Interesting dilemma but think the oncologist has it right. Salvage to pick up everything, a PSMA PET may not pick micro mets anyway so my personal view would be to hit the lot in one go. I do find it interesting how the ‘experts’ have slightly different takes on treatment. Hope this helps. David
Hospitals work so differently, my PSA is rising after HT/RT, I asked if I could go back on HT to control the rise , my teams response was that’s fine , however you will need a pet scan first before we do that . It would be interesting to hear their reasons why they wouldn’t give H a scan before , unless they are certain what area to treat ..
Hi Tony thanks for replying. They said that in their opinion as it was found that it had gone into the margins when they removed the prostate extra tissue was removed but they believe that some has unfortunately been missed and it will be in the prostate bed . They will do the whole pelvic area to make sure they get it all.
Thank you fir replying. Just worried they will treat the whole pelvic area with the possible side effects and it maybe somewhere else. Maybe I am over thinking it !
This depends on lots of things. PSMA PET scans are a limited resource, which means they can't do it for everyone, and it might involve a long wait to get one. They may already know the likely cause from the pathology report, and from the profile of the PSA tests. The most common cause is cancer left in the prostate bed, if PSA went very low after the prostatectomy but then rose. However, a trial did show that a PSMA PET scan did result in around 2 in 5 cases of salvage radiotherapy having their targets modified in the light of the scan result. A PSMA PET scan really needs a PSA of 0.2 or 0.5 (depending on the scanner) to have a 50% chance of showing anything at all. This can mean weighing up the risk of waiting for PSA to get high enough, versus the risk of further spread during that time for the majority of cases where it is just in the prostate bed. If a PSMA PET scan found something significant further from the prostate, curative treatment might not be offered, whereas if prostate bed is treated and only later a hot spot is found further away, it might be treated with curative intent at that point (double-edged sword).
