2021: PSMA and Prostate Imaging | Dr. Thomas Hope | 2021 Moyad + Scholz Mid-Year Update | PCRI

Watch the entire 2021 Mid-Year Update here: • 2021 Moyad + Scholz Mi...
Radiologist and nuclear medicine expert, Thomas Hope, MD gives a survey of the imaging modalities being used in the management of prostate cancer with an emphasis on the PSMA PET scan which was recently FDA-approved thanks in large part to the efforts of Dr. Hope at the University of California, San Francisco.
Thomas Hope, MD, is the Director of Molecular Therapy in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. He also serves as Chief of Nuclear Medicine at the San Francisco VA Medical Center.
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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better-individualized care. Feel free to explore our website or call our free helpline at 1 [phone] with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
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#ProstateCancer #PSMA #ThomasHopeMD

[@jamespmullin21753]

I had 16 PSA, was told today, I have prostate cancer. I knew days ago when I read my MRI and Biopsy results. This Friday i will have bone scan and CT scans of chest and abdomen. It took about 4 months to get my diagnosis. 4 months for the cancer to grow. During this time period my treatment consisted of solely foley catheter changes, no meds, no treatments. Biopsy was delayed by 2 weeks.

[@Freedom24560]

Why no PSMA pet scan?

[@daisuke6072]

I think another good use is where a patient is on active surveillance with low grade PCa following biopsy and the PSA begins to rise and is considering the need for definitive treatment rather than doing a further biopsy which is more invasive and in any event may not pick up metastases [albeit this is improbable in this diagnosis]

[@maebnus46]

This is an amazing very useful educational presentation. Thanks so much . I have had the 68Ga-PSMA-11 scan at UCLA , but my PSA was 0.5, with a low detection on a lymph node.

[@6bluestrings]

Thank you Dr. Hope. I watched this presentation as a layman undergoing this scan tomorrow. I found it very helpful and somewhat comforting. Thank you.

[@joycecw3531]

This presentation is timely. My husband diagnosed with Prostate cancer and is scheduled for Pet scan

[@jackierainey4117]

This explains a lot very well done for someone that is not a expert

[@roboodonnell3224]

Thank you folls for having this information available. You are much appreciated.

[@joeharris2074]

I just had a PSMA PET. Make sure you have good insurance because they billed my insurance almost 28k for it. Luckily, my insurance covered it but damn, know what you’re consenting to.

[@hodshonf]

Great video as usual. Good timing too; I have my first urology appointment on Monday in Seattle.

[@artmaltman]

Is anyone in the Northeast offering PSMA PET scan yet?

[@randygreen007]

It’s available at the Asheville VA medical center in North Carolina.

[@JustaReadingguy]

Remarkable.

[@kennelson3848]

Imformative...enlightening. Thanks

[@raybailey1651]

Awesome video. As a patient that just had a PSMA at Sloan’s this provided me with the knowledge I was looking for

[@JonnyTBooker]

Where is Sloan's? Do They Really have the PSMA PET CT Scan availability? (with the gallium) I have been told by Many Doctors that there are only two places in the United States that do PSMA PET/CT Scans both are in California UCLA and UCSF That would be fantastic if there are other options, as there is currently a 2 1/2 month wait to get a real PSMA Scan

[@raybailey1651]

@@JonnyTBooker it's memorial sloan kettering in New York.

[@dalegerberding9517]

@@JonnyTBooker My husband traveled to Ft Lauderdale FL in early August to PET Imaging Institute of South Florida for a PSMA PET (F18-DCFPyL).

[@mattnmoe]

@@dalegerberding9517 was this covered by insurance or medicare (if that is what you are on?) ?

[@dalegerberding9517]

@@mattnmoe It was not. I had Christian Healthcare Ministries, a membership program not insurance, and they reimbursed me for it. It was $5,600 (I am now in medicare age 65)

[@ovhome6841]

Very informative video! Hope the USA follows the lead of other countries and gives this an FDA approval for AS patients not wanting another biopsy and prefers this scan instead.

[@cchang2771]

Dr. Hope is with the University of California San Francisco (UCSF), a top medical center in the nation. Not the University of San Francisco (USF)

[@kevinvitale8980]

I am seeking out the PSMA/PET scan as we speak. I just got my PSA test after 6 weeks post prostatectomy. I have a .6 PSA. I need doctors to find where the cancer resides.

[@JonnyTBooker]

You may want to go out of the USA in Europe it is standard of care but very hard to get here

[@MacYYur4me]

@@JonnyTBooker follow up. I found a radiologist oncologist at another hospital with a PET scan. He found where my cancer resides and now getting treated with a focus. I can’t believe my medical network had no interest or fortitude to do this step. I had to get out of network.

[@cindybuell4059]

@@MacYYur4me where did you go? My husband has reoccurring cancer, with rising PSA.

[@kevinvitale8980]

@@cindybuell4059 The doctor I found is Brian Christopher Baumann @ BJC (Barnes Jewish Center) Radiation Oncologist in St. Louis

[@Freedom24560]

I brought up the idea of a PSMA Pet CT with my urologist, and he acted like I'd lost my mind. I guess he'd rather punch my prostate full of random holes. Thinking of getting a second opinion....

[@chunglee7531]

Thanks. We need more of similar, updated presentations for all human diseases. I figure this test will be too expensive to replace very ineffective PSA and office digital tests, but just wonder how much will cost a patient if he can afford to pay for it? Or where I can get the needed information?

[@alfonsobenitez8574]

Chung lee, you can avoid getting cancer. Just stop eating the the things that feed the cancer cells. Don't eat junk food, processed food, no red meat, pork. Eat wild caught fish, broccoli, spinach, cabbage, drink as much water, and try to install a reverse osmosis system. Check out A World without Cancer by Dr Griffin in KZbin. It will help you. I was told that I had cancer in may this year and i went on a strict diet, with the grace of God I am well.

[@chunglee7531]

@@alfonsobenitez8574 thanks. I am extremely aware and equipped with works by Dr. William Li and researchers on whole plant food etc.

[@alfonsobenitez8574]

Great! You take care.

[@deemika]

Dr Hope does a good job comparing the different imaging methods EXCEPT he said that approx 5% of prostate lesions will NOT be identified using PSMA PET but he didn't mention the percentages of prostate lesions not identified using the other imaging methods (MRI, CT, Bone Scan, and PET/CT). I think that would be important when comparing these different imaging methods.

[@tatianaschoenfield9819]

My understanding is that 5% of patients have PSMA negative prostate tumors meaning those patients’ tumors can’t be identified using PSMA 20:20

[@deemika]

@@tatianaschoenfield9819 Yes, that was my understanding as well. But my question was: what is the percentage of prostate lesions not being identified using the other imaging methods (MRI, CT, Bone Scan, and PET/CT).

[@solomonnyaanga610]

Very informative indeed and wish it was here sooner.

[@StanJarzabek]

most useful and timely, thank you! I have this question: Can I do PSMA PET scan after having the first shot of 120 mg ADT Firmagon? Does ADT interfere with PSMA PET scan? ill be grateful for answer

[@ThePCRI]

We are asking him! We should have a video out soon.

[@lavenderfrench1742]

thanks , good information and does Medcare Plan A and B covers this service? we are in not far from UC LA anyone have a good experience with this? thank you

[@ThePCRI]

Lisa, The commercial version of the PSMA PET scan (F-18 DCFPyl, trade name "pylarify" -- owned by Lantheus) is more widespread than the gallium-68 PSMA PET scan that is available at UCLA and UCSF, and it works just as well according to the studies that have been conducted. The website below shows where the scan is available. There is a phone number that you can call and they should be able to tell you how it will work with your insurance at the present moment. Hopefully, in the near future, it will be covered completely by all insurances. www.pylarify.com/ordering-and-reimbursement

[@lavenderfrench1742]

@@ThePCRI thank you so much, we are in Socal , not far from UCLA, but its so hard to get hold of the UCLA PSMA team, we called so many times , every times we had different answers for how to make an appointment, we are just ordinary Americans here, but we felt so hard to get anything done right , can you help us please?? I am so stressful and can not sleep over weeks after my husband's diagnose, thank you so much for reaching me out

[@PCarpe]

@@lavenderfrench1742 I am getting a PYL PSMA Pet CT Scan at SMIL here in Scottsdale. Mayo also said they would order one thru my Oncologist at Mayo but that it may not be medicare reimbursed. I received notification from my prostate oncologist that medicare does pay for the scan. Go figure.

[@kevinfagan16]

I've had recurrence in prostate cancer.I've Watched a vast majority of your video They are great and informative. Here in France the uptake of new technology is slow. Having just finished 37 radiotheraphy sessions.and prior to the treatment having had an unreliable not conclusive diagnosis for bone mets. Would PSMA PET scan clear up the doubts. As of now the urologist and oncologist treating me are on holiday the only guidelines were a prescription to have a PSA test, no time limit given. and when due, continue with the 3 monthly hormone treatments. Poor aftercare I'm sure you'd agree. What do you suggest ? many thanks for providing this site. Best regards Kevin

[@F8Tributo]

Kevin, Sorry no one answered your inquiry. I am a mechanic and electrical type of person, so take the following with a "grain of salt". But I have been doing some reading, and hope something here helps you. The root cause of biochemical recurrence is metabolic, which is the same reason for the cancer to occur in the first place. But instead of addressing the metabolic roots of cancer, the SOC ( standard of care) clips the dead leaves off the tree, so to speak, without making the tree healthy "from the roots" first. So "of course" there will be a biochemical recurrence. Read Dr Thomas Seyfried's book- "Cancer as a Metabolic Disease". The first thing that should be done with any early stage cancer patient is to put them on a tailored Keto diet. This reduces serum glucose, which removes one of the two energy sources for cancer cells (any type of cancer cell, anywhere in the body) The second and final source of energy for cancer cells is glutamine, which can be reduced through fasting. Even intermittent fasting helps reduce glutamine. Also, glutamine reducing drugs such as "DON" may used, when it becomes available. Reducing glucose and glutamine removes the fuel source for cancer cells to produce ATP thru fermentation, and the cancer cells become weakened. (Normal cells with healthy mitochondria are like "flex fuel" vehicles, making energy thru oxidative phosflorylation. They can use glucose and even make ATP with the ketones from burning fat, but cancer cells cannot, because of their damaged or mutated mitochondria) After the cancer cells are weakened thru this targeted "starvation", relatively small doses of SBRT or chemo may be used to further damage the cancer cells, without toxifying the patient. This is done gradually, to avoid dumping an abundance of dead cancer cells into the body, giving time for them to be eliminated naturally. The patient actually becomes stronger on the Keto diet. Contrast this with the emaciated patient receiving chemo, with their hair falling out and constant sickness. Then the hospital kitchen brings them a meal high in carbohydrates and sugar! Exactly the fuel that cancer thrives on! WHAT'S WRONG WITH THIS PICTURE? Reduce carbs to about 50 grams max a day, and reduce sugar to 5 grams max a day! Eat healthy fats like salmon, avocados, cruciferous veggies like cabbage and broccoli, real food! Stay away from processed foods. Doing this will weaken any type of cancer cell, slow, stop, and possibly reverse tumor growth. Then if further action is needed, radiotherapy or chemo can be used in a "one, two punch" to eradicate or manage a tumor. Dr Thomas Seyfried calls this the "Press/Pulse" method of cancer therapy. If the metabolic origins of cancer growth are not addressed, the proverbial "can has only been kicked down the road", and of course there will be a "biochemical recurrence", because absolutely zero has been done to address the metabolic environment of the body. Instead, after failing with radical prostectomy, the SOC moves to chemical castration, and after failing with that, the cancer has metasticized, and the SOC falls on its face again and then the patient dies. The SOC fumbles around with chemo, operations, etc, chasing cancer like they're herding cats. To ignore the metabolic origins of cancer is unscientific and obtuse, and harmful to patients that need help.

[@robertmonroe3678]

Not sure if PCRI experts or others can answer this but how commonly does Prostate Cancer NOT express PSMA. I had an initial staging PSMA Pet Scan here in NYC and there was no cancer related findings of any sort. Not even in the Prostate (wherein biopsy confirmed PC 3+4 with very little 4).

[@bmrbca3658]

If PSMA/PET is that accurate should they be done before a biopsy? Possibly avoiding a biopsy if the scan comes back negative?

[@ThePCRI]

It may be used that way in countries other than the USA or in the future, and it may be an option for someone who is willing to pay out-of-pocket for off-label use, but at the moment it is only FDA-approved for people who have been diagnosed with prostate cancer (typically via biopsy) and metastases are suspected, that is, a Gleason score 3+4 or higher.

[@Freedom24560]

I'm no genius, but it seems that a mpMRI combined with a PSMA pet CT would obviate a biopsy. The standard of care in the USA may be lagging a bit.

[@JudahKibalama]

But is this suitable for a cancer patient with RKF Renal kidney failure because the dye isn't filtered by the kidneys and it can be fatal

[@ovhome6841]

@JK what dr did a biopsy using your PSMA PET scan, was the biopsy done at UCLA?

[@mattnmoe]

PSMA PET scans should be allowed and covered by insurance for patients on AS even if low risk, yet considering treatment, rather than another biopsy. Is this already approved by the FDA?

[@ThePCRI]

It is only FDA approved for men with suspected metastases which would require a Gleason 3+4=7 or higher since Gleason 6 does not metastasize. It might be useful in men with low-risk to see if there is an occult tumor that is Gleason 3+4 or higher, but that has not been researched and MRI may still be better than PSMA PET in that setting; it is unknown at this point.

[@beerman204]

The doctor showed some residual pc after radiation because it was not originally seen. So now that it is seen after radiation treatment by PSMA....what can be done at that point?

[@JustaReadingguy]

27:07 here Dr. Hope explains the radiation treatment plan because of the detection. The now detectable cancer is now targeted with an improved outcome.

[@beerman204]

@@JustaReadingguy thanks for this. I hear him say the recurrance occured because of no psma detection. If they had psma detection before radiation treatment they could have radiated that area... and no recurrance. but I still do not hear him site current radiation protocol for recurrance due to missed radiation. Sorry if I'm being dense here!

[@JonnyTBooker]

@@beerman204 You are correct! there is no standard radiation treatment that can be done after the fact. If they had picked up on that area (through the PSMA test) it could have been treated in the original treatment, but because they missed it, unfortunately, they cannot just go back and radiate it again. (Your body cannot handle that much radiation) It is possible to do Lutetium 177 and maybe some other treatment...... That is why it is SO Important to know what is going on first and the PSMA Pet/Ct Scan is so great for that but if that's unavailable the next best thing is the MRI tesla 3 for prostate cancer ($500 or less for this scan)

[@user-xy5sd4fe7l]

@@JonnyTBooker "not going back for radiation is an incorrect statement..if you feel correct state , quote the DR that said that. EMRT, in IMRT or SBRT can be done. Dose can be adjusted..that is why there is 5 treatment ABRT, and IMRT in 28 or 45 treatments, and each of those has dose management within that treatment.

[@theeradejhonghiran6937]

Should the surgeon order PSM A pet before doing radical Prostatectomy ? Most surgeon don’t even offer that to patients. Why?

[@jkl6868]

I got my PSMA before I got HIFU.

[@JonnyTBooker]

You Should ABSOLUTELY get the PSMA PET/CT Scan (with Gallium) before either Radical Prostatectomy/Radiation or other treatments At the Very Least get a Tesla 3 MRI done this MRI is more accurate than a biopsy and the PSMA scan is better than that Also there are many other options ECT (Electrochemotherapy), Lutetium 177, Focal Laser Ablation (FLA), HIFU, Nanogold particle therapy, Photovoltaic, Cryotherapy, and several others I wish I would have known of ALL of these other treatment options before I did anything...... Great resource from other men that have actually done these treatments is inspire.com God Bless You and good luck :-)

[@JonnyTBooker]

Sorry I didn't answer "Why?" Most surgeons/doctors are just used to doing the treatments they are familiar with and have been doing for a long time.... If you really dig deep and do your research you'll find that there is no conclusive evidence that a Radical Prostatectomy stops the spread of PCa (Dr. Kohli, my doctor, at the Huntsman cancer institute has told me this also) You really should get a second and 3rd opinion before doing any treatment

[@jkl6868]

@@JonnyTBooker my 1st urologist just wanted to take it out! 2nd urologist wants to zap it! 3rd wants to freeze it.... lucky I joined the local cancer support group. Did my GALLIUM PSMA -11 test, and targeted biopsy from the psma results. Was going for HIFU at ucla, but ucla only offers spot treatment. Met a Px that had HIFU to treat his whole organ, with minimum side effects and the least invasive method among most procedures, happy that I did not jump and have the prostatectomy!

[@lavenderfrench1742]

did you finally go to UCLA get PSMA?

[@jamespmullin21753]

Is survivability tied to your location and hospitals? I'm in Bismarck ND, should I go elsewhere if I want to live?

[@snozcocram]

I would think so. The equipment and skill level I was privileged to costs millions, maybe tens of millions of dollars. Keck USC…

[@fatfrreddy1414]

Rising PSA is not a sign of cancer in itself..

[@colly3177]

Slow down the talking to quick t take in arrragh

[@Northwichita]

Click on settings on the player, playback speed can be changed to suit.

[@F8Tributo]

​@@NorthwichitaTthhhhaaannnk Yoooouuu!