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  • Axiom PET Scan vs PSMA

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    Old 10-19-2020, 02:15 PM   #1
    JWPMP
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    Axiom PET Scan vs PSMA

    Well our insurance doesn't cover the PSMA scan which makes it $4000 out of pocket.
    I've messaged Dr Carroll's office concerning advisability of Axiom vs PSMA.
    I'm also going to look up online.
    Wondering if anyone here has experience with this?
    Paula

    Jim 64 years old
    First PSA ever 7/2020 53.5
    Retest 9/2020 66.3
    MRI 9/2020. Biopsy 10/2020
    Entire prostate involved.
    T4 Tumor
    Gleason 5+4 = 9
    Invasion of Anterior Rectal Wall.
    Possible two pelvic nodes.
    Seminal Vesicle invasion.

     
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    Old 10-19-2020, 03:51 PM   #2
    Steve135
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    Re: Axiom PET Scan vs PSMA

    Axumin isn't any cheaper but it may be covered better under your insurance as its been out and approved longer? Non providers want 4k up front for the dose. The insurance tend to bundle the payments and the provider doesn't see the high fee for dosage. Penn med charged over 13k and insurance covered all but 600 2 years ago. But I needed to go round and round with Penn. before I paid.
    A side note the Axumin Pet didn't see any PCa but a standard mri did a few months later. Crap shoot. I was part of the USA trial study for Axumin for men with less than psa 1.0 with a BCR. it was free...


    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02 5/20 <0.02 6/20 <.02 7/20 <0.014 8/20 <0.014 9/20 <0.014

     
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    Old 10-19-2020, 03:53 PM   #3
    Eonore
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    Re: Axiom PET Scan vs PSMA

    I am not an expert by any means, but my understanding is that the Psma is not yet approved by the FDA, therefore the carriers will not cover it. There are studies indicating that it is more effective in locating metastatic tissue than the Axumin scan. How much more effective it is, and whether it may have an impact on treatment decisions is something you need to discuss with your team. When I relapsed after surgery, I had the Axumin scan.
    Because you are dealing with a high risk case, if your doctors see an advantage to the Psma and you can afford it, I would do it on the theory of throwing everything you can at the beast. Your doctors should help you make the call.

    Eric

     
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    Old 10-19-2020, 04:10 PM   #4
    Steve135
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    Re: Axiom PET Scan vs PSMA

    This is where you find out just how good your insurance is. Its ashame that we need to find this out during the worst times of our lives. Drug companies offer assistance on cost but each has its own means test. When I was looking for help on chemo drugs (12k) a month insurance got it down to 3400 my house whole income needed to be less than 100k for any asistance . So I recieved nothing. You need to get in you insurance company benifits online and see if you can get the drug through pharmacy rather than medical. It worked for my two most costly drugs. (a chemo pill and injectable) Both were able to be had for a co-pay of 50 bucks. Specialty pharmacy was a key word. Sorry if I sound off base but this info will be big for you as you proceed.
    steve

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02 5/20 <0.02 6/20 <.02 7/20 <0.014 8/20 <0.014 9/20 <0.014

     
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    Old 10-19-2020, 05:00 PM   #5
    IADT3since2000
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    Re: Axiom PET Scan vs PSMA

    Quote:
    Originally Posted by JWPMP View Post
    Well our insurance doesn't cover the PSMA scan which makes it $4000 out of pocket.
    I've messaged Dr Carroll's office concerning advisability of Axiom vs PSMA.
    I'm also going to look up online.
    Wondering if anyone here has experience with this?
    Paula

    ....
    Hi Paula,

    The Axumin scan is an outstanding and fairly recent advance in imaging. I'll try to find expert views comparing the two, but my hunch is that you would be just fine with Axumin.

    One area, an important one generally, where the PSMA PET scan has the edge, is in low PSAs, such as less than 1, as already mentioned on this thread. Fortunately (? ) your husband does not have to worry about that.

    One area where I believe Axumin has an edge is that the cancer must "express" PSMA if the PSMA scan is going to spot that cancer, but the Axumin scan does not need the cancer to express PSMA. I've heard that 80% of patients' prostate cancer expresses PSMA.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 10-20-2020, 07:16 AM   #6
    DjinTonic
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    Re: Axiom PET Scan vs PSMA

    We are still awaiting FDA approval for PSMA scans in the U.S., so its is currently available only out-of-pocket or through clinical trials. The axumin PET/CT scan should do nicely to identify the extent of the cancer.

    One disadvantage of the PSMA scan is that the radionuclide is eliminated via the kidneys, so the entire bladder "lights up" on the images and it is difficult to evaluate cancer spread near/into the bladder. Axumin is eliminated mainly by the liver, so it doesn't present this problem.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)

     
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    Old 10-20-2020, 09:51 AM   #7
    JWPMP
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    Re: Axiom PET Scan vs PSMA

    Thank you everyone for your input.
    Extremely helpful.

    A little clarification. As several of you correctly mentioned, the non coverage of this scan is due to it is still considered in "clinical trial " and the Gallium is not FDA approved.

    Dr Carroll's office reached out and said once its been denied, they will contact the insurance "physician to physician " with evidence of medical necessity. They said oftentimes they can get it covered.
    If not, they said the Auxium scan is also excellent.
    Jim however, now has his heart set on the PSMA and will pay out of pocket if necessary. I personally would rather not, but I will not seek to influence his decision.
    The comment regarding kidney involvement rather than liver was a bit concerning to me, but the doctors are aware of Jim's single kidney situation and have not been concerned as of yet. Especially since his kidney function/numbers are excellent.
    So I will leave it between Jim and his Drs.

    Again, thank you for the input it was extraordinarily helpful.

    Paula

     
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    Old 10-20-2020, 12:24 PM   #8
    IADT3since2000
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    Re: Axiom PET Scan vs PSMA

    More detail on Axumin vs. Ga68 PSMA PET Scans

    The NCCN, National Comprehensive Cancer Network, an organization of leading centers treating cancer and a publisher of guidelines for each, has a table comparing various PET scans for prostate cancer. It is available at, after registration under the physician version (you don’t have to be one), nccn.org, at the following URL and under the following table.

    https://www.nccn.org/professionals/physician_gls/pdf/prostate_blocks.pdf

    NCCN Guidelines Version 2.2020Prostate Cancer MS-63 Table 2. Summary of Main PET Imaging Tracers Studied in Prostate Cancer

    In essence, it shows that both scans have about the same upper limit of the range for finding a cancer if it is at a position in the body (“sensitivity”): 90% for Axumin and 86% for PSMA, but the lower limits of the range are much better for PSMA: only 37% for Axumin but 76% for PSMA.

    The table also shows that for “specificity”, which basically is the ability to rule out other causes for a signal at a position in the body, the upper limits are the same at 100%, but the lower limits are far superior for PSMA: 40% for Axumin vs. 80% for PSMA.

    While both scans are improvements over the previous best PET scans available, it looks lie PSMA is remarkable in that it is both extraordinarily sensitive and extraordinarily specific. However, the context for these figures may mean a lot to an expert, which I am not. It is possible that both scans would perform about equally well if the patient has a high PSA level. As I noted before, the PSMA scan won’t work if the patient’s cancer does not express PSMA, as I understand it as a layman; I’m curious whether Dr. Carroll is planning a preliminary test to determine that.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

    Last edited by IADT3since2000; 10-20-2020 at 12:26 PM. Reason: Minor polishing and signature added

     
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    Old 10-20-2020, 02:45 PM   #9
    JWPMP
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    Re: Axiom PET Scan vs PSMA

    Quote:
    Originally Posted by IADT3since2000 View Post
    More detail on Axumin vs. Ga68 PSMA PET Scans

    The NCCN, National Comprehensive Cancer Network, an organization of leading centers treating cancer and a publisher of guidelines for each, has a table comparing various PET scans for prostate cancer. It is available at, after registration under the physician version (you don’t have to be one), nccn.org, at the following URL and under the following table.

    https://www.nccn.org/professionals/physician_gls/pdf/prostate_blocks.pdf

    NCCN Guidelines Version 2.2020Prostate Cancer MS-63 Table 2. Summary of Main PET Imaging Tracers Studied in Prostate Cancer

    In essence, it shows that both scans have about the same upper limit of the range for finding a cancer if it is at a position in the body (“sensitivity”): 90% for Axumin and 86% for PSMA, but the lower limits of the range are much better for PSMA: only 37% for Axumin but 76% for PSMA.

    The table also shows that for “specificity”, which basically is the ability to rule out other causes for a signal at a position in the body, the upper limits are the same at 100%, but the lower limits are far superior for PSMA: 40% for Axumin vs. 80% for PSMA.

    While both scans are improvements over the previous best PET scans available, it looks lie PSMA is remarkable in that it is both extraordinarily sensitive and extraordinarily specific. However, the context for these figures may mean a lot to an expert, which I am not. It is possible that both scans would perform about equally well if the patient has a high PSA level. As I noted before, the PSMA scan won’t work if the patient’s cancer does not express PSMA, as I understand it as a layman; I’m curious whether Dr. Carroll is planning a preliminary test to determine that.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.
    That is a very good question, that wasn't mentioned during enrollment today, and none of our documents addresses that.
    I will check with Dr Carroll's office...

    After re reading the enrollment documents, Jim is beginning to lean toward the Axium scan IF our insurance denies PSMA after physician review. As I mentioned, Dr Carroll's office indicated both scans were excellent in pre treatment evaluation, but the PSMA was more sensitive at very low levels of PSA recurrence post prostatectomy or prostate cancer treatment.
    That backs up your statement about my husband not having to be concerned about "low level PSA" at this point.
    So we wait and see what they advise.

    Thank you for bringing that up.
    Paula

     
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    Old 10-20-2020, 02:48 PM   #10
    JWPMP
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    Re: Axiom PET Scan vs PSMA

    Quote:
    Originally Posted by Steve135 View Post
    This is where you find out just how good your insurance is. Its ashame that we need to find this out during the worst times of our lives. Drug companies offer assistance on cost but each has its own means test. When I was looking for help on chemo drugs (12k) a month insurance got it down to 3400 my house whole income needed to be less than 100k for any asistance . So I recieved nothing. You need to get in you insurance company benifits online and see if you can get the drug through pharmacy rather than medical. It worked for my two most costly drugs. (a chemo pill and injectable) Both were able to be had for a co-pay of 50 bucks. Specialty pharmacy was a key word. Sorry if I sound off base but this info will be big for you as you proceed.
    steve

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02 5/20 <0.02 6/20 <.02 7/20 <0.014 8/20 <0.014 9/20 <0.014
    Does not sound off base at all, and appreciate your insight. Personal experience is valuable to others.
    Thank you

     
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    Old 10-21-2020, 12:16 PM   #11
    IADT3since2000
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    Re: Axiom PET Scan vs PSMA

    Assessing a Patient's Level of PSMA Expression

    I ran across a German study that used initial biopsy samples to assess a patient's level of PSMA expression. (I learned from the abstract that PSMA expression can be at different levels; in the study, they used these categories for the different levels: no, low, medium and high. I don't know whether the pathologist has to set up the biopsy ample ahead of time so that PSMA can be assessed, or whether it can be done on any biopsy sample at a later date. (Can anyone answer that?)

    Here's a reference to the study: https://pubmed.ncbi.nlm.nih.gov/30619757/

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 10-21-2020, 12:39 PM   #12
    JWPMP
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    Re: Axiom PET Scan vs PSMA

    Quote:
    Originally Posted by IADT3since2000 View Post
    Assessing a Patient's Level of PSMA Expression

    I ran across a German study that used initial biopsy samples to assess a patient's level of PSMA expression. (I learned from the abstract that PSMA expression can be at different levels; in the study, they used these categories for the different levels: no, low, medium and high. I don't know whether the pathologist has to set up the biopsy ample ahead of time so that PSMA can be assessed, or whether it can be done on any biopsy sample at a later date. (Can anyone answer that?)

    Here's a reference to the study: https://pubmed.ncbi.nlm.nih.gov/30619757/

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.
    Could they have possibly have tested for that with the biopsy sample they
    already took? Just a thought

     
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    Old 10-21-2020, 01:11 PM   #13
    IADT3since2000
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    Location: Fountain Valley, CA, USA
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    Re: Axiom PET Scan vs PSMA

    Quote:
    Originally Posted by JWPMP View Post
    Could they have possibly have tested for that with the biopsy sample they
    already took? Just a thought
    I read parts of the study to try to clarify that. There's a convenient link to a free copy of the complete paper.

    I'm thinking that's exactly what they did. Moreover, it looks like some, probably most and maybe all of the biopsies they reassessed were somewhat old. Here's a key sentence leading me to think that from the Discussion section: "Limitations of the current study are that the analyses are based on a retrospective data set,..." As you may know, retrospective means looking backward, as contrasted with setting up something in advance.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 10-21-2020, 01:48 PM   #14
    DjinTonic
    Senior Veteran
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 561
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    Re: Axiom PET Scan vs PSMA

    Quote:
    Originally Posted by IADT3since2000 View Post
    I read parts of the study to try to clarify that. There's a convenient link to a free copy of the complete paper.

    I'm thinking that's exactly what they did. Moreover, it looks like some, probably most and maybe all of the biopsies they reassessed were somewhat old. Here's a key sentence leading me to think that from the Discussion section: "Limitations of the current study are that the analyses are based on a retrospective data set,..." As you may know, retrospective means looking backward, as contrasted with setting up something in advance.

    ….Jim
    I don't think age of the tissue samples matters, since the biopsies in the paper you cited were done on patient who had their RP in the years 2002 to 2014 and PSMA measurement was done for this study, published in 2018.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)

     
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