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GALLIUM68 PSMA (Prostate Specific membrane Antigen) PET/CT SCAN.

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GALLIUM68 PSMA (Prostate Specific Membrane Antigen) PET/CT SCAN.  or


Having recently undergone the above scan due to the alarming rate of my PSA recurrence, and to perhaps qualify for a current Oligometastatic trial in Melbourne, I got, perhaps, more than I bargained for.

Hoping to identify possible activity in the para-aortic lymph node region, which has been mentioned since diagnoses (and later ruled unlikely), which then perhaps was able to be treated with targeted radiation.  https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363885

Indeed, this was found-“Malignant PSMA avid small left common iliac node,” but also “small or tiny left distal common iliac nodes (beneath iliopsoas muscle) {left hip} and enlarged left inguinal {groin} node.”  {red italics are my interpretations}

Unfortunately, it also identified four other sites of PCa activity in my bones, which puts me right into the metatastic club, not somewhere I wanted to be.

I personally am comfortable with what I now know, but suggest that this level of knowledge may not suit all who are travelling this path.


The Gallium68 PSMA scan, is, I believe the best tool I have seen for identifying areas of PCa activity with great accuracy, and is not limited to areas of bone degeneration, as is the current bone scan. However, until these areas can be treated in Australia (as in the above trial) as they have been able to in the US for the last 15 years, the knowledge is perhaps, wasted.

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Geoff, Thanks for posting your experience with the PSMA PET Scan.


As previously posted in these forums:

There are radiologists who will do stereotactic radiation without it necessary to be on a clinical trial (for example, Steve Cavill mentioned Dr Andrew Kneebone at Royal North Shore Hospital in Sydney); and

There are other clinical trials of stereotactic radiation apart from the POPSTAR trial that you mention (for example the TRANSFORM trial at the Epworth in Melbourne which is less than 5 mets).

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  • 2 weeks later...

I had a PSMA PET scan on 21 October at Peter MacCallum Cancer Centre in Melbourne.

The scan found a 1.5cm node in the prostate bed and a lesion on the liver, both of which

had not been detected by previous imaging.

All in all it came as quite a shock, and I can empathise with Geoffb's comments.

The prostate bed is to be treated as salvage radiotherapy (IMRT).

An MRI using a special dye confirmed prostate cancer cells in the liver lesion. This lesion is

to be removed surgically after I have finished the radiation treatment.

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  • 5 weeks later...

More to the above:


With consultation with Patrick Bowden (Radiation Oncologist)  and Ben Tran (Medical Oncologist) and after seeing a Liver Surgeon have come to the decision to treat the liver met  with stereotactic radiation at the same time with the prostate bed salvage radiation. (-am at present having salvage radiation  --37 sessions which finish on Xmas eve--- my Xmas present--)   Ben Tran wants a liver biopsy which will be on Monday 8th Dec before the stereotactic radiation so that the cells can be identified maybe for future gene therapy.

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You are lucky that you seem to have a competent team on your case.

I traveled to Brisbane last week last week for an appointment with my Urologist (who is all I have at the moment, apart from GP.) and was informed in no uncertain terms that although the malignant node has now been identified, it would change nothing. 

The only treatment I am to receive is continual Hormone Therapy until that fails, only then possibly palliative radiation and second line therapies.

In fact he became quite agitated when I suggested that had this technology (PSMA PET/CT) existed when I was diagnosed, the outcome of my treatment may be different.

I get the impression that the advent of this scanning technology is not welcomed by some members of the Urological profession, as it may inhibit their opportunities to perform surgery. (probably on a Gleason 6, who should be on watchful waiting)

However, until I, (and my GP.) get his written report (Takes about a month!) I am unable to progress further.

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  • 2 months later...

Thanks to all for the valuable information.  I have had similar reactions to Geoff when suggesting an alternative course of action.  My initial hormone therapy (Lucrin) post external beam radiation has now failed, and I am on Cosudex + Zoladex to see if that will control it, but I am not happy that we only seem to be delaying the inevitable, and not doing anything about fixing it.  Maybe I'm expecting too much of the medical profession ??  I intend to pursue a PSMA PET scan through RBH Brisbane to see where it is, as nothing has shown up on CT and bone scans yet.

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  • 7 months later...

Thank you for approving my membership and giving me the opportunity to make this post. I hope I've chosen the right forum.


I had a radical prostatectomy 15 years ago and radiation treatment 7 years ago after a small rise in my PSA.

In August this year my PSA reached 1.0 and my oncologist sent me for a bone scan and a PSMA/Pet scan.  The bone scan showed nothing but the PSMA/Pet showed up a few hot spots in lymph glands in the pelvic area.  No bone metastases thank goodness.

If I have treatment I have to decide between more radiation or surgery.  The radiation oncologist predicts no more than a 60% success rate and a 10% risk of further bowel damage (the radiation7 years ago apparently resulted in some bowel changes which showed in my last colonoscopy in 2011) from both procedures. Further bowel damage does have a small but possible risk of a colostomy bag according to the oncologist and that applies to both radiation and surgery (this I'm advised will be major surgery as they go in from the front and do the work right at the back below the spine).  Tomorrow I see the urological surgeon who did the initial surgery for his opinion so I'll know more then.  And then mid-October it's back to the oncologist to discuss the future

This PSMA/Pet (Gallium68) Scan testing is so new I've not found a single entry on Google about surgery/radiation treatment after it especially after already having had a prostatectomy and salvage radiation. Prior to that test if was impossible to pinpoint hot spots so hormone therapy was the only thing available (so I've been advised).

This will be a tough decision.  As I'm 67 one question I will ask is that with a PSA of 1.0 combined with my age is a third option no surgery or radiation?

Needless to say I'm very worried.  When I had the prostatectomy and the radiation there was a ton of literature, forums and support groups from which to glean imformation but as I said above, there's none that I can really find that relates to my current situation.

I would be interested to hear from anyone in a similar situation or links that might provide some information.

Thanks for reading.

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Welcome to the Australian Advanced Prostate Cancer Support Group.


Just a few weeks ago I faced a similar situation.

My PSA was rising.

PSMA scan showed active cancer (in the base of my prostate).


Surgery was very high risk.

Radiation, because of earlier, unrelated, abdominal surgery, was high risk.


My medical oncologist recommended systemic treatment with ADT (Androgen Deprivation Therapy, or hormone therapy).

I have just had my third Firmagon injection yesterday.


So that may be an option your doctors will discuss with you.




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Thanks, Jim.


I'll report back after the consultion with my urology surgeon today.

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Hi Darby,


I have recently had more stereotactic radiation , this time to my right inguinal nodes. ( these nodes are on the right side of the pelvic area and thigh area ) This showed up on a Ga68 PSMA scan when my PSA started to rise once again. Both my medical and radiation oncologist agreed on this path. This consisted of ten days of radiation ( about 15mins each time )  I have to wait about another month to make sure the PSA is going down again. It worked last time.....hope so again!


hold the line



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I have to wait about another month to make sure the PSA is going down again. It worked last time.....hope so again!




I hope so too, Terry.


I had my visit to the urologist who did my original prostatetectomy yesterday and he has advised against surgery.  He said it would be like looking for a needle in a haystack.  He also said the although the PSMA scan shows  some spots they could be just the tip of the iceberg as some things could still be hidden.  He said the best options are radiation because it covers a wider area or hormone therapy.  He also said the surgery would be major.


I got the impression that PSMA scans are so new that it's a diagnostic tool looking for a practical application.  The surgeon said there's very little literature or history yet and that's why I haven't been able to find much on it.


I see the radiation oncologist later this month so that's all I can do for now.  I will mention the "stereotactic radiation" which I've never heard of.  He did say last week that if I chose radiation, it would for six weeks (ie 30 treatments).



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Hi Darby


In what part of NSW are you located?   This may affect your options.

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Hello Paul.


Western Sydney so access to plenty of specialists and Nepean and Westmead hospitals as well as other Sydney facilities.

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In the last few years there have been significant developments in both the imaging of, and radiation techniques for, prostate cancer. 


Improved imaging techniques mean that metastases can be identified at an earlier stage.  Improved radiation techniques mean that these metastases can be targeted.


"Standard imaging techniques such as technetium bone scan , CT scans and MRI are usually  unable to see tiny recurrent tumors.  On the other hand, PET scans that work by exploiting various aspects of cancer metabolism, can often visualize and locate these small tumors.


Knowing the location of a cancer recurrence is important since recurrence in or near the pelvic lymph nodes may be amenable to additional curative focal therapy. " - Dr Fabio Almeida, Director, Arizona Molecular Imaging Center in the Prostate Cancer Research Institute Insight Newsletter February 2015, Vol. 18 No.1


"I think the concept of oligometastatic disease, which basically means limited metastatic disease, is very important.  If a man has metastatic disease everywhere, the disease is not going to be curable. But if one has a few well-defined lesions, the radiation oncologist can target these lesions with very little damage to the surrounding tissue ....... There is great hope for men with limited metastatic disease."
Dr. Reginald Dusing, a diagnostic radiologist at the University of Kansas Hospital in Dr “Snuffy” Myers Prostate Forum Newsletter Volume 16 Number 12.


There are a number of members of this forum (including TerryC and me) who have had cancerous lymph nodes in the pelvic area successfully ablated by stereotactic radiation.


You may wish to investigate using stereotactic radiation to treat the lesions on the lymph nodes identified by your PSMA PET Scan.  Because stereotactic radiation is so highly focused, there is a lower rate of patient-reported adverse outcomes and a high rate of oncological control than older forms of radiation treatment.


Whilst stereotactic radiation has been used for some time with other types of cancer, its use for prostate cancer is not yet standard treatment.  If having stereotactic radiation, in my opinion, it is important to choose a radiology oncologist who has significant experience with stereotactic radiation (for example, the radiology oncologists at the Peter MacCallum Cancer Centre in Melbourne have significant experience gained through extensive involvement in clinical trials).  I don’t how much experience your current radiology oncologist has had with stereotactic radiation.   You may want to get a second opinion from a radiology oncologist who is experienced with stereotactic radiation.


If such localised treatment of the pelvic lymph nodes is successful, you may be able to avoid systemic treatment such as Androgen Deprivation Therapy.  The side effects of Androgen Deprivation Therapy are not pleasant and, in my opinion, should be avoided if at all possible.


If you try localised treatment of the pelvic lymph nodes, it may not be successful.  As your urologist suggests, the spots on the lymph nodes may be the tip of the iceberg – you may already have micro-metastases circulating in your blood stream which cannot be seen by imaging   If localised treatment of the pelvic lymph nodes is not successful, you still have Androgen Deprivation Therapy available.


You mention that you had radiation treatment 7 years ago.  Depending the extent and dose of that previous radiation, it may not be possible to have stereotactic radiation to the pelvic lymph nodes.


Disclaimer: Please recognize that I am not a Medical Doctor and am not giving advice.   You should not rely on these comments in making decisions about your prostate cancer.  You should form your own views on these matters after making your own enquiries and research and after discussing them with the doctors providing your prostate cancer care.

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  • 4 weeks later...

Next step confirmed today - six weeks of radiation starting in December.  Things have certainly changed since I had a similar six weeks of RT 7 years ago.  Then it was just the appointment to have the tattoo dots then turn up for the daily treatments.


This time I have to have a CT scan two or three weeks before the RT starts (this after the PSMA/Pet and bone scans last month).  One week before the CT scan I have to have two sachets of Fibrogel each day with two litres of water.  This may have to continue right up to, and perhaps during, the the actual six weeks of RT as well.   This will be decided every couple of days as things proceed. 


The phone call today telling me all this has certainly put a damper on the day.  Certainly more complicated than 7 years ago.

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