What is the BEST Way to See if Prostate Cancer Has Spread? 

Thank you for sharing. I was diagnosed with PC approximately 4 weeks ago. Prior to my upcoming PSMA Pet Scan today, my results were uploaded on my patient portal approximately 5 days prior to my follow up visit to discuss the biopsy results. Of the 12 core samples, (2) 3+4=7 and (6) 3+3=6 were diagnosed as Adenocarcinoma. As I continued my due diligence I located one of the Gleason 6 scores indicated Perineural Invasion. First time I was aware of this result. After reviewing numerous presentations on youtube, I became concerned. I was able to continue researching options on PNI. I did review your presentation (very well by the way). Thus, in preparation for my follow up visit I decided I would have a prostatectomy. My Urologist reviewed several procedures to combat PC. The Urologist was very positive and stated "this is very curable" 🙂. He did not discuss a PSMA Pet Scan. I brought the scan up and asked how do we know if the cancer metastasized? Collectively, he agreed to order a PSMA Pet Scan. I'm praying that this has not spread. If it has not spread, I will continue with the Prostatectomy. I appreciate you Dr. Ahdoot for sharing this valuable information.

Good information. Recently had a PSMA Pet scan as part of a clinical trial for an FDG contrast agent that is approved by the FDA but not yet by Health Canada (BC Cancer Agency). My PSA has remained high even after TURP surgery last July hence the decision to have the scan. Interestingly, the scan indicated Gleason 6 cancer is confined to the prostate, but did pick up a suspicious 2.1 cm thyroid nodule

As somrone facing radical prostatectomy, I very much appreciate this information. I like to be informed and appreciate Dr's that are aware of developments. Thanks so much.

Thank you for the information!!! This is awesome!!

Clear, thorough explanation of specificity, sensitivity, and negative predictive value. Thank you.

Very helpful stay blessed doc

THANK YOU DOCTOR. EXTREMELY ABOUT THIS INFO.

Thanks for smart advice. I like your enthudiasm and caring demeanor.

Thank you dear doctor. I have a lump on my prostate test psa was 1.0

Great information! Thank you.

Great video I am going for this scan in a few days

Well done doctor. You speak to men in language we ca understand!

So glad I found this channel 53 years old and was diagnosed with Gleason 7(30%) in one out of 12 cores 2 months ago. I’m scheduled for a transperineal biopsy in 8 weeks to see if there is any spread or additional cancer that was not detected in the standard biopsy. Thoughts as of now are active surveillance unless the second biopsy shows movement. Thanks for educating us on less invasive treatment options and outcome statistics

Thank you sir for your posting. I wished 😪 I had the PET scan approximately 3 years ago. My standard of care was of course the soft tissue pelvic scan, followed with tge skeleton imaging 3 weeks later. It did not show any metastasis anywhere. Opt for radiation treatment, 60/20

Thank you for this excellent video. You are a very good teacher. We are gathering information to help us decide what to do. On a sincere note. Please get more rest or have your liver checked. Your eyes are very dark underneath and that ,as you know, is a sign of something very wrong. Good health to you too doctor.

Thanks

Thanks!

I had a prostatectomy 2yrs ago, my Gleason was 8, fortunately margins were clear, and had not spread to lymph nodes. PSA dropped from 9 to less than 0.01 where it has remained for past 2 yrs. I am still concerned with spreading and requested a referral from my urologist to have a PSMA Pet scan but he refused saying PSA is so low there is no cancer - who is right? I totally agree with selecting young eager, proactive doctors who are using today's technology and science.

Had a random biopsy, bone and CT scan. I changed doctors and had color doppler ultrasound and 3tmri and psma pet scan. Also second opinion on biopsy at John Hopkins

Very helpful 👍

Very useful information !!

Very well-explained & very helpful. Thank you!

Really appreciate the education! 58 PSA 5.3, getting MRI , live in SF area, do you provide second opinions via in person visit and all records provided to you.

Very Informative. So, I see online that Medicare will offer a rebate for the PSMA PET scan as of July 2022. You state that it is now a full pay starting in early 2023. Am I correct?

here in south africa the psma pet scan is damn expensive and the medical aid dont want to pay for it yet ,it will probably take a bit longer to catch on

Great video. Is a PSMA Pet scan more advanced when compared to a 3T - Multiparmetric MRI? I have had 2 3T's and I am scheduled for a 3rd. Should I investigate getting a PSMA PET scan instead. Have Gleason 3+3 2 cores. PSA has risen in the last 2 years from 11.8 to 15.3. I am on active surveillance. 68 years old. Looking forward to the next video.

I think I just found my go-to source for up-to-date information.

I often wonder about that

Much appreciated and highly educational video. I wonder if pre-surgery bone and CT scan are negative for metastasis, and post robotic-assisted radical laparoscopic prostatectomy PSA (2months out) is negative (0.02) for a Gleason 4+3, grade 3 prostate cancer (pT3a N0) with genomic confirmation (DECIPHER SCORE =0.75) of high risk grade cancer (with intraductal features, cribiform pattern 4 identified, lymphovasular invasion identified, focal extraprostatic extension identified, microscopic bladder neck invasion identified, margins of resection are positive for tumor but seminal vesicles are negative for tumor), how accurate is it to conclude there is in fact no metastasis? Thanks for considering to offer your expert input :)

What is the variance or standard error of the SYVs?

PSMA PET CT scans are quite a leap forward in detecting metastasis and quite useful as long as limitations are understood. One limitation seems to be detecting ECE on intermediate risk patients when deciding on curative (surgery v radiation) initial therapy. One would imagine that would greatly decrease positive post-surgical margins as those with ECE would go the radiation route. At the same time PSMA is now also used for radiation targeting and even guided surgery.

Curious to know what the PSA cutoff is before you think that the scan likely would not see the cancer. In other words what PSA level is required before the negativity result is statistically correct 75% of the time. I used 75% but maybe there is a better way to pose the question of what level of PSA should we NOT perform the PMSA scan?

Great presentation.

In France it is just Forbidden to use PSMA for first line evaluation. The doctor can ask for it only in recurent cancer. 😢

My father's recent medical situation has left us feeling uncertain about the next steps. After his PSA level reached 13.5, an MRI showed PIRADS V, but a PET-guided biopsy came back negative. His PSA level has now decreased to 2.09, but we have received conflicting advice from doctors regarding monitoring the PSA or repeating the biopsy. We would greatly appreciate your guidance on the best way forward. Your expertise would be invaluable in helping us make an informed decision.

I am suffering from a group of symptoms that could either be from a bad case of enlarged prostate or even from prostate cancer. I have heard that some forms of prostate cancer do not affect PSA levels. The last PSA test had me at 1.6 ng/mL. which is a very good number. How confident can I be that my bothersome symptoms are not from prostate cancer?

Do you have any opinion about IsoPSA test developed at Cleveland Clinic? My urologist had me take the test (immediately following a DRE) a couple days after a lab PSA which showed my PSA slightly elevated. The IsoPSA showed my PSA significantly higher only after 2 days compared to the lab PSA. My urologist wants me to re-take it in 30 days. Many thanks.

ED here, my journey continues. been thru surgery, radiation, and some lupron. now my PSA # is easing off 0 again, like .36 for 1 year. next app. is Jan 15. Do i need PSMA scan and is PSA of 2.0 or above the beat time to do the scan. THANKS

I had a radical prostatectomy performed 28 months ago, nodes taken during surgery were negative however some cancer in seminal vesicles and had very high Gleasons pre-surgery. Post surgery, PSA levels were nearly undetectable until last week my PSA was .17. Just left urologist who is having another PSA test done and recommending a bone CT scan. BCBS apparently doesn’t cover PSMA PET scans but I am willing to pay the out of pocket costs to have it done. If PSA test results come back at .17 or lower on second test, would a PSMA Pet Scan be the course of action? Lots of confusion regarding radiation and ADT. I am only 60m years old.

Hi Doc, thank you for superb video and information, please keep them coming. Psma pet scans do seem to be the best thing we have at present time, I would love to have one to show exactly what is going on in my body, I just wish my backwards thinking NHS Oncologist at the local cancer hospital was as enlightened , they do have a Psma pet scan on site but not for me,, Gleason 9 with bone metz, so if not for me then who ?

Insurance companies are still rejecting PSMA PET scans even now.

So how do you convince your doctor to order a PSMA PET Scan if they are reluctant to do so?

It seems like the first step with a high PSA 4.18 is a trip to the MRI machine. Is that screen accurate if you use a 1.5T or 2.0 or 3.0 machine. I got a PIRAD 5 using the 1.5T machine, lesion size 1.6x5.0 cm on both sides of the back of the prostate. What might be the next step. Been eating lycopene and diet change and now PSA came down 23% to a 3.20.

Recently Dx PSA 49.5 Gleason 4+4 and 4+5 PSMA-PYL done today awaiting results Are you still at Cedars?

How is a PSMA “hit” validated (biopsy) when the PSMA is the most sensitive & specific test available?

If PSA is high and steadily increasing but neither ultrasound nor MRI show anything suspicious, isn’t it the rational thing to do to first get a PSMA PET/CT scan before deciding whether to get a biopsy? If PSMA PET/CT too doesn’t show anything, then biopsy could be avoided or else, using the imaging from PSMA PET/CT fusioned with the ultrasound and MRI images, a targeted biopsy could be made instead of a systematic biopsy.

This is all wonderful, but my prostate cancer had already spread to 15 places in my bones when it was first discovered 27 months ago. What I want is a cure! Fasting ?

Can this test diagnose a cancer in the prostate at an early stage as a noninvasive alternative to a biopsy? Is 3T MRI a better test?

How often should or could you have a PSMA test?

So my PSA was 5000 so CT and bone scan was then done and cancer was in all my lymph nodes and all very enlarged. Told there was little to be done. So I lsy here waiting to die. Cannot even eat or drink! At least a palliative nurse helos me with pain meds.

My PSA test 4 months post my radical prostatectomy is 0.2 and my urologist said it should be 0.02 at this point in time. Now I'm terrified the cancer spread before I could get the surgery. My urologist has not mentioned a PSMA PET scan, Should I seek a second opinion from another urologist and does Medicare even cover this test?

I have a psa of 21 and a Gleason score of 4+3 and the doctor told me I am not eligible for one of these.

My VA doctor refused to set up a psma scan.

Very informative video why this test is better for cancer prostate spread, Thank you . My PSA=5 , DRE negative, 3T MRI PI-RADS 2 = LOW , TRUS biopsy found 2 cores positive Gleason 3+4 low volume , Gleason 4 was 15 % total tumor volume posterior RIGHT SIDE of Prostate. On the other hand the PSMA-PET GA-68 says localized prostate cancer N0 M0 , Mild focal uptake in the LEFT SIDE of Prostate peipheral zone may well represent the site of the primary prostate cancer. The BIOPSY and the PSMA-PET do not agree on where the tumor is located, Could useful to have a Transperineal Prostate Biopsy before deciding on treatment to clear confusion? I have watched all your videos with advantages and disadvantages of different treatments and need to make a decision. I have been told I have time to decide on treatment. Thank you very much for all the videos they are excellent .

So why won't a urologist use this scan before doing a biopsy especially if you had a clear MRI

I’m just asking your opinion or do I need a 2nd opinion on my prostate cancer with a Gleason Score of 3+7 which is 7. However my PSA is 1.75 and MRI Cat shows I have cancer. However I did a PSMA Pet Scan it didn’t highlight the cancer. My Urologist said I have I different type prostate cancer that is not detected by Pet Scan or PSA. However the biopsy confirmed I got prostate cancer Gleason 7 (3+4) and was shown via MRI Scan showing lesions in my prostate. My Urologist gave me two options Radical Prostatectomy using Robot or Radiation Therapy. I chose Radical Prostatectomy. Do you think I made the right decision. I will do in March next year. I was only diagnosed prostate cancer 2 months ago.

Hi I'm 65yrs young and for the last 14 months my PSA has been 12.4. My Urologist sent me for an MRI scan and the results came back as inflammation and enlarged prostrate. Urologist told me i have Prostatitis the reason why my psa is high. I did mention about a biopsy but the Urologist was against the idea as their is no target with the biopsy needle as the mri scan is showing nothing suspicious. Im a little nervous as both my Dad and Grandad both passed away with prostrate cancer. Im even contemplating paying private to have my prostrate removed as its causing anxiety. How accurate is an MRI scan? I had another psa blood test yesterday 2 months after my last one so hoping the psa levels have come down. Results next week 🙏🙏

Does a negative PSMA PET scan that is revealed to be no longer accurate by a positive PSMA PET scan showing 2 lymph nodes with cancer approximate 6 months later mean the spread is recent (within the last 6 months) or does it mean the original PSMA PET scan was just wrong and the nodes were positive all along? Also, is it likely there’s even more spread not appearing on the most recent PSMA PET scan?

Biopsy may actually spread cancer cells before therapy even begins. Why else do most patients have recurring tumors years after radiation or prostatectomy.

You are much more credible when you shave!

Wow! Very impressive! Extremely educational! My PSA just came back at 5.7 my Doctor Immediately wanted to do a transrectal biopsy! I said NO! Finally after 6 months he agreed to a standard MRI with dye. Going to ask for the PSMA PET scan now! I am a disabled Air Force Veteran I find the VA very frustrating! To deal with 6 months just to get an initial appointment. Can you offer any additional advice? It would be most appreciated 🙏🇺🇸✅🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸

I am regreting to get complete prostate surgery since it was on first stage i should have just take a rediation because now i dont have any sex filling nor it eject its driping pee all the time no spurm coming out it fill like i have no pinus or another word its only good for pee now nothing else

Looking for more advice, my PSMA-PET Scan provided the following results,. Thank you for this video and response to my questions. I pushed my insurance to cover the scan. Background, 60 yr old, biopsy done with high Gleason scores, radical prostatectomy 2.5 yrs ago, great PSA follow up results, a month ago my PSA started to go up, scan had the following results. Shocked to hear cancer might now be in my ribs. Any suggestions? What would be the next step? My Urologist mentioned there was a trial for metastatic prostate cancer but waiting on the details, are we talking radiation and hormone treatments or are you aware of something else? Petrified in Michigan. Narrative PET-CT Illuccix Ga 68 Gozetotide PSMA Todorov PROVIDED HISTORY: * 60 years old Male * Malignant neoplasm of prostate, status post prostatectomy COMPARISON: No prior PET/CT scans at William Beaumont Hospital for comparison. CORRELATION: Bone scan dated 04/26/2021 PROCEDURE: The patient (weight 205 lbs; height 6 ft 1 in) was injected intravenously with 4.75 mCi of Ga 68 Gozetotide (Illuccix PSMA) assayed at 2:51 pm hrs. Injection site: Right antecubital IV. After waiting an approximately 60 minutes a series of bed positions were acquired to cover the skull base to mid thighs. The data was reconstructed into a three-dimensional volume rendered display. CT imaging was performed for anatomic correction and anatomic localization. Prior to imaging, the patient was prepped with 450 mL of oral contrast. This report represents interpretation of the PET-CT imaging by nuclear-medicine physician. FINDINGS: PELVIS AND ABDOMEN: Images in multiple projections demonstrate no definite focal intense tracer activity in the post prostatectomy region. There is no gozetotide avid adenopathy in the peri-prostatectomy, lower pelvic, retroperitoneal and abdominal areas. No focal intense tracer activity in the liver, pancreas and adrenal glands. CHEST AND NECK: There is no subdiaphragmatic lung parenchymal lesion bilaterally. No tracer avid adenopathy in the hilar, mediastinal, axilla, clavicular and neck regions. BONES: There is sclerotic lucency in the right posterior fifth rib with a maximum SUV of 4.3, metastatic disease cannot be excluded. Tiny focal activity in the left anterolateral fifth rib shows a maximum SUV of 3.8 IMPRESSION: Ga 68 Gozetotide PET/CT scan demonstrating sclerotic lucency in the right posterior fifth rib and focal activity in the left anterolateral fifth rib with a maximum SUV of 4.3, metastatic disease cannot be excluded. No scintigraphic evidence for gozetotide avid SOFT TISSUE disease.

Thanks!