Will PSMA PET replace mpMRI for diagnosis of prostate cancer? A/Prof Daniel Moon presents
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- Опубликовано: 11 сен 2024
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My oncologist would not finalize my treatment plan before seeing the results of s PSMA PET scan. That was 3 years ago!
You have a very good oncologist. Where are you? Australia?
You have an excellent Oncologist.
I had a PSA of 12, so they did an MRI to find out where to target. They found very small tumors with a Gleason score of 7. Even though it was unlikely, the oncologist wanted to rule out the possibility that the cancer had metastasized. A regular PT scan was ambiguous with regards to about 8 spots on my ribs, so they did a CT scan, and most of them were sites of prior fractures. There were still 3 areas that were concerning. They wanted to do a PSMA PET scan, but United Healthcare refused to pay for it. I paid $4800 for it out of pocket, because I wanted to know. Unfortunately, the results were still ambiguous. As I understand it, normally where there is no cancer, it reads 0, and where there is, it reads over 25. On my three spots on my ribs, it read about 1-1.5. So, I still don't know if it has metastasized. They could do a bone biopsy, which, if you extract some cancer cells reveals cancer, but if you don't find any cancer cells, the results are ambiguous because you don't know if there is no cancer, or just no cancer in the specific samples.
Will the PSMA Pet continue to improve, so that if I do it again in a year or so, I am likely to get a clear "yes" or "no"? Are there reasons to do it again? Is it now something the Insurance Companies will pay for?
I am not a doctor, I have researched prostate cancer and treatments for months now, since by husband's diagnosis in 12/23. Possibly the insurance didn't pay for the PSMA pet because of your recent pet scan being performed. Pet scans are typically a once a year approval. Why did your oncologist not order the PSMA first? Many say the PSMA pet scan is far superior to a MRI exam. Did your oncologist not order a decipher test from your biopsy tissue samples?
Your Gleason score of 7, was it a 3+4? or a 4+3? A 3+4 is a Grade Group 2, Risk Group Intermediate (favorable) A 4+3 is a Grade Group 3, Intermediate (unfavorable) The Decipher test is a genomic test. that analysis your biopsy tissues samples. It is a tissue-based prostate cancer marker (PCM) that helps inform the decision of treatment vs. active surveillance in patients with low to intermediate grade prostate cancer confined to the prostate. It gives more confirmation that your Gleason score is accurate. Some actually do 2nd opinion testing, and have the biopsy tissue tested by another group to see if the Gleason Score changes.
Was your PSA of 12 your first PSA test? If not, what was your PSA 6 months ago? a year a ago?
No test is 100%...I found this information....PSMA PET scans another common finding on PSMA PET Imaging is a single mild tracer uptake in the ribs. It is usually not related to prostate cancer, and does not require further investigation (i.e. bone scan or MRI) as the dedicated CT from PET.CT is often sufficient for a confident diagnosis.
The reason I asked if it was your first PSA test is my husband never had an abnormal PSA result. He had issues with prostatitis due to high miles on a bike a few times. His highest PSA was 3.7. But because is PSA test from 6 months prior was 2 point lower, that was a big red flag to further investigate the cause. He had a Gleason Score of 4+3=7, a decipher test, a MRI, then a PSMA pet scan. Results show highlighted areas only in the prostate.
He is now in his treatment phase, which does not include removing the prostate.
I wish you the very best in your journey to be cancer free.
@@threeftr3349 Thank you for your concern, and I can see that you have done a lot of research on this. In my case, the PET/CT scans were not enough for a confident diagnosis, so I guess I won't know for sure for awhile, probably years. I wish the best to you and your husband as well. By the way, there are a few supplements that might be helpful as well. A 2008 study showed that keeping Vitamin D levels above 50 result in decreased tumor sizes in many patients, and in some cases reduced the Gleason score. I take 5000 IU a day, along with K2 and Magnesium, which should be taken along with that much Vitamin D. I also take Liposomal Fisetin.
Simple things I tell my brothers to do, since they are at risk, obviously, is to eat less meat, drink green tea, eat more cooked tomatoes and eat more mushrooms.
@@threeftr3349 My reply was apparently deleted as I tried to give some information that I thought might be helpful to you, though you may know it already. First, I'll answer your question, then try to give you the additional information, not in a reply, but in a link to other RUclips videos.
I appreciate your reply. My PSA was between 3 and 4 for a long time, but it would occasionally pop to 5.5 or so, then the next test would be back under 4. That continued from 2013 until 2019. Finally, in 2019 I got consecutive readings of 6.4, 6.7, and 8.3. Once it stayed over 4, I scheduled the biopsy, but it got deferred due to Covid, and was finally done in late 2020. In early 2021, I got a PSA reading of 12, and about that time I went onto Bicalutamide, and since then it has fallen steadily, and the last reading was 3.5.
They did an MRI first to decide which places in the prostate were most likely to have prostate cancer present. Three of 7 samples showed small tumors, one with a 3+3 Gleason score, and two were 3+4. I was assigned an Oncologist, and both he and the Urologist recommended active surveillance, but with the addition of Bicalutamide. As additional precautions, they checked me for DNA deficiencies (which I did not have), and then checked for Metastasis with a PET scan and a CT scan. Next the insurance was willing to pay for a bone biopsy of the two suspicious locations. The problem with a bone biopsy is that, while it can give you a positive reading, if you have cancer in the sample, you can never use it to prove that the cancer ISN'T there. It can only prove that it is not in that particular sample. I opted to pay for the PSAM instead in the hope of getting a firm negative, but sadly, it was also ambiguous.
At this point, I will probably not find out if the cancer has metastasized for a few more years. At some point, my PSA will presumably start going back up. At that point, perhaps insurance will pay for another PSAM, and hopefully I will get a better answer. If not, I will probably have the bone biopsy done, and if it is negative, depending the situation at that time, I may take a chance on having the prostate removed and hope the PSA falls to 0, showing that there is no cancer in the bones. Or, I may not. We shall see.
Good luck to you and your husband. Having prostate cancer is not the best thing, but neither is it the worst. Hopefully he and I both have a lot of good years ahead.
@@threeftr3349 Her is a link to a youtube video that I found useful related to Prostate Cancer: ruclips.net/video/IyPTNpj54S4/видео.html
And another: ruclips.net/video/7ppEtPi_ZHE/видео.html
Regarding the latter, fisetin is not readily absorbed, but there are liposomal versions out there that claim to have much more effective absorbtion.
Uologist visit in two weeks with recent PSA of 5.00. Thanks. I know more for my questions/discussion with my urologist.
1) MRI
2) PSMA/PET
3) With improved accuracy, a biopsy will be not as likely needed if 1+2 comes out negative, or biopsy needed if 1+2 is positive. I don't want a biopsy on a whim or due to lab negligence, etc.
How did it go?
Less Biopsies ....less $$$$$$$
Asked my urologists why no pet scan done, he said it was not a canidate for one. Talked to a radiation urologists and he ordered one. Will find out in march.
Fire your Urologist.
I mentioned this test to my urologist and he abruptly said no because I am not yet diagnosed
It's all about saving money for the insurance companies; sadly saving the patient is an afterthought...
Very nicely Done! And extremely informative! Sounds like we almost have it perfected ✈️👍🏻✅😊🇺🇸 just beginning my research with 5.7 PSA
Why is this not being done in the US?
I believe it has recently been FDA approved, maybe 2 years ago. Most insurance were waiting on some type of code or number. Especially Medicare. I recently had a PMSA PET SCAN for a bio recurrence etc,,,, I previously had radiation treatment. My PSA initially dropped pretty low, but only after 4 months, it raised rapidly
@@BigZWDThe name of the code is CPT (Current Procedure Terminology).
@@karimaogden3875Thank you
I had a PSMA PET Scan. But I do not know how to interpret SUV max value. Is SUV max value of 4.3 good or bad?
yes or no?
Not at 5,000$ a pop, PSMA PET SCAN IS AWESOME, When i hear biopsy, i think of Brave Heart, didn’t do that too him . mid evil medicine, 5 percent chance of Sepsis. HELL NO!