Thursday, June 9, 2022

Better Than The Axumin Scan Last Year- The PSMA Will Finally Identify The Prostate Cancer Mets Anyplace They Are

The urologist 1 month ago - on seeing my PSA went up to 10.5 - basically offered me two choices: 1) Another invasive biopsy, or 2) Having a newer, vastly more sensitive PET scan for prostate cancer, called the PSMA.  The latter having the advantage of using a radioactive tracer that actually seeks out prostate -specific cancer cells - which most likely have become "mets" or metastases.   See e.g.

The urologist has known I've been postponing going the anti-androgen route for as long as possible given the horrific side effects: soaring triglycerides (mine are already high at 191), risk of diabetes, heart attacks and strokes, cognitive dysfunction, severe depression and massive weight gain.   E.g.

But he indicated that if there are any bone mets - metastases of the cancer in bones - all bets were off and I'd have to go the anti-androgen route. It was either that or suffer sporadic broken bones, possibly even paralysis if a met or mets in the spine weakened it to the point of collapse.

The problem was that the nearest PSMA scan site was in Lone Tree, Colo.,  the Rocky Mountain Cancer Center- nearly 50 miles away.  But rather than deal with yet another bloody biopsy - which would not locate bone mets anyway- I opted for the PSMA.

We arrived at about 1:30 p.m. yesterday at the center, where I was met by a staffer who escorted me into the prep room. There, I first had to complete the requisite insurance forms.  Then 10 minutes later, an NP arrived to find a vein site, into which the radioactive tracer would be infused.  The infusion process lasted something like 50 minutes using an IV drip, during which time I remained in a recliner.

Fortunately, I'd had the good sense to bring a book to read to pass the time.  I was also given a bottle of water to drink and told to consume it in the time to help disperse the tracer for a more effective scan - and in any case the bladder needed to be empty for the optimal effective result.

By 2:45 it was  'show time' and I was told to use the restroom after which I was. led by the actual technician to the scanning table. The procedure meant  I had to remain perfectly still for a full 25 minutes. Still a lot better than a trans-rectal biopsy with up to 15 'sticks' by a needle gun, into the gland. All that and then blood in urine, semen etc. and possible sepsis.  Thanks but no thanks.

By about 3:15 the final scan was completed, but as I tried to get up I immediately became dizzy and had to be assisted to the restroom. There I changed back into regular street clothes, after which the tech ordered a wheel chair.  As she put it: "Wouldn't look good for our Center to have the last scan done of the day ending up with the patient falling and breaking his nose!". 

I didn't' argue as it was a long way to the car, and having already taken one bad fall in Budapest 7 years ago, I was not anxious to repeat the experience!  After the scan we drove to an Indian restaurant in Lone. Tree where we enjoyed some of the best Lamb Vindaloo, Lamb Korma and samosa either of us ever had. It was a memorable day for sure, but now I have to await the scan results due on Monday or Tuesday.

  If any mets - namely bone mets- are visible - it means the newest drug (Orgovyx) will be prescribed to lower the testosterone (already low at 223 mg/ dL) and especially the PSA. It is the T which feeds the cancer cells and enables them to metastasize, wherever they are.  This 'medical castration' first developed in the 1940s, remains the last and literally only hope for men with advanced prostate cancer. (The other is surgical castration or orchiectomy which we are told is vastly cheaper than the drug route - but fewer get it for obvious reasons.)

'Jeez, if we could go to the Moon couldn't we find something better by now?".

  Well, no, that is where we're at: basically an 80 year old 'remedy' which is more like a cancer 'controller' not a cure.  And ultimately the cancer will win since as the Johns Hopkins specialist Patrick Walsh has noted ('Surviving Prostate Cancer') only the PSA-sensitive cells are affected - the others continue to grow.

The ultimate end is reached with the castrate resistant phase, which may be in 5 years, or even 10 if one is lucky.  The benefit of Ogovyx is it can be taken by tablet (120 mg) a day with an initial 3x 120 mg 'loading dose', as opposed to having to come in for shots.  There are also far fewer side effects than the other major anti-androgen, Lupron. 

The problem is the drug is expensive, and although I've been approved for it by Medicare, the last co-pay quoted (by the specialist pharmacy that provides it) was $1,017 a month.  Which I am now trying to get reduced by applying for whatever assistance is available. Anyway, we will see what happens with the scan. If no bone Mets are present I will likely postpone getting the Orgovyx. 

Maybe the cost will come down in the meantime.  Maybe, but I am not placing any Vegas bets!

See Also:

PSMA PET Scan for Prostate Cancer | UCSF Radiology


Prostate Cancer | Rocky Mountain Cancer Centers

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