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Post-Op Soaring PSA: Next Step? Axumin Scan?

slickjy
slickjy Member Posts: 26
edited January 2017 in Prostate Cancer #1

 

Full history of my prostate cancer is on MY CSN Space.  Summary:  64 yr old, 3 and half years after laparoscopic radical prostatectomy , Gleason 8, with removed pelvic lymph nodes also positive.  Post-op, PSA level rose.  I have been through radiation therapy (completed late Feb 2015) and on/off Casodex (off since Sept 2016) .  PSA level  is 12.0 now, and since July 2016 has been doubling every 3 months . 

 

Without success, my medical oncologist has been trying to get Axumin-enhanced scan approved by the organization of which he is a part (Florida Cancer Specialists) and, as of yesterday, is now trying to find an alternative to his own organization.   Goal would be to hopefully locate cancer at the cellular level.  (Bone scans, PET Scans, etc. have all been negative.) 

 

I feel like I should do something other than continue waiting (since Sept) for my doctor to succeed in his search. Does anyone have any advice regarding how to find organization(s)/provider(s) who conduct Axumin-enhanced scans?  I live in the Tampa Bay area, but can travel for treatment, if necessary.  Any other advice on appropriate next step? 

 

 

 

Comments

  • VascodaGama
    VascodaGama Member Posts: 3,430 **
    68Ga PSMA PET/CT can be an alternative to Auxumin

    I recommend you to check your Creatinine levels and Glomerular filtration rate (GFR). These markers will impede tests using contrast agents. HT drugs may also influence such tests so that you should be clean. Can you specify which contrast was used at your previous PET exam and when was it done?

    68Ga PSMA PET/CT could be an alternative to Auxumin, if your doctor manages to get you into one of the recruiting trials or off-lable.

    At the above link provided by Old Salt enter "68GA PSMA PET".

    I looked in your "mypage" and read that the path-report indicates "surgical margins benign, no tumor in seminal vesicles". I am curious for the existing positive lymph nodes. I wonder which route has cancer taken to reach the nodes.  

    Welcome to the board,

    VG

  • Old Salt
    Old Salt Member Posts: 834 **
    Search for clinical trials

    Please go to clinicaltrials.gov and enter 'fluciclovine'

    When I did that, (at least) four trials showed up that are recruiting patients for axumin related projects. One of them is at the U Florida

    Then see if you qualify for entry into the trial. And do look at the other trials as well, obviously.

    Good Luck!

  • slickjy
    slickjy Member Posts: 26
    edited January 2017 #4
    Old Salt said:

    Search for clinical trials

    Please go to clinicaltrials.gov and enter 'fluciclovine'

    When I did that, (at least) four trials showed up that are recruiting patients for axumin related projects. One of them is at the U Florida

    Then see if you qualify for entry into the trial. And do look at the other trials as well, obviously.

    Good Luck!

    Thank you!

    I will follow up with my doctor regarding the trial in Jacksonville.  Appears that i am eligible, depending on the meaning of "ongoing" treatment with systemic therapy, since I have been getting quarterly Lupron injections.  Hopefully, "ongoing" means that if I were to stop getting these injections, I wouldthen not be excluded from eligibility.  You have hlped a great deal.  Thank you very much!

  • slickjy
    slickjy Member Posts: 26
    Thank you for your reply!

    Thank you for your reply!

    May 2016:   Creatinine is 1.11 & GFR is 70

    Bone scan was 5/24/13 (pre-surgery) with F18 Sodium Fluoride

    Bone scan was 12/3/14 (18 months post-surgery) with radioactive agent Tc 99m.

    CT Scan was 10/22/15 with Magnevist

    Regarding curiosity about lymph nodes, the only other lymph-related detail on the surgical pathology report is "There is lymph-vascular and perineural invasion present".  I do not know what this means.

    Thank you for your welcoming attitude as well as your time!

  • VascodaGama
    VascodaGama Member Posts: 3,430 **
    edited January 2017 #6
    Perineural invasion present = cancer found along nerve fibers

    "Perineural invasion present" means that they found cancer in the nerve bundle surrounding the gland. These run in the skin involving the gland so that it could be the route of the cancer to exit the gland. Once reaching the lymph nodes cancer typically advances to bone. Your next PET scan should aim bone too. Probably the 68Ga PSMA is better for your case as it is more specific to PCa than Auxumin. The F18 Sodium Fluoride (NaF) PET/CT (you did in 2013) is considered the best for detecting metastasis in bone. It is even superior to the Tc 99m Bone scan you did in 2014.

    I recommend you to discuss the above with your radiologist.

    Best wishes for the success in the exam.

    VG

     

  • slickjy
    slickjy Member Posts: 26
    edited April 2017 #7

    Perineural invasion present = cancer found along nerve fibers

    "Perineural invasion present" means that they found cancer in the nerve bundle surrounding the gland. These run in the skin involving the gland so that it could be the route of the cancer to exit the gland. Once reaching the lymph nodes cancer typically advances to bone. Your next PET scan should aim bone too. Probably the 68Ga PSMA is better for your case as it is more specific to PCa than Auxumin. The F18 Sodium Fluoride (NaF) PET/CT (you did in 2013) is considered the best for detecting metastasis in bone. It is even superior to the Tc 99m Bone scan you did in 2014.

    I recommend you to discuss the above with your radiologist.

    Best wishes for the success in the exam.

    VG

     

    SCan Results & Xofigo Treatment plan

    Thank you for the replies.  I updated details in "my story": PSA rose to 23.0 at end of March.  Finally had the PET w/Axumin scan done on 4/13. Skeletal metastases present, I have opted to treat with Xofigo as the next step. 

  • Break60
    Break60 Member Posts: 1
    slickjy said:

    SCan Results & Xofigo Treatment plan

    Thank you for the replies.  I updated details in "my story": PSA rose to 23.0 at end of March.  Finally had the PET w/Axumin scan done on 4/13. Skeletal metastases present, I have opted to treat with Xofigo as the next step. 

    after ceasing ADT my PSA started to increase. When it reached 2.3 I had the axumin scan. It found lesion on right femur, my first bone met. It found nothing anywhere else. So I went back on ADT3 and am having SBRT, 27 grays in 3 fractions, to the lesion. 

    Bob

  • VascodaGama
    VascodaGama Member Posts: 3,430 **
    edited May 2017 #9
    Any condition regulating/limiting the Axumin exam?

    Bob,

    Thanks for posting on your experience with Axumin (Fluciclovine F18). I am in fact waiting for the increase of PSA to reach 2.0 ng/ml with the intent in having a similar exam to verify oligometastases and, as you, follow with spot radiation (if possible). However, while waiting I was caught with renal defficiency which may prohibit my planned PET exam with 68Ga PSMA. I wonder if Axumin also has limits in creatinine/eGFR to get the test. Can you share any information on the above?

    What does the ADT3 protocol include?

    Best wishes for successful treatment.

    VGama

  • denistd
    denistd Member Posts: 597
    edited May 2017 #10

    68Ga PSMA PET/CT can be an alternative to Auxumin

    I recommend you to check your Creatinine levels and Glomerular filtration rate (GFR). These markers will impede tests using contrast agents. HT drugs may also influence such tests so that you should be clean. Can you specify which contrast was used at your previous PET exam and when was it done?

    68Ga PSMA PET/CT could be an alternative to Auxumin, if your doctor manages to get you into one of the recruiting trials or off-lable.

    At the above link provided by Old Salt enter "68GA PSMA PET".

    I looked in your "mypage" and read that the path-report indicates "surgical margins benign, no tumor in seminal vesicles". I am curious for the existing positive lymph nodes. I wonder which route has cancer taken to reach the nodes.  

    Welcome to the board,

    VG

    Pet Scans

    Vasco, the material used in pet scans is not nephtoxic, it is cat scans and MRI's where they use contrast, pet is nuclear. I had them for up to three years after treatment, with the docs fully aware that my kidneys had been compromised. Denis

     

  • VascodaGama
    VascodaGama Member Posts: 3,430 **
    Denistd; Radiopharmaceuticals in PET scans

    Denistd,

    I am sorry for this late reply to your post (family concerns). Thanks for providing some info on the imaging contrasts. This is something I have been investigating recently due to the CKD condition (we discussed in another thread) and the restraint of certain substances for PCa imaging.
    Surely the best to locate the bandit seems to be a PSMA PET scan (nuclear medicine). However, the isotope transporter (method used for scanning) can be damaging to kidneys. It seems that the half-life of the radiopharmaceutical and its uptake dependency turns this into lesser or more friendlier in CKD patients, or even probably being prohibitive when guys got an acute status.

    The main differences between 68Ga and Fluciclovine F18 is that the former has a half-life of 68 minutes and needs metabolism (at PCa cells membrane), but the F18 apart of a long half-life it doesn't need of metabolism but uses the sodium dependent ASC system. My above question regards the excretion of the substance because in the literature they indicate Axumin having negligible uptake in the kidneys, wherever other agents are more effective providing an higher concentration in this organ. This radioisotope may be more feasible for CKD patients than the 68Ga.

    Can you please provide details of your PET scans. What was the pharmaceutical used and the transporter (the name of the scan)?

    For those curious on this matter, I would add that CT's Iodine based and MRI's Gadolinium based agents are prohibitive in CKD patients with (eGFR <30 mL/min/1.73 m2.) or avoid in CKD of (eGFR <60 mL/min/1.73 m2).

    Best wishes,

    VGama