Imaging Alternatives For PSMA Negative

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0:21 What is the procedure for imaging the ~10% of patients where the PSMA scan doesn't work?
4:06 The situation is not common in most newly diagnosed patients
4:58 How effective is an Axumin PET scan when compared to a PSMA PET scan?
5:55 What other imaging alternatives to Axumin are there?
7:41 How effective are FDG and Choline scans in comparison to Axumin and PSMA?
8:48 Do patients need to double-check their negative PSMA scan results?
11:03 Is hormone therapy mandatory for patients in which PSMA doesn't work?
12:54 How useful would genetic testing be for a patient who is PSMA-negative?
14:29 How well can MRI help fill in the details about a patient's prostate cancer?
16:14 Are there any further alternatives?
17:40 Alex's conclusions
18:44 If you need more help
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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 at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.

[@colemant6845]

This was the BEST PCRI video to date. I am one of the PSMA patients with MUTIPLE PSMA Lymph node and Prostate indications of spread after Relapsed Radiation treatment. All subsequent physical biopsies (4) .. were benign.! Now a Guided Focal Biopsy of my Prostate is scheduled. I am so confused in this Process.... also as are my Doctors. I spoke with the PCRI network (Jonathon, amazing man) for advice. He helped greatly... But I will continue my treatment plan here (Metro Detroit) until I see concern. THANK YOU for being here!

[@TERRY-cb2ku]

Of course everyone wants a long life and to be cancer free. My MRI has shown an 8mm lesion in the left anterior portion of my prostate. Nothing showing in the lymph nodes or pelvic area. Highest PSA was 5.56 but after being treated with antibiotics, because of a uti, it dropped to 4.3. Haven't scheduled the biopsy yet. That will probably be in the next month or two. I keep coming to the comments section on this site to get a better understanding of the outcomes and consequences of various treatments for prostate cancer. I've come to the conclusion that there are no easy answers, 100 percent safe treatments or perfect outcomes. Sometimes it comes down to the question of quantity or quality of life and how to balance the two, or even if that's possible. I knew 15 years ago that I had "calcifications" in the prostate gland with imaging done by CT scans with and without contrast. Wasn't told to follow up with a urologist. So, I'm hopeful that what was seen on the MRI is benign or very low on the Gleason scale after having a biopsy. I'm 73 and still capable of sexual activity and would like to keep that ability a few more years by avoiding any treatment that would endanger that function unless absolutely necessary. This is my favorite site to get perspectives from experts in the field and for the real life experiences of those who are going through the process/treatments.

[@nelsonoliva2119]

Im 55 and 6 months post prostatectomy , had an aggressive cancer so chose to take it out which I know Dr. Sholz is not a fan of. Its been rough, I am just recently recovering urinary function id say I am at 90% which is a brutal side effect. Cant ejaculate anymore and erections are still zero even with 100 ml of viagra. I was very potent before surgery and my surgery was nerve sparing and still I am at zero. You are past a psa of 4 so I would get a psma scan to see if there is spread before you make a any decisions, if no spread you may just watch it and enjoy your few yrs. The biopsy btw is no picnic, I know ill never be the same after this process. I am happy to be undectable though at this point and pray that continues, but surgery is rough my friend, it is however better than leaving a growing cancer alone to wreak havoc. TBH I would have had a hard time leaving a tumor in my body. At the very least monitor psa. Cheers

[@stevehall8345]

I have a similar prostate history - MRI showed a 6mm lesion with a PSA of 6.7. Then, I did have a needle biopsy in May of 2023. 13 tissue samples removed. The 2 samples from the lesion area came back negative. Out of the 13 tissue samples, 1 came back positive for the slow growing (Adenocarcinoma) cancer, Gleason score of 7 (3+4). With this grade of cancer and the fact that it is slow growing - a few options were discussed with me, including active surveillance. I spent a couple of months researching other alternative treatments. Dr Scholz does speak about the importance of diet and exercise in slowing down cancer growth. There are also studies that indicate that certain supplements will not only slow prostate cancer but will cause it to "retreat". The Allicin in raw garlic , the capsaicin contained in cayenne peppers and the sulforaphane contained in broccoli and broccoli sprouts. I hope that whatever decision you make going forward is successful. Steve in Texas

[@TERRY-cb2ku]

@@stevehall8345 Thanks Steve. I know that not everyone has devastating effects from traditional treatments, but I have seen some terrible examples of it in people I know. From some studies I've read, it's about 50/50. A close friend of mine is in misery every day of his life, mostly from incontinence and frequent blockage, but he is also impotent from the treatment, amongst other side effects. I'm supposed to see my urologist at the end of the month to schedule a biopsy. Our little cancer center only offers trus biopsies and traditional treatments. I'm still researching the newest options but from what I've learned, none are offered anywhere near me and most of them are not covered under insurance. I'm praying that my results will show that I can leave well enough alone.

[@leonardola9161]

Wishing you the best. Im 64 and had 28 radiation treatments and i told my doc i still wanted a romantic life with my wife

[@MartinSmith-lx4kp]

I finished radiotherapy on my prostate gleason 3 plus 4 in December last year and have been on monthly ADT therapy since then. PSA test was undetectable. Due to ongoing side effects, I am considering stopping the hormone treatment early as my quality of life has been badly effected. As I have had seven months of treatment already, I am wondering what are the risks of stopping early. Bone scan before treatment showed no signs of spread. I would appreciate your comments on my dilemma. Thank you ,and many thanks for all the interesting and informative posts Dr Scholz.

[@stuartjordan525]

Hi, Great video (as always) thank you for the great content you are providing. I have a question about PSMA negative. Is that strictly identified when you know something is there and it fails to show up? Is there any correlation between PSMA negative and PSA? I am newly diagnosed with Gleason 3+4 based on MRI and targeted biopsy. My PSA levels have always been very low, latest was 2.16 this spring. My doctor postulates that I am in the small % of patients where PSA does not indicate the presence of cancer. So my question is, if I have low PSA and a confirmed cancer, does that mean that PSMA scan will not be helpful to analyze what's happening in my case? Thanks

[@suzannahwhite4292]

Excellent information, thank you. I tune in from the UK on behalf of my partner to ensure he's getting the best and most up to date information.

[@jeffmorgan5152]

I'm one of the few. Do we know anything more about psma negative cancer? i.e. does it present any other characteristics that would raise or lower concern regarding the level of aggression? any correlation to other information included in the decider grid report?

[@tonybegg7324]

I had a PSMA PET scan after an MRI showed a prostate cancer lesion and it biopsied Gleason 4+4. It delineated the lesion and I had no apparent metastasis. I have been on ADT pending radiation therapy. Does ADT reduce the sensitivity of the PSMA PET scan? Certainly my PSA now is virtually zero. I know PSMA and PSA aren't the same. I had a HoLEP operation and a HoLEP surgeon at the Mayo viewing my images believed the lesion was wholly within the adenoma which is what is removed in HoLEP rather than the surgical capsule where cancers are more usual.

[@bestaircraftdeal]

I was diagnosed with prostate cancer after PSA tested at 13.6 and confirmed with biopsy. Gleason score of 6. I. Later 2019 i underwent cyberknife radiation and over the next 2 yrs PSA came down to 0.08 which is insignificant. In mid 2022 my PSA went from insignificant to 11.4 by November 2023, i decided to get a PSMA pet scan which confirmed a new tumor in the prostate, a bone scan showed no mestatize however the PSMA showed molecules in volcal chords and lungs. I kept studying about alternative treatments , I started taking ivermectin 6mg 3 times a day every other day as I learned that anti parasitic medecines are effective against cancer cells anyway I also started drinking green tea and making citrus tea out of peels of lemon , oranges and grafefruit. A month later my PSA had only grown by less than 1 point to 12.4 compared to a super aggressive growth rate the months prior. Now May 2024, and my PSA is at 12.9 or just .05 growth in 5 months, ivermectin does not kill the cancer tumors but stops their growth and further development maybe its a fluke but its working. Ivermectin has no side effects and Ill keep taking it maybe upping the dosage to 4 6mg pills a day. Also worth noting of a new development post PSMA pet scan and that is Theranostics treatments, when PSMA pet scan identifies the molecules Theranostics treatment can be focussed to the tumor cell specicially and destroy it. I will be consulting with them shortly to see what is next. Anyway hope this helps anyone with prostate cancer.

[@jlu72665]

Hoping you're not taking ivermectin in place of the std of care for your situation. There are clinical trials involving use of ivermectin for PCa, but thus far, there has been no indication the off-label use results in any better outcomes that doing nothing at all.

[@xokissmekatexo]

@ThePCRI , New dx (my husband 58yr/old) + biopsy 4+3 on the left, PSA

[@robertmonroe3678]

Patients are routinely unaware of the detection threshold for PSMA PET and view a pre-surgery ‘clear’ scan as indicating there is no cancer beyond the gland. All the guys with rising PSAs and current ‘clear’ scans post-surgery know the PSA is not coming from the [removed] gland. It is the PSMA detection threshold at work. Fortunately, post-RP salvage is quite successful nowadays (see SPPORT) and is generally done when PSA is below the PSMA detection threshold.

[@sjamgo1874]

My husband is PSMA negative. Biopsy was Gleason 7/Grade 2 with Intraductal Carcinoma of the Prostate (IDC-P). PSMA PET scan done prior to prostatectomy and completely negative just like the patient of Dr. Scholz (nothing showed on the scan not even in the prostate). Bone scan done afterwards which showed no metastasis. Prostatectomy done one month ago and staging went to T3a, Gleason 9, Grade 5, Cribriform glands with necrosis, PNI, EXE. Lymph nodes, seminal vesicles all negative. Waiting to get into the RO in one month now. Thanks for the video on other scan options. I had read about FDG and Choline 11 but the Axumin PET was something I hadn’t heard of. Also made note of the cell free DNA blood tests and will be on the lookout for those if they aren’t offered. Thank you this has been very helpful.

[@DipalPatel-jr4lm]

Hi, My dad has exact same situation. His PSA rich to 0.19 and his urologist ordered PSMA pet scan and it was negative

[@dansjourneythroughprostate5665]

Informative, as always, and timely for me, personally. One thing I think you're getting better at is letting us know the shortcomings of PSMA PET scans, especially as it relates to the percent likelihood they'll detect something at varying PSA levels. (It might be a good video dedicated to the topic for each of the major scans.) I knew going into my first PSMA PET scan at UCLA in November 2021 when my PSA was only 0.22 ng/mL (in a post-surgery, biochemical recurrence situation), that there was likely a less than 35% - 40% chance that the scan would detect anything. It didn't. I went into my second PSMA PET scan 14 months later in January 2024 with my PSA at 0.37 ng/mL (after salvage radiation failed) hoping that it might pick something up at this higher PSA level. It didn't. My PSA on 1 May 2024 was 0.52 ng/mL and I have a meeting next week with my medical team to discuss what's next. But given Dr. Scholz's comment that, at a PSA of 0.5 ng/mL there's a 50-50 shot of the scan detecting something, I'm inclined to delay trying a third time until my PSA is at least above 0.7 ng/mL or, as he suggests, closer to 1.0 ng/mL to get to that 90% chance of success. My medical oncologist in February suggested we wait six months (August 2024) and do another PSMA PET scan then, especially if my PSA has increased. If the third scan doesn't pick up anything at the higher PSA values, then I think it would be safe to say that I fall into the 10% of patients for whom PSMA PET scans aren't of value.

[@RH-xd3nx]

Sir, looks like a positive upward trend. Did your team suggest Axium ?

[@dansjourneythroughprostate5665]

@@RH-xd3nx We meet next week to review the most recent PSA test. We'll definitely discuss alternatives.

[@FMFVeteran]

very interesting, thank

[@DCGreenZone]

I watched Dr. Tom Roger's video on artemisinin and fenbendazole.

[@derekhammonds]

Why is a PSMA pet scan off the table for G6 AS patients?

[@Nicko52784]

i was diagnosed with advanced prostate cancer. gleason 9, metastasized to pelvic lymph nodes 1 1/2 years ago. being treated with radiation and hormone therapy and secondary hormone therapy, my numbers are good, psa of .02. What is your opinion on my prognosis?

[@santoshkgupta9063]

Could a liquid biopsy test such as CTC (circulating tumor cell) aid in reassessing the PSMA-pet negative or any other complex case, or even for the monitoring treatment?

[@afshinPROF]

It seems I'm in a slightly different situation. I've just had BCR after RP (2017). Original biopsy and post-op pathology report both said my Gleason score is 3+3, but my recent PSMA scan showed what appears to be metastasis in a rib. Pelvic area was clear. I'm considering radiation and hormone therapy. I think this poses the the question: Will the innovation of the PSMA/Pet scan make us rethink the idea that Gleason 6 doesn't spread?

[@ThePCRI]

Hello, we are not able to answer case questions on our comment section but we can help you through our Helpline who can speak with you either by phone or email. Here is the link to contact them: pcri.org/helpline

[@ThePCRI]

Hello, here is a video on Gleason 6 that may help: kzbin.info/www/bejne/l2HWm4iXodGNh7c

[@charliepryer6026]

What is an FACBC pet scan?

[@Jdeneik]

I’ve had two Lymph nodes in my chest which PSMA has detected. I’m over a year out from chemo and I’m undetectable. My doctor in Oct wants to do a bone scan, CT scan. Why wouldn’t I be getting a PSMA again?

[@threeftr3349]

Ask your doctor, it could be insurance related, because they are cheaper test would be my first thought.

[@michael1704]

I just had a PSMA scan this week. The results showed a small amount of cancer in the prostate but no metastatic disease. Seven years ago, I was diagnosed with one core Gleason 3+3 and two cores Gleason 3+4. Genetic testing was on the borderline for active surveillance or treatment. My doctor and I decided on active surveillance (PSA test every 3-6 months). Mine has fluctuated between 5 and 9.4 due to acute and chronic inflammation. When I was first diagnosed I read through the medical literature and found a study on vitamin D and possible effects on prostate cancer. I started taking approximately 4,000 IU per day ever since. Can you please do a video on your opinion/understanding on the correlation of vitamin D and poster cancer. Another reason I have continued to take vitamin D is because of its effect on my mood/depression. It’s more effective than any prescribed antidepressants i have tried. Thank you so much for your informative videos. They have helped me immensely.

[@stevehall8345]

Fenbendazole has shown to arrest many types of cancers, including prostate cancer. Pls send me email and we can discuss what course I decided to take 10 months ago with a Gleason score of 7 (3+4).

[@jeffw8616]

Even with low or undetectable PSA after radiation and ADT, and a clean PSMA Pet, I read that the cancer might metastasize anyway despite good PSA results, so I want a regular PSMA Pet to be more certain. Is this a reasonable request? Annual?

[@ThePCRI]

Hello, our Helpline may be able to help you gain information regarding annual PSMA scans. Here is the link to contact them: pcri.org/helpline

[@ashishgaumat2686]

First tym I thought doctor not sure of what he is concluding, also concerned that how many tests one needs to do diagnose prostate cancer, psa dre biopsy mri bone scan ct and now pet scan also not 100% accurate, is it not better to not keep on testing and exposing to nuclear medicine, radiation invasive procedures, but live with the disease

[@mikeoniones667]

I had the actimin it cost 8000 dollars now using pmsa medicare only pays for 3 in a lifetime.

[@threeftr3349]

That is so horrible, limiting your healthcare in such a way, so they make more profit. You must have an advantage plan. Some independent Medicare certified insurance agents recommends getting an extra Cancer and Hospital indemnity plan that pays you cash for Cancer related care, and hospitalization when taking an advantage plan