Welcome to the 2023 ZERO Prostate Cancer Summit! In this segment, hear about PSMA/PET imaging for prostate cancer from Dr. Daneil Kuftinec. For more information on ZERO Prostate Cancer, visit zerocancer.org.
I've just been diagnosed with PC. The biopsy results indicated 8 of 12 samples were positive for Adenocarcinoma. (6) were Gleason scores of 3+3. (2) were Gleason scores of 3+4. Then I saw the Perineural Invasion on 1 biopsy, 3+3. Did a lot of education on this PNI and became confused. Found out PNI means the cancer is growing in our touching a nerve within the prostate. Obviously I became more concerned that the cancer has spread. Reviewed several excellent RU-vid presentations including this one and became aware of the PSMA Pet Scan. Wow, as a non-clinical individual why not have this completed initially and then determine how to proceed with Prostate Cancer? Unless some medical professionals have another objective?
16:00 shows great use and result from PSMA scan. At some point that person might be a candidate for follow-up Radio-guided surgery (Pylarify given again prior to surgery and surgeon can view and excise the avid cancerous tissue). Of course the PSMA dream is the ability to view all cancerous tissue and thus sort out the proper primary therapies for all intermediate risk cancer patients.
Excellent presentation. My dilemma is still having elevated PSA six-months post-TURP, latest biopsy only shows a few cores with low grade cancer (Gleason 3+3). Finally in the queue for a PSMA PET scan which should provide a clearer picture of my diagnosis. The MRI's I have had in the past have been inconclusive (Pirads-3).
The PSMA/Pet scan is great in some cases, but it does not always give helpful results. When diagnosed I had a PSA of 12. They did an MRI to determine likely areas to biopsy, then drew samples from those areas. Several showed some tumor growth, most were 3+3, but two were 3+4. It was considered unlikely that it had spread, but they tested anyway. A bone scan showed several suspicious areas in my ribs. A CT scan revealed that most were related to previously broken ribs, but three were still suspicious. They wanted to follow it up with a PSMA/Pet, but Medicare wouldn't pay for it, so I paid $4800 for it out of pocket. The result was ambiguous, and not helpful, reading about 2-3 in the three suspicious area. As I understand it, 25 is the minimum to confirm cancer, and 0 means no cancer, so 2-3 means maybe a small, early tumor, or maybe a false positive? I really don't know. To me it seems that targeted radiation at the three specific points as a preemptive strike, to eliminate any cancer that might or might not be there would be a good idea, as it would take me back to a relatively safe situation where the cancer is only in the prostate, but I'm told that radiation can not be done without an absolute confirmation that cancer is actually present. Since the cancer is small, if present at all, a bone biopsy would likely be negative even if cancer is there. So, it seems that I have few options. One would be to have the prostate removed, and see it the PSA goes to zero. The other, which I am doing, is to take Bicalutamide to keep the cancer at bay everywhere, until it becomes no longer hormone dependent, and then take further action. My PSA is still falling, and down to 3.5, but I have no idea is simply waiting will end up being a decision I regret.
My MRI came back negative; however, my biopsy revealed 4+3=7 in four out of 12 samples taken. After watching this, I hope my urologist agrees that a PSMA/PET scan is in order. At this point, even though radiation therapy has greatly improved over the years, I'm still leaning toward surgery to allay my concerns of a prostate specific recurrence. Not an easy decision by any stretch.
Early part of 2023, I made the decision for radiation instead of surgery. Completed treatment early March,, PSA was 0.19 at it lowest after treatment, now I'm sitting at A PSA 4.25.😮 Finally got scheduled for a PMSA PET SCAN, I believe we missed the cancer outside of the prostate. The CT soft tissue pelvic scan and skeleton imaging scan didn't show no spread before treatment started. And again ir didn't show anything approximately one year later. Very anxious to see what the PMSA shows. Note: The PMSA was not available when I was first diagnosed 3 years ago. My urologist said I'm his second patient in only 6 months that he has given this too. Don't know if it's a insurance thing or what?😢
PSMA PET scans are now covered by Medicare. FYI, my urologist didn't mention anything about PSMA PET scans either, it was only after watching this channel that I learned about them and requested one to be done, otherwise, I may not have ever received one. It's yet another example of how imperative it is to do your own research regardless of how good your doctor may be, or seem to be. In the interim, remain positive, continue with your independent research, be your own advocate, and I wish you all the best. It's just gonna mean more inconvenience, but you'll get through it. 👍@@BigZWD
@@toddmorrison7342 That is good. I has a PSMA PT Scan done two years ago, and Medicare would not pay for it, so it cost me $4800 out of pocket. Sadly, all I got was ambiguous results. It may have spread to the bones, or maybe not.
Excellent presentation and Clarity. Thank You. I too am re-current PSA of 3.0 after 8 years of a PSA of only 0.3 (Radiation Treatment). Thought I was "Cured". My Urologist has ordered a PSMA Scan. My biggest worry is the Cancer is now Metastatic... which I fear is a high probability? I understand now what is ahead. Again... Thank You!
Thanks for your presentation. These examples are exciting news and I am sure the availability will become more wide spread and the costs will hopefully come down, and be used earlier in disease. One question I have is could the chemistry used that attaches to the cancer membranes be transformed into some kind of higher accuracy screening test? For example, could an injection of the attaching chemical, without the radioactive element, be made and the dwell time measured or something. A longer time could show an attachment to cancer. Sure this not the way it would be done, but something could be measured that relates directly to cancer attachment?
Its well proven that PSMA/PET should be used instead of using needle core samples for the intital detection of Prostrate cancer. Insurance companies dont want this secret to get out. PSMA/PET has %90 detection rate and can go up to %98 combined with CT. The standard 12 needle core tissue samples have %40-%70 detection rate. PSMA/ PET is far better technology and needs to be used for initial detection instead of needle biopsy.
Thank you for this. I have unfavorable intermediate risk with 9 of 13 positive cores and cancer on both sides of the prostate. I’m hoping my radiation oncologist will agree to a PSMA PET scan before we decide whether or not to radiate the whole pelvic area. CT and bone scans were negative for metastasis. We’re leaning toward not radiating the whole pelvic area, and I like the idea of minimizing side effects by just focusing on the prostrate, but I’m worried we may be losing out on our first and best shot to deal with my cancer.
My neighbor just went thru HD Brachy + SBRT for unfavorable intermediate (of course all situations are different and your experience will vary). He was VERY happy to avoid ADT.
I was in a similar situation like yourself. Unfavorable immediate risk, PSA at it highest was 14.1. Did the two standards of care scan before choosing radiation. PSA initially dropped to 0.19, but after about 3 months began to rise quickly, now it's 4.25. Urologist sent me to an oncologist . He ordered a PMSA SCAN. Will have that on January 25th . It appears 😳 that it had spread before initial radiation treatment and the pelvic CT scan and skeleton imaging scan did not pick it up or the radiation didn't work and it has come back aggressively. Continue to do research and asked many questions. I thought I asked all the pertinent questions, I see now I only asked about 25% worth. I felt I had some time to get my feet underneath me. I was kinda moving as if my hair was on 🔥 fire. Trying to regroup now and figure out what is best for me moving forward
Everything I've come across so far is pretty conclusive, PSMA PET CT is very accurate. Find it very hard to believe that 9 cores Gleason 9 would not show up. I'm 69, PSA 12, 18 cores 10 positive. 1 3+3, 8 3+4, 1 4+5. Bone scan negative CT with contrast also negative. Small opacity detected in left lung, doctor ordered PSMA PET. Results yesterday show no metastatic spread, spot on lung still inconclusive. However the scan very clearly detected the cancer in the prostrate, exactly where the biopsy found it. In my mind the PSMA could have made the bone and ct unnecessary. Medicare Advantage plan covered it with a small copay (285.00). Haven't talked to urologist yet, but I am leaning towards surgery. Cleveland Clinic is doing Single Port prostatectomy. Hope I'm a candidate. Everything I've read indicate that Proton Beam, Hifu is not an option with high risk gleason 9 cancer. As I see it surgery first gives me two chances, surgery followed with radiation if needed.
WHAT? First she said 35,000 die from it. It is the second leading death in men! THEN she goes on to say most men do not die from prostate cancer. You lost all creditability!
How so? She is correct in that most men diagnosed with prostate cancer do not die from it. Majority are low-grade Gleason 3+3, and likely confined to the prostate.
