PET Scan

Hello Cuthbert .

It is always worrying when the PSA starts to rise after treatment and we have been through this cycle 3 times since 2020. The scan your oncologist has suggested is probably a PSMA PET CT scan. Hubby has had 2 so far and they are extremely accurate in showing up where the cancer cells are in the body. It uses a tracer which specifically binds to a protein on the surface of the cancer cells and can be used when the PSA reaches 0.2 but is most accurate when it is above 0.4. It is a nuclear scan so you will need to avoid children and pregnant women for a few hours after you have had it. Hubby did not have to do anything to prepare for it and had no side effects afterwards, but was told to drink plenty of water to flush it out of the system. Also told to flush the loo after each visit. If you have any questions then please ask.

I recently had a PSMA Pet scan and was instructed not to eat anything for 6 hours before (but might be different for anyone who is diabetic) and to drink only plain water (4 or 5 glasses) during this period as well as not to undertake any strenuous exercise for 24 hours before the scan because you need to be as relaxed and rested as possible. These requirements were the same for other non-PSMA PET scans I had several years ago.

Specific instructions will no doubt be issued alongside the appointment confirmation.

The PSMA scan is a very good tool to identify any problem areas and a wonderful example of technology in medicine.

Wishing you al the best. Hope you don’t have to wait too long. WW

Hi Cuthbert and welcome, My PSA is also rising and had a PMA PET CT, no preparation required, you get injected with a tracer Gallium 68, wait 60 minutes, have the scan which take about 30 minutes, you just lie still, I have other health issues so I'm asked to wait 30 minutes before going home, PS the scan is 30% more accurate than other scans, best wishes.

Eddie

I have found this link which answers many questions about the PSMA PET CT scan if you are interested. All the best with it and hopefully it will only show local spread which is usually treated with salvage radiotherapy.

https://www.petimagingflorida.com/psma-pet-scan-faq/#hfaq-post-21692

Hi eddiel .

With hubby they used the F18 tracer as opposed to the Gallium 68 so I thought I would see what the literature says about them. From what I understand the F18 tracer is more sensitive at picking up recurrence, particularly in the prostate bed but does tend to show more false positives for bone lesions. With the Gallium 68, uptake in the bladder can obscure results in that area but can be improved if a diuretic is previously used. Like all things, there is a lot of research going on into how to improve detection.

https://www.nature.com/articles/s41391-023-00755-2#:~:text=Overall%2C%20%5B18F%5DDCFPyL,its%20predominant%20hepatobiliary%20excretory%20route.

The other thing to say is that neither tracer is 100% accurate as some prostate cancers do not bind. Also hormone therapy can interfere with the binding.

I see that the UK have approved the use of a F18 tracer this year, 3 years after it was approved of by the FDA in the USA. Some UK hospitals in the UK have already been using it but under the warning system because it hadn't gained approval at the time.

https://www.gov.uk/government/news/piflufolastat-approved-as-diagnostic-tool-for-adults-with-prostate-cancer

This may give more opportunity to use it at the diagnostic stage as well as the recurrence stage.

Hi AH the Gallium PSMA is definitely not prostate specific and there are false positives especially after RT, you really want an experienced radiologist on your case. You made me laugh when you said, you would read the literature on the tracers, I think everyone on the forum already knew that. Anyway how's life in Greece, is hubby's recovery continuing nicely and how are you and how did the night out to celebrate go. I hope you are both doing well, best wishes.

Eddie xx

Hi eddiel .

Oh dear. Am I getting a reputation as a real nerd?

Hubby is doing brilliantly 3.5 weeks after having SBRT. Energy levels are coming up, nausea greatly reduced and almost back to normal on what he can eat and drink. Belching reduced. Most importantly we are not having as many down sessions and they are of shorter duration. 

One of our favourite tavernas opened for the season this week so we had a lovely celebratory meal out with friends.

It must be a year for weddings - any plans made yet? Another set of friends have just turned up and announced that they got married in April after being together for 36 years - he is 79 and she is 72.

Hi AH,

It is great you both doing well and thank you for all the brilliant research and optimism. It does help beyond belief. 

Lots of love

Dafna