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  • PSA at 5.3, then dropping

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    Old 11-11-2019, 06:45 PM   #31
    ocman
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    Re: PSA at 5.3, then dropping

    Quote:
    Originally Posted by IADT3since2000 View Post
    You are doing a super job of getting educated so you can take your shot!
    So much information in a short period of time.

    Quote:
    Originally Posted by IADT3since2000 View Post
    my hunch is that this pathologist has spent a great career working mostly with surgeons at an institution that is renowned for surgery.
    Yes, I absolutely feel the same way.

    Quote:
    Originally Posted by IADT3since2000 View Post
    I suspect that this brilliant pathologist has not kept up with advances in radiation therapy.
    From what I understand the last 5-10 years there's been quite an advance in RT compared to the last 50.

    I have an appt. on 11-22 with a medical oncologist that works as a team
    prostateoncology.com, hopefully this will be an unbiased opinion

    peace

     
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    Old 11-23-2019, 06:48 PM   #32
    ocman
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    Re: PSA at 5.3, then dropping

    So I met with a Medical Oncologist that specializes in prostate cancer yesterday. He said I was on the right track since I was already leaning towards HDR Brachytherapy.

    He did suggest that I get a Gallium-68 PSMA PET/CT Scan. The cost is about $2800.00 cash, since the scan is so new.

    Will keep you posted!

     
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    Old 11-26-2019, 05:06 PM   #33
    ocman
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    Re: PSA at 5.3, then dropping

    This is a followup on my previous message.

    I posed the question to my Urologist, Surgeon, & Radiation Oncologist regarding the Medical Oncologist recommending the PET scan.

    I got a message from the Surgeon that I had the consultation with regarding the PET scan and he said, "Please let him know that his calculated lymph node involvement is less than 10% so we don't usually recommend doing it. There is minimal harm is the scan but it would not be approved by insurance so it would cost about $3000."

    Then I got a message from the Urologist and he said, "You have a diagnosis of unfavorable intermediate risk prostate cancer (NCCN risk stratification). In this setting it would be prudent for you to have further imaging. The recommendation is for CT abdomen and pelvis as well as a bone scan. PSMA PET scan could be performed instead of these however it is not covered by insurance and is only available at select academic care centers due to it being a fairly new test. UCLA does perform PSMA PET scans.

    I then asked the Urologist if he was recommending the CT & Bone Scan because he didn't mention that in the post biopsy consultation, neither did the Surgeon or Radiation Oncologist.

    Now I'm trying to find out if the CT & Bone Scan will give me enough information OR do I pay out of pocket and get the PET Scan?

    thanks!

     
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    Old 12-01-2019, 05:58 AM   #34
    IADT3since2000
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    Re: PSA at 5.3, then dropping

    Hi again.

    I hope to think about this some more, but here is what comes to mind now.

    If you go to one of the top medical oncology practices that are dedicated to prostate cancer, the advice you get from them is based on expert experience with a great many cases like yours with the patients usually getting thorough monitoring with appropriate scans, tests, and exams. Typically, in contrast, surgeons/urologists and radiation oncologists are more oriented toward what they need to know to do their kind of treatment, and unless highly expert, they tend not to have as good an overview. They seem to me to think that their treatment will work for most of their patients, and then, if it doesnít, they can try something else, rather than aiming to cure with high confidence right out of the gate. You can make an argument for either approach, as the latter approach, while more effective, is likely to cost more in the short term.

    Personally, if it were affordable and sufficiently convenient to me, I would go for the PSMA PET scan. It would give the best view by far compared to the CT scan and the conventional bone scan (technetium based). Both of those require a fairly large tumor before those scans pick it up, such as pea sized for the CT scan and about 10% of tumor bone involvement at a site for the bone scan. (My CT and bone scans back in late 1999 were both negative despite my Stage 3, Gleason 4+3, all cores positive, PSA 113.6 cancer.) In contrast, the PSMA PET scan will often pick up a tumor as small as a beebee. If the PSMA PET scan is not practical for you, the Axumin scan, one of the carbon 11 scans (C-11 acetate, C-11 choline), and or the NaF18 CT/PET scan for bone could be about as accurate and more affordable and convenient.

    I too had to decide whether to get advanced scans back in 2011 and 2012, a time when radiation had improved enough for someone in my situation to warrant a try for a cure. My doctors, including an expert, suspected I had small metastases that had survived well over a decade of intermittent hormonal therapy at that point. A really good bone scan had been approved and available for a few years (the NaF18 PET/CT scan), but the only really good scans for lymph nodes and other soft tissue were investigational. One was the feraheme USPIO scan, and it was available in Florida, a thousand miles to the south. If the scans revealed a metastasis or a few of them, the plan was that I would get radiation to the prostate and pelvis plus spot radiation to whatever metastatic spots showed up, unless there were a lot of them, in which case, back then, I would not get radiation. Local radiation facilities did not then offer the supplemental spot radiation, so the plan was that I would go to a place in Florida where the full package was offered. That would have involved being away from home for two months, and would have been quite a burden. Fortunately for me, both scans showed no spots. That enabled me to get the radiation at an excellent local facility. Thatís the difference that the scans made for me. For you, it seems to me the issue is less clearly drawn; there are pros and cons to getting the really sensitive and specific PSMA scan or another excellent scan, or just going with the less effective but less expensive conventional scans in a case where the odds are pretty good anyway but still with substantial room for improvement.

    By the way, I wanted another scan, an mpMRI, after my encouraging results. I wanted to know where the cancer remained in my prostate. However, since radiation would be wiping out any cancer that was there, the mpMRI would not have added any value. I did not get that scan. It often comes down to whether the value added is worth the cost.

    Iím sympathizing with your work in trying to sort this out.

     
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