UCLA is now running a randomized clinical trial of the Ga-68-PSMA-11 PET indicator for men with a recurrence (PSA≥ 0.1 ng/ml) after prostatectomy who are considering salvage radiation therapy (SRT). They are expanding and adding a control arm to the trial they did earlier (see this link) that found that the PSMA-based PET scan was able to change treatment decisions in about half the men.
Here are the trial details and the contact info:
https://clinicaltrials.gov/ct2/show/NCT03582774
UCLA normally charges $2650 for the PET indicator, so this is an opportunity to save some money. If a patient is randomized to the control group, he may still get an Axumin PET scan when his PSA is confirmed above 0.2 ng/ml, which is covered by Medicare and most insurance. The Axumin PET scan only detects cancer in 38% of patients if their PSA is in the range of 0.2-1.0 ng/ml, while the Ga-68-PSMA-11 PET scan detects cancer in about 27%-58% of recurrent men whose PSA is between 0.2 and 0.5. UCLA recently completed another free clinical trial comparing Axumin to Ga-68-PSMA.
I'm told that the NIH trial of another PSMA PET indicator, DCFPyL, has a waiting list of 2-3 months, and they are no longer taking patients whose PSA is below 0.5 ng/ml. It is possible to pay for PSMA-based PET scans in Germany and Australia. The newest and perhaps most accurate PSMA-based PET indicator, F(18)-PSMA-1007, is in clinical trials in Germany (see this link).
This trial is not open to men who have already had SRT, have known metastases, have had ADT within the last 3 months, or who cannot have radiation for any reason.
Can one still pay for the Gallium scan, or has that trial concluded recruiting?
ReplyDeleteOne can still pay $2650 for the Ga-68-PSMA-11 PET scan at UCLA if biochemically recurrent after prostatectomy (PSA ≥ 0.2 ng/ml)or primary radiation (PSA rose at least by 2.0), or if diagnosed as high/intermediate risk before prostatectomy.
ReplyDeleteWill they do it at 0.1? Apparently many ROs, in line with the belief the earlier the better for salvage RT, want to pull the salvage trigger at 0.1 psa. Thus, an inherent conflict, if one wanted to avail themselves of both very early RT and this breakthru ultrasensitive imaging technology.
DeleteUnfortunately, none of the PET scans are very good at finding mets when the PSA is that low. PET scans are not as sensitive as we'd like them to be.
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