PSMA & Newly-Diagnosed

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0:48 What is a PSMA scan and what is it used for?
1:51 What are 3T and 1.5T MRI's?
3:00 Can PSMA scans be used to guide targeted biopsies?
3:50 Are PSMA scans ever approved for early stage disease?
5:13 Are there situations when a 3T MRI is used instead of PSMA?
7:47 Can PSMA scans be used to shorten the course of hormone therapy?
10:15 Do patients ever forego hormone therapy after a PSMA scan?
11:29 How is PSMA monitored in someone foregoing hormone therapy?
12:50 What exactly does it mean to be "cured" of prostate cancer?
13:36 Do PSMA scans work for every patient?
14:43 Can those who PSMA doesn't work still forego hormone therapy?
16:28 Alex's conclusion
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[@texasrider5621]

Alex, you ask a lot of great questions doing a good job keep it up

[@mikesimons1544]

Thanks for key insight at 6:24, insurance likely only "approves" PSMA if did biopsy, MRI not good enough. Well I can afford it. Will gladly pay if not cancer, they pay if it is.

[@dw566]

Extraordinarily useful, state of the art information! What a gift your videos are to those of us dealing with prostate issues. It pains me to think that most men do not have the significant advantage of considering the knowledge and treatment protocols outlined in your videos. Thank you Alex & Dr. Scholz. A donation is headed your way.

[@bestaircraftdeal]

I just got my PSMA Pet scan at UCLA it's a very expensive test, in Florida they wanted to charge me $124000 at UCLA I paid $6300. Insurance usually won't cover it because of the cost, I'm self pay. The results were amazing, I had prostate cancer with 3 tumors in 2018 I opted for Cyberknife radiation in Miami, which is 5 days of high intensity radiation using markers in the prostate. It took 2 yrs for my PSA to get down from 13.6 to .85 . Then this yr my PSA started climbing and back to 6.7, so I decided to do the PSMA scan . The results were a new tumor in the prostate and no metastasis however the PSMA showed up in salivary glands, hepatic lobe and thoracic aorta, so this test can show potential of new cancer or whatever I'm not a doctor. Anyway, I would highly recommend this scan so you know what is going on and potentially coming up and get appropriate treatment.

[@robgerety]

Pretty sure medicare covers it.

[@robertmonroe3678]

There are some typical locales that will turn up as positive in a PSMA but NOT actually indicate prostate cancer. The very experienced radiologists know these areas and will indicate appropriately on the report.

[@Rockinrn]

I have Cigna Medicare advantage insurance. Had a PSMA PET scan. My cost was $150.

[@iamric23]

bestaircraftdeal,are you comfortable sharing what the final outcome was?

[@bestaircraftdeal]

@iamric23 yes finishing up my last few days , took my PSA today and will have results Monday so let's hope it had some effects

[@joethecomputerguy1]

Diagnosed with Gleason 7, 4+3 GG3. Getting a PSMA PET next week. Then I can make a decision on treatment. Thanks for the team on the phones helping me through this process.

[@barrie888]

great stuff as usual and clearly explained ,a Dr. here

[@robertm7637]

Your videos are so informative and helpful. Thank you

[@edwardbertorelli7358]

Thanks for your presentation.....had a MRI guided biopsy then a PSMA PET scan ..a small tumor on right side of prostate non metastatic 4+3 unfavorable intermediate...just finishing up a 44 course of radiation plus on 6 months of darolutamide as part of the Intrepid study..in working with Dana Farber ... I'm on Medicare

[@toddhupp]

Thank You. Thank You. Amazing this info arrived for me as I decide on treatment. Being pressured for surgery or radiation but focal may be fine.

[@StarExplorer123]

I would like to request a video about the differences between the various PSMA PET scans. Some are Gallium-68 but many others are F-18 (Florine). Age is 73. I had urinary symptoms very much like BPH. My pre-treatment peak PSA was on 3.9 and the last one (before treatment) was 3.7. My urologist wanted to assess the true size of my prostate which seemed only slightly enlarged. DRE from both GP and urologist negative. An MRI was ordered. Prostate was only 42 ccs, slightly enlarged; however, the 1.5 Tesla MRI resulted in a PIRADS-5 finding. Ensuing systematic biopsy found cores 70% and 80% carcinoma on left side; right side of gland clear. Later, a F-18 PSMA PET scan revealed no spread, but the cancer barely showed. A quote from the findings: "Subtle left peripheral zone prostatic uptake at 4.4 SUV max". Interestingly, the scan showed many other features of my body that were thankfully free from apparent disease. From what I have read and heard, Gallium scans are the best because they have much more contrast. But Gallium-68 is hard to get. In southern California, UCLA is the only medical center to provide Gallium. I listened to numerous talks on KZbin about PSMA PET scans but the speaker does not make clear which kind of scan. Please make a video explaining the value of all these various PET scans. Thanks...

[@cabacronulla]

Hi there from Australia..Recent diagnosed with Intermediate Contained cancer with a Gleason 4+3 and PSA 6.3..Biopsy showed 3 Positive Cores. Urologist wants to do full Radical Surgery Removal.Im 64 n Fit n Healthy..This was an absolute shock and im struggling to deal with the situation..The radiation Oncologist said 5 weeks of daily Radiation and Hormone treatment..My main concerns are of course Side Effects and ReHab.. Cheers, Thanks.. Love your Insight.

[@db_carguy4833]

I had a similar diagnosis from my Urologist about radical surgery, however I am returning to Sperling Medical in Del Ray Beach Florida whom is a specialist in 3T MRI and targeted biopsies, and focal laser ablation. He said he had a 90%+ success rate of no side effects. I am going to proceed with focal laser ablation next month. The process is repeatable if micro metastases occur down the road. Radical prostatectomy was way beyond what I was ready for.

[@asanabri]

@@db_carguy4833 Hi there. I have a similar diagnosis and recommendation from urologist (Prostatectomy). What is your experience with Dr. Sperling? I am considering consulting with him. Thanks in advance.

[@markn3586]

Do you mean an ultrasound ablation procedure? I've heard of a TULSA procedure which is ultrasound ablation or are you talking about something different.

[@cabacronulla]

@@markn3586 Hi Mark.. Ended up having SABR Radiation Treatment..Just 4 treatments over 2 weeks.. PSA test 3 months ago -3.2. Results from latest PSA test due to day.

[@TOOFERMAC53]

So why don't they just order psma pet scans before biopsy I just don't understand why I do understand because it's a big money game and a big Insurance brawl

[@RADLADRICK]

@@TOOFERMAC53 really my thoughts exactly. I just did a third biopsy Then I’m told I need to do this test

[@MIKEG-g1g]

The biopsy is done prior to the PSMA because insurance companies want a prostate cancer diagnosis before they’ll pay for the scan. He explained this.

[@RADLADRICK]

Ok thank you

[@tomjgrant]

excellent. Thank you

[@Gary-e6y]

Thank you for the information - I'm new but all of your videos have blessed me abundantly. Thank you.

[@aidanmiller4595]

Thank you Dr. Scholz and Alex. You provide a priceless service to the community. I have had my 2nd prostate biopsy of 3+4 confirmed and a slight increase in size of the left side tumor. The right side and most of the prostate shows that it is 3+3 or benign. I just had my first PSMA pet scan at UofM Ann Arbor yesterday as a precursor to brachytherapy treatment and don't understand the results summary. It summarizes that the state that overall is normal but then has a statement about rib area possible pirads 3. The three past prostate MRIs show containment in the prostate gland. The recent fusion MRI confirms this. My PSA has risen from 4 eight years ago to 11.4 today raising suspicion by my oncologist of possible spread. We have decided to go forward with brachytherapy soon. My UofM brachytherapy physician is going to treat the entire prostate even though there is only a legion on the left side where the right side appears to be completely benign. Just don't understand why not leave the other benign side alone.

[@andrefuentes2320]

Excellent intervew!!

[@joemurone4898]

What are your feelings on using Fasting & Diet for controlling Prostrate cancer.

[@crankyneanderthal6784]

When halting ADT and then relying on PSMA PET scans to detect any future metastatis is there any advantage getting scanned on new 2nd generation high resolution PSMA Scanners (Quandra) which are 10 times more accurate (?) than first generation PSMA PET scanners? I am Gleason 4+5 with low level mets to distant lymph glands. After treatment with ADT, Chemo and radiation I have had undetectable PSA for past 6 months, If and when can I drift off ADT? My oncologist said never! After being diagnosed with PC, PSMA PET scans are free in Australia.

[@GalaxyCat001]

They are not free. Medicare will pay for a few but more than that or more than a certain number in a period & you would have to pay. I was quoted $750 for a privately paid psma pet scan in Aus.

[@bunyipal]

@@GalaxyCat001 I was diagnosed in 2007 treated in 2008 Gleason 9 (5+4) PSA 17 18 Months ADT then Bracytherapy followed by 5 weeks external beam. For the last 12 Years PSA below 0.8 . Over the last 18 months PSA has risen to 5,5. Just undergone a free PSMA PET scan in Hervey Bay, two spots have appeared right lung. However the prostate is free of any PSMA indicators. Waiting on the Urologist in Brissie for his report. Cheers Glenn.

[@GalaxyCat001]

@@bunyipal When did you 1st detect a rising PSA and how big are the spots? Will you be going for another round of hormones therapy. Apparently you can get 3 free psma scans, after that, currently, you ave to pay.

[@bunyipal]

@@GalaxyCat001 Hi, I have only just read the radiology report through my GP I am currently waiting on a response from my Urology clinic at the Mater, I will update further as it comes to hand. The PSA started to rise more rapidly over the last 12 months. as for the two spots one is app 1cm and demonstrates mild PMSA and the other smaller one does not. Cheers Glenn.

[@JasonRoberts556]

Newly diagnosed with PC 3+4, PSA 22.9, no spread, 18mm tumor (was 9mm on MRI, but with PSMA PET, Pelvic CT, & Biopsy Pathology) the interventional radiologist seems to believe that the lesion is actually 18mm NOT 9mm. In addition, the cancer is “very close” to the external urinary sphincter. My treatment options are limited, so I am considering doing nothing at the age of 42.

[@johnmchale8308]

why would you consider doing nothing? Sorry to hear

[@JasonRoberts556]

@@johnmchale8308 what’s the point? To continue going through cancer treatment for the next 30 years? Miserable? Versus living another ten happy?

[@edwardkirby7679]

​@@JasonRoberts556I am 63, in excellent shape (besides the PC diagnosis), with an 8 (4/4). PSMA PET showed no metastasis yet. I, too, am looking for something other than what seems interminable treatments. . . for the rest of my life. ADT is, I have read over and over again, horrendous--with equally horrible "consequences." Surgery leaves a man incontinent and impotent. The radiation is a slow impotence onset. This a seemingly no-win situation, with the only "winners" the medical community and the insurance companies. So I am seeking some kind of HOLISTIC ALTERNATIVE. I implore you, my brother, to do likewise!!! -EK, Phila., PA

[@bjhelder]

What about using PSMA PET for Active Surveillance? Rather than additional biopsies

[@ga6589]

My husband's Mayo Clinic oncologist has told us that another PSMA PET scan would only be done if his PSA starts to rise. He's been in remission for over two years, with a negligible PSA. PSA rechecks are done every 3 months. (Initial diagnosis: Stage 4, low volume. Treatment: 26 rounds of radiation and continued ADT therapy.)

[@hn5460]

This is a good idea. You should go for it if you can afford the cost. Keep in mind that they will do a CT scan at the same time too, so you can have both images at the structure and molecular levels to gauge the progress of the cancer.

[@samirkumar4031]

I'm 51, based out of India, My PSA is 13.7 and Gleason score 7, 4+3, Doctor advised to go for Robotic prostatectomy, Next going for PSMA scan on 30th Dec. what are best options for me.

[@toddhupp]

OK. Would beam without the hormone be acceptable for a contained tumor?

[@robwells230]

It should always be the patients decision, not something dictated by the doctor alone, unless you are being treated like a concentration camp inmate, like the ALBERTA CROSS CANCER INSTITUTE treats us. Be assertive and demand some say in your treatment, or fire your doctor. If you have serious health issues like a heart condition, you may well decline their ADT CASTRATION and avoid its quality of life destroying horrific side effects. Carefully weigh benefit vs risk and demand full disclosure so you can give FREE AND FULLY INFORMED CONSENT

[@edwardkirby7679]

Yes, one of the questions I have also. ADT (hormone therapy) is, according to many, many men who have had it, horrendous. Tantamount to a kind of physical-mental-emotional torture, something out of the old Soviet-era prison camps.

[@fabish22]

Thanks again for the invaluable information. I'd like to hear Dr. Scholz weigh in on the 2023 Japanese study conducted by Yorozu, et al.cited and by Dr. Ankit Agalwar in the most recent video conference, The study involved men with high-risk prostate cancer who underwent combination therapy with brachytherapy, EBRT, and a course of either 6 month or 30 month ADT. The study followed the men for over 9 years and showed similar outcomes for both the 6 month and 30 month administration of ADT.

[@mikeinnc4960]

Not accurate when you only say they are 'disease specific'. I lit upon the spine, T11. Had a biopsy and it came back negative. However, very informative video as usual. Thank you.

[@robertmonroe3678]

Dr. Scholz states that PSMA scans can occaisionally have false positives (starting about 3:08).

[@heartchakra2]

PSMA showed it positive you mean but biopsy did not ?

[@foropera]

I think they do not answer to the comments, but have a look at them. So I would like to inform them that , in Paris, France, I have been told by a radiotherapist that it was just forbiden to give a psma pet-Scan to look for an outside extension of the disease, in "first line". It's only possible on a recurence of the cancer...what a pity. So I had only a choline Pet-Scan.

[@RobLefler]

Can you please help me find A doctor in my area that has a open policy on all treatments.

[@stpetebackyardorchids]

You can fly to Cancun and get the PSMA PET scan for under $2,000.

[@joseclaudiobastospadilha103]

Please send yours excellent informations with subtítles. It helps a lot.Jose Padilha Rio de Janeiro.

[@kendavis1198]

So How is a Targeted Biopsy Conducted?? What's the Process??? And what the Heck is Focal Therapy??

[@bimalarora5704]

After prostectmy and radiotherapy my PSA continuously rose for 18 months but last time almost 2 months ago my PSA dropped from the last time oe 3 months back..sir why my PSA dropped

[@gshenaut]

I may have missed this in the video, but it seems to me that one huge difference between a needle biopsy and a psma pet scan is that the needles can detect cancer inside the prostate but the psma pet can't (because the membrane of every cell in the prostate has oodles of psma so the cancerous cells wouldn't be differentiated from noncancerous ones). Am I wrong?

[@gshenaut]

@@koof1776 Why?

[@koof1776]

@gshenaut 95% of the time PSMA lights up cancer cells from head to toe, no difference from bone to liver to prostate.

[@gshenaut]

@nvan78 Yes, since I posted my question, I have learned that PSMA is abundantly over-expressed by cancerous prostate cells, to the point where they can be detected by PSMA PET even within the prostate itself.