Calling Radgirl New Prostate Cancer Scan?

[bafanguy]

Calling Radgirl !! By "Rad", are you perhaps a radiologist ?

Do you have any opinion on the relatively new technology scan of the prostate to detect cancer: PSMA-PET scan ? From the link below, it seems it could be promising especially if treatment can be tied to it. I'd be curious to hear your opinion.

https://provisiondiagnosticimaging.com/psma-pet-for-recurrent-prostate-cancer-is-a-game-changer/

[BBK]

Men with confirmed localized prostate cancer where metastatic disease is suspected
Men previously treated for prostate cancer where disease recurrence is suspected based on rising PSA levels

BAFANGUY

The above is from the article you have linked. My understanding, not as an expert, is that it’s used to detect cancer previously diagnosed. Apologies if you were previously aware. I have some knowledge of the procedure so PM me if you’d like some info.

BBK

[bafanguy]

BBK,

Fortunately, I have no need for prostate intervention (yet) but a non-pilot friend of mine does. They suspect his previously treated cancer "might" be returning hence the PSMA PET scan.

Since the technology is pretty new (the facility told him they'd only been using it for ~2 years), I was wondering what other docs thought/knew about it. The people at this facility alluded to the potential for this scan replacing other diagnostic/treatment modalities. That remains to be seen. But any progress is important.

I've lost track of the number of guys I know (pilots and non-pilots) who've had prostate cancer. It's been informative and puzzling watching them each deal with it. There is a bewildering array of treatment options available. I'm just curious where this PSMA-PET might fit in that list of options.

This is the time of year where I get my PSA and digital so all this is fresh in mind. Apparently, I'm good until next year. :ok:

[Radgirl]

It is an honour to be asked, and no I am not a radiologist (no more clues!!!). This is a complex and fast moving field

The main interest is in initial detection of prostate cancer. We know early detection has a higher remission rate (although we do not know which method of treatment is best - robotic prostatectomy, HIFU, radiotherapy, combinations.....)

The issue is that with all current screening techniques we undertake major treatment in seven men unnecessarily for every one we help

So currently lots of different studies are going on. In London there is excitement about a screening technique using MRI. A pathfinder study showed it detected cancer and a formal study is now planned. PET has also been used but PET scanners are few and far apart, time consuming and costly. As the article says they are being used to follow patients after detection but this is still experimental as a modality, although that is not to say some doctors will recommend a PET scan for information

So at the moment we are no further forward. Guys have a PSA annually so you develop a baseline and can identify a rise - the same as you do with a particular engine - each engine may have different Ts and Ps but if you know what they are you can detect it going wonky earlier. If your PSA does go up, dont panic but see someone who only treats prostate cancer, sit down and talk about your options. However I think we will see significant advances in diagnosis in the next few years

Finally remember most men over 60 die with but not from prostate cancer. The challenge is to identify which ones need treating and which dont.

[bafanguy]

Radgirl,

Thanks for your input. I was really hoping you were a radiologist. So, you're just radical ?

My friend took a long series of biopsies (there's a fun morning) and radiation doses to knock down his prostate cancer. They had it whipped for a couple of years but his PSA went from 0.5 to 2.5 in about a year and a half. So...his docs suggested he get this new PET scan. He's still waiting to hear the results.

There are a number of things that can raise the PSA so he'll have to wade through those to avoid more unpleasant diagnoses and treatments.

We're reaching the age where the wheels start to come off. Just trying to understand what to do about it. :confused:

[RatherBeFlying]

I have declined including PSA in my periodic bloodwork and my doc is good with that. Prostate cancer is not a factor in my male line – YMMV.

My stepfather in his eighties with a number of conditions was operated on for prostate cancer and came out even more frail. He was gone not that many months later. The op shortened his life and added misery to his final months.

It's of course a very different situation with a family history of men in their fifties taken out by prostate cancer.

[BBK]

BAFANGUY

I wish your friend well. It’s a worrying time for sure so hope he is treated well. Re the PSA test my understanding is that it can be unreliable in both senses. A high score doesn’t necessarily mean one has prostate cancer and a low score does not guarantee that cancer is not present. This is, I believe, a fundamental problem with the test in that it does not directly detect for cancer but provides an indication that may be useful in determining if further tests are required such as MRI, template biopsy etc. For what it’s worth my own Aviation physician thinks PSA tests should be given to every man over 50 and younger if there is a family history.

The PSMA PET scan you asked about involves an injection of a radioactive isotope that will, if present, attach itself to any prostrate cells present. For a patient that has had a radical prostatectomy there shouldn’t be any cells because the prostate is now in a jar in some hospital having been sliced and diced to analyse the extent of the cancer within it! I believe ten percent is a typical value. What the scan provides is a cross sectional image where prostrate cells appear a different coiour to the surrounding tissue. Hence the PET scan is a useful tool in aiding detection but is not part of the treatment as such.

Anyway, happy to be corrected by Radgirl or anyone suitably qualified. This isn’t a clear cut issue - no pun intended!

[BBK]

I have declined including PSA in my periodic bloodwork and my doc is good with that. Prostate cancer is not a factor in my male line – YMMV.

My stepfather in his eighties with a number of conditions was operated on for prostate cancer and came out even more frail. He was gone not that many months later. The op shortened his life and added misery to his final months.

It's of course a very different situation with a family history of men in their fifties taken out by prostate cancer.

RBF

I’m very sorry to hear that about your stepfather. One doctor said that as a general rule surgery might be better for a patient under 60 where they are able to recover from the impact of the operation. Over 60 then maybe radiotherapy is better. So many things to consider and the information available can be contradictory.

[bafanguy]

BAFANGUY

I wish your friend well. It’s a worrying time for sure so hope he is treated well. Re the PSA test my understanding is that it can be unreliable in both senses. A high score doesn’t necessarily mean one has prostate cancer and a low score does not guarantee that cancer is not present.

The PSMA PET scan you asked about involves an injection of a radioactive isotope that will, if present, attach itself to any prostrate cells present. What the scan provides is a cross sectional image where prostrate cells appear a different coiour to the surrounding tissue. Hence the PET scan is a useful tool in aiding detection but is not part of the treatment as such.


BBK,

Yes, the PSA is just a heads up for potential prostate cancer and there are several benign(even normal)reasons it might be elevated.

What makes the PSMA PET so intriguing is its potential for being a treatment mechanism by delivering cancer-killing agents directly to the prostate cancer itself. That would sure be a game changer but much more needs to be done to make that happen if it even can happen. The medical people where my friend got his PSMA PET were very encouraged at the prospect.

The males on both sides of my family lived to be absolutely ancient. While many may have died with prostate cancer (if the possibility was even considered back then), none of them to my knowledge died of it. Sure hope the stats mean something for me. :ok:

[BBK]

BAFANGUY

I wasn’t aware the PET PSMA procedure was being looked at in that way. That would be a welcome benefit. I hope your own PSA stays suitably low!

In the UK I think the incidence of prostate cancer is something like 1 in 8 overall and for Afro-Caribbean men even worse at around 1 in 4. The ongoing research will hopefully lower these numbers.

BBK

[tdracer]

A sudden jump in PSA doesn't mean you have prostate cancer, but it's a good indication that further investigation is in order.
In my case, my PSA had been really low for ages, then suddenly jumped in one year. While the actual number wasn't that bad, the sudden change worried my doctor who sent me off to a specialist.
Yep, a biopsy showed cancer - only one sample came back positive, but the Gleason score was 8 (scale of 2 to 10), which was very worrisome.
Treated with focused radiation - both external and radioactive 'seeds' implanted into my prostate. Not fun, and the side effects stink (I have to urinate way more often than before). But that was six years ago, and every indication is that the cancer is gone - hopefully not to return.
Ultimately, around half of all men end up getting prostate cancer. Many men die with prostate cancer, relatively few die from prostate cancer.
Most don't require active treatment - monitoring to make sure the cancer doesn't expand, or spread is all that is needed. But sometimes the cancer is aggressive and doesn't bother to stop with the prostate, and spreads to the surrounding tissues and organs. That's when people die.
Sticking your head in the sand and pretending it won't happen to you is not a good plan.

[bafanguy]

BAFANGUYI wasn’t aware the PET PSMA procedure was being looked at in that way. That would be a welcome benefit.

BBK,

Yes, they're looking at the therapeutic potential. This from the linked article:

"While researchers are still studying the therapeutic capabilities of the radiohybrid tracer, the potential is very promising. First, using a diagnostic radioactive isotope like Flourine-18, the radiohybrid tracer would latch onto cancer cells, revealing their location in the body. Then later, using a therapeutic radioactive isotope like Lutetium-77, the same tracer could be injected, this time latching onto those same cancer cells and attacking them with radiation."

It would be a real breakthrough if it comes to pass.

tdracer,

Yes PSA "velocity" is a real sign that more info is warranted. I've gotten a real education watching many of my friends deal with this.

[BFSGrad]

Many men die with prostate cancer, relatively few die from prostate cancer.

Sticking your head in the sand and pretending it won't happen to you is not a good plan.
Some mischief hiding in the word “relatively.” In the U.S., prostate cancer is the #2 cause of male cancer death and has about the same death rate as breast cancer for females.

As for sticking your head in the sand, after (and during) your first prostate biopsy, you will be paying attention. The ultimate attention getter.

[Nightstop]

There is a new predictive blood test for prostate cancer, it’s called a PSE test by Oxford BioDynamics PLC. Apparently it boosts the accuracy of the PSA test from 55% to 94%. It’s supposed to be available in the USA and the UK, but I’ve been unable to find any UK medical professional willing to facilitate the test for me (a non UK resident). Anyone know of one that does?

More details of the PSE test within the link www.94percent.com (http://www.94percent.com)

[tdracer]

Some mischief hiding in the word “relatively.” In the U.S., prostate cancer is the #2 cause of male cancer death and has about the same death rate as breast cancer for females.

As for sticking your head in the sand, after (and during) your first prostate biopsy, you will be paying attention. The ultimate attention getter.
The number of men who die from prostate cancer is relatively low compared to number who get prostate cancer (like I said - more than half). Further, the cure rate if detected fairly early is very, very high.
Most of the men who die from prostate cancer are the ones that bury their head in the sand and never get checked. I agree, once you get to the biopsy stage, it's pretty hard to ignore. Problem is mainly the guys who don't bother getting their PSA/Prostate checks. By the time the prostate cancer symptoms become impossible to ignore, it's too late.
I once told my Urologist that I didn't like seeing him - he kept doing very unpleasant things to me. He laughed and said he'd be a bit worried about me if I didn't feel that way...