Does that mean that patients with BC should wait for PSA to rise to a certain minimum level before having a scan?
Is GA68 PSMA scan now available outside of clinical trial in the US?
My understanding is that there are
locations where you can pay out-of-pocket for this scan. However, it's not (yet) FDA-approved, so AFAIK, the only way to get it without charge is through a clinical trial. My uro thinks that once it gets approval, more
locations will invest in the setup.
How long to wait for the scan is an active topic of research. There is some evidence that for post-RP BCR, the higher the G grade and the great the number and extent of the adverse findings in the path report, the earlier you start SRT the better. However, there is no use irradiating use the prostate fossa if the only sources are pelvic or more distant mets, and the higher the PSA, the better chance of revealing all
locations on the scan. If you had extensive positive margines, extraprostatic extension, and/or seminal vesicle invasion, you might make a case that the fossa is a likely source of BCR. Recent papers emphasize that there isn't a one-size fits all answer to the PSA for post-RP SRT. The AUA has not changed it's position that post-RP BCR is a PSA of 0.2 and rising. Some are advocating SRT at as low as 0.03 and rising for high-risk cases, which is adjuvant territory.
Other parameters are the time from primary treatment to the onset of BCR and the velocity of the increase.
Other will have to chime in on post-RT BCR. There is the nadir + 2 guideline.
Post Edited (DjinTonic) : 2/14/2020 11:07:26 AM (GMT-7)