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Research results: PSMA scan best to diagnose prostate cancer

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ProPSMA.thumb.png.808af18a552624d2db4967c5271074fe.png

 

Jim Marshall (not a doctor) said ...
Men ask: Why was my Gallium-68 PSMA PET/CT scan (PSMA scan for short) not covered by Medicare?
The answer is that the CT scan part was paid for by Medicare, but the newer PET part was not covered because it is so new that there is not the evidence showing that it was better than what came before.
We assume that will soon end, because the clinical trial has been done with patients in 10 Australian hospitals, and the results are in.
Thanks to PCFA CEO Jeff Dunn AO for the links in this posting. PCFA was a major sponsor of the trial.
YouTube video of Dr Michael Hofman of the PeterMac Cancer Centre, who led the trial, is on the post in our forums.
... end Jim
PCFA news release: PCFA MEDIA RELEASE - ProPSMA - March 2020.pdf
Financial Review article by Jill Margo:Australian Financial Review - Prostate cancer's new standard of care - 23 March 2020.pdf
YouTube video:

Bonus before/after pic:

43234436_Conventionalscanningvnewscanning.jpg.4ea23c0cb2dba7dfc00281deee8f8860.jpg

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Geoff Buttfield

Hooray...and none too soon. The much more accurate staging at Diagnoses or Progression can only lead to improved outcomes!

Unfortunately, even when medicare covers the out of pocket gap (currently $750.00+/-) it's unlikely to be backdated.😒

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Patrick Turner

Hi everyone,

I've lost count of PsMa Ga68 PET/CT scans I've had; maybe 7, and about $700 each, so about $5,000 cost including transport to get scans.

I was diagnosed in 2009, age 62, outrageously healthy, Gleason 9, with Psa 6, but inoperable, and so I had worse rated treatment of ADT + EBRT to PG which didn't do much, Psa went up.Full body CT scans showed nothing. In 2015 PsMa scans became available at Bridge Rd radiology place as directed by staff at Epworth. I had my first PsMa scan in 2016, Psa 6, and it showed PG was full of Pca, and it was feared it might spread locally. two small spots of Pca were seen each side of esophagus so I was first in Oz to get additional "salvation" IMRT at Epworth to PG, and to the two small lymph node mets, estimated to be 2mm dia. These would have been invisible to CT scan.

I also began Cosadex. Psa went from 6 to nadir of 0.4 in 5 months, and I thought Cosadex masked any effect the extra IMRT had, and I also thought any sort of X-ray type RT was likely to be useless because of failure of initial EBRT, but at that time there was not any better idea, and maybe salvation IMRT could work with men with wussy Pca, the easy to kill type. My Pca is anything but.

But my Pca had not spread to surrounding organs near PG. 

So I had a second PsMa scan before quitting Cosadex and scan showed more mets with 2 in bones. I began Zytiga which worked for 8 months

and a third PsMa scan showed many bone mets and more lymph-nodes and I began chemo which made Psa rise from 12 to 50 after 4 shots, so chemo was useless.

Yet another PsMa scan showed I had pea sized bone mets, and I was in serious trouble. Some bone pain. Not enough for pain killers.

I had watched the research going on at PeterMac about Lu177, and wanted this stuff even before I got Chemo, but it seemed I had to fail chemo to be able to buy Lu177 from Theranostics Australia who began operation in Perth in 2015, but in 2018, they has a clinic in Sydney.

I had 4 shots of Lu177 after November 2018, then another PsMa scan after 2 shots, and some Pca reduction was seen, not much, but After 3rd shot Psa started to go down, and I began Xtandi because docs thought this increased PsMa expression, and Psa went down to 1.7 after 4 shots Lu177, and a followup scan in August 2019 showed I'd had a good result from Lu177 and nobody said anything about doubtful results, or about mutant Pca that didn't have PsMa expression, or about FDG scans.

Last November Psa nadir was 0.32, and I began to feel entirely well. But since then Psa has crept up to 1.3, docs here got me to have CT scans that showed only 2 active small bone mets. I expect Psa is now about 5 because doubling time is a month, and I will ASK for a PsMa scan next Thursday when I see my oncologist. I has Psa test yesterday. I expect more mets to be seen. If I have mets that don't make PsMa, maybe these will be seen, or I may be directed to have FDG scan. So maybe I will have more Lu177, perhaps with small amount of Ac225 added.

But it all depends on whether I have enough PsMa avidity, ie, high enough Specific Uptake Value for Ga68.

The PsMa scan sure would have been good for me in maybe 2004 when I feel my PG may have begun, well before any of the slightest symptoms. So PsMa scan sure have removed all the silly guesswork used to treat Pca that was so common in past years.

This last week I cycled 240km. I did 82km last Sunday. I did a 25.2kph average for first 27km to cafe stop across town over a couple of hills.

I feel 27, not 72. So my body seems to be healing as the last years PsMa scan report suggested, but then there is some Pca that is generating the Psa that I see now.

Basically, I have been extremely lucky to last long enough with a lowish Psa < 12 before chemo, and <25 before getting Lu177, and lucky that the new theranostic treatment came to be so easily available here in Oz, and before I found myself in palliative care.

All this theranostic stuff should be Medicare funded, but it ain't, even though Govt can quickly find $84billion to get Oz through this virus challenge.

But I bet I won't see a cent of that dough, and interest on dough in bank has collapsed, and negative interest rate may be next where bank robs my account to pay ppl to get loans.

The virus trouble may interfere with Lu177 availability. I just don't know yet. 

During today's 60km cycle ride, roads had far less traffic than usual. Cafe was take away only. Self isolation is very easy for me, just normal life without a wife and any kids or grandkids, and lifestyle is mainly alone, even at Easter, Xmas, and got used to working mainly alone as a builder about 30 years ago, and in a second trade of electronics after my knees failed. I had both knee joints replaced in early 2017 when Psa was > 1 and there was the "window of opportunity" - best thing ever did. 

The PsMa scan is wonderful, but it did not see any of my mets until 7 years after diagnosis and I think they were there, but just small, and suppressed by ADT while it worked. A man can have countless microscopic mets and he thinks he is OK, but from little things, big things grow.

So ya gotta act fast on getting best treatment, and not worry much about the cost.

Patrick Turner. 

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