Anyone know if the C11-Choline PET scan is available anywhere in Australia?

[stevecavill]

I'm curious to know if anyone knows if the C11-Choline PET scan is available anywhere in Australia yet.   I read about this scan at healingwell.com.  I have metastatic disease and am just about to start radiation to my prostate and SBRT to mets on my spine.  My urologist wants me to get a F-18 FDG scan , but it's not covered by medicare and I'm not sure it's all that useful.  The C-11 scan looks a lot more useful, but I can't identify if I can get it done anywhere in Oz.

Thanks, Steve.

[JimJimJimJim]

Steve

Sorry.

Only one site in the world is licenced to produce this product (Mayo Clinic, USA).

 

As it has an extremely short life, there is no chance of exporting it anywhere.

 

Perhaps other members can comment on best scans available to you.

Jim

[Charles (Chuck) Maack]

The C-11 Choline PET/CT is “only” available at the Mayo Clinic in Rochester, Minnesota….right now, no where else.  Added to having to only travel there is that Medicare and likely most insurers will cover the imaging, but will NOT cover the $7000 cost for the active C-11 choline product. 

 

A C-11 Sodium Acetate PET/CT is available in Phoenix, Arizona, but here again, though Medicare and most insurers will cover the imaging, they will NOT cover the $3000 active C-11 sodium acetate product.

 

Likely just as sensitive in identify locations of metastatic prostate cancer is the 18F Fluoride PET/CT, and this imaging is covered by Medicare BUT under the following conditions:

 

 

Info received from an oncology nurse….it appears that the 18F-Fluoride PET/CT scan, and I found on the internet also the 18F-FDG or 18F-NaF PET/CT scans, will be covered by Medicare ONLY as explained below

 

“Right now the only way Medicare covers an 18F PET (and PET/CT) is if it is performed at a designated NOPR (National Oncology Pet Registry) facility that has a grant to follow prostate cancer patients to collect data to hopefully get it fully covered in the future. The test is fully covered under diagnosis code 185, however, it will only cover those patients who have been on some type of  therapy (systemic like Avodart, proscar, casodex, hormones, chemo or radiation therapy, surgery) or has a suspected recurrence from a rising PSA and/or other markers or scans indicating suspicion of mets (bone or otherwise). It is NOT covered for those patients newly diagnosed with none of the above parameters met. Locally we send our patients to Imaging for Life, but there are nationwide Registries.” 

 

So, important to ascertain the facility you are to have the 18F-fluoride PET/CT is part of the NOPR.  From what I found, that facility will also require your physician to provide a letter of necessity explaining your treatment to date.  I expect other health insurers will base their payment under the same conditions.

 

More from http://www.cancerpetregistry.org/patients.htm ....

 

“What Patients are Eligible to Participate in the NOPR?
All Medicare beneficiaries who have Medicare as their primary insurance and are referred for a FDG-PET scan to evaluate a cancer that is currently not reimbursable (or specifically excluded) under Medicare are eligible to participate in the NOPR. Additionally, Medicare beneficiaries who are referred for an NaF-PET scan to evaluate proven or strongly suspected spread of cancer to bone are eligible to participate in the NOPR. Patients with insurance coverage other than Medicare (including those with Medicaid) are not eligible. Patients with managed Medicare health plans, such as Medicare Advantage, are eligible for the NOPR. 

Who Will Pay for the PET Scans?
The PET scans will be paid by Medicare. Co-payment costs or deductible payments will be paid by the patient or by the patient’s Medicare Supplemental (Medigap) insurance 

How is a Patient Entered in the Registry?
The PET facility must be registered to participate in the NOPR and the patient’s referring physician (medical oncologist, radiation therapist, surgeon, etc.) must agree to complete pre- and post-PET data collection forms that ask several questions regarding the patient’s planned treatment. The PET facility will enter the patient’s information into the registry database through a secure web site.

Who Will Have Access to Patient Information?
The PET facility must be registered to participate in the NOPR and the patient’s referring physician (medical oncologist, radiation therapist, surgeon, etc.) must agree to complete pre- and post-PET data collection forms that ask several questions regarding the patient’s planned treatment. The PET facility will enter the patient’s information into the registry database through a secure web site.

Additionally, patients will be asked at the time of the PET scan whether or not they consent to allow their data to be used for purposes of the research being conducted at NOPR. The referring physicians also asked to provide their consent for research use of the information, and for NaF-PET scans, the physicians who read the PET scans will also be asked to provide consent. The dataset used by NOPR investigators for research will contain only the data of patients and physicians when both (or all three in the case of NaF-PET) have consented to have the data included. Only members of the NOPR working group and NOPR project staff at ACRIN and the Center for Statistical Sciences at Brown University will have access to this individual patient data. These are the people who are responsible for making a recommendation to CMS on what types of PET scans should be paid for by Medicare. At no time will data that identifies individual patients be made public.“

 

 

Chuck

 

Disclaimer: Please recognize that I am not a Medical Doctor.  I have been an avid student researching and studying prostate cancer as a survivor and continuing patient since 1992.  I have dedicated my retirement years to continued research and study in order to serve as an advocate for prostate cancer awareness, and, from a activist patient’s viewpoint, to help patients, caregivers, and others interested develop an understanding of prostate cancer, its treatment options, and the treatment of the side effects that often accompany treatment.  Readers of this paper must understand that the comments or recommendations I make are not intended to be the procedure to blindly follow; rather, they are to be reviewed as my opinion, then used for further personal research, study, and subsequent discussion with the medical professional/physician providing prostate cancer care.

 

Always as close as the other end of your computer to help address any prostate cancer concerns.

 

"What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others."

 

If the suggestions/recommendations I have provided have been helpful, please consider a donation, in any amount you can afford no matter how small, to one of the prostate cancer research projects (your choice)  identified at http://www.StartACure.com              

 

Charles (Chuck) Maack - Prostate Cancer Patient/Activist/Mentor

2008 Us TOO Intl., Inc., Prostate Education & Support Network “Edward C. Kaps Hope Award”

2012 Prostate Cancer Research Institute (PCRI) “Harry Pinchot Award”  

Email: maack1@cox.net  

PCa Help: "Observations" http://www.theprostateadvocate.com/observations.html

[Geoff Buttfield]

I Believe in Brisbane that the FLUORINE PET BONE SCAN is available at both the Mater and Royal Brisbane. I have been advised (but have not contacted the practitioners to confirm) that for advanced men it is covered by Medicare in Australia. (Remember that Chuck's Info is for the USA). Given that there are 2 sites in Brissy, It is likely that there will be 2-4 at least in Sydney.

 

Geoff 

[stevecavill]

Thanks Geoff, is Fluorine the same as FDG?  I know there's also Sodium Fluoride.  The similar names is very confusing!

Steve

[Paul Edwards]

It's confusing, isn't it.

From Wikipedia

"Radionuclides used in PET scanning are typically isotopes with short half-lives such as ....... fluorine-18 (~110 min)......These radionuclides are incorporated either into compounds normally used by the body such as glucose (or glucose analogues), water, or ammonia, or into molecules that bind to receptors or other sites of drug action. Such labelled compounds are known as radiotracers. PET technology can be used to trace the biologic pathway of any compound in living humans (and many other species as well), provided it can be radiolabeled with a PET isotope. Thus, the specific processes that can be probed with PET are virtually limitless, and radiotracers for new target molecules and processes are continuing to be synthesized; as of this writing there are already dozens in clinical use and hundreds applied in research. At present, however, by far the most commonly used radiotracer in clinical PET scanning is fluorodeoxyglucose (also called FDG ), an analogue of glucose that is labeled with fluorine-18."

A Fluorine PET Scan simply means that the isotope being used is Fluorine-18(F18).

I've had a Fluorodeoxyglucose (FDG) PET Scan: the vast majority of scans are done with this sugar-like substance. As tumours use sugars to grow, it is useful for imaging a wide range of different tumours.

Following the FDG PET Scan, in order to get a better look at lymph nodes with possible metastases, the radiologist decided to do a Fluorocholine (FCH) PET Scan which is not commonly used. They were doing FDG PET Scans daily but were only preparing the radiotracer for the FCH PET Scans once a fortnight.

As I had both PET Scans as part of a clinical trial, I'm not sure whether Medicare in Australia covers these - I suspect not.

[DavidAbrahams]

Steve,

 

With respect to your initial query and Geoff's reply here is what I'm aware off. Qld X-Ray conduct the Sodium Fluoride PET Scan at the Mater Private. Cost is $350.00 but can be bulk billed in special circumstances. Not sure what portion Medicare would cough up or a Private Health Insurer. Seemingly it is 1980s technology that has been rejigged and enhanced for the digital world. The clarity and detail is meant to be way ahead of a NBS. I do believe many Medical Oncologists are aware off it, however your GP can make the referral.

 

Goodluck

David