, I hope he can do some SBRT on that node and or treat the presacral area, looking on line is above the bladder.

guess I have to look at it as they only found one met that they could see.