There is one thing that Dr. W does not bring out that may help clarify why PSMA PET scans are not more widely uses for AS and low/intermediate disease currently.
All prostate cells express PSMA, whether healthy or cancerous. The more cancerous and less healthy these prostate cells are, the more PSMA we think they produce. If you like, healthy prostate cells have a low PiRads and cells with more advanced abnormalities (cancer) show up much more intensely, the equivalent of a higher PiRads. Just a note - I am not sure they use PiRads scoring on PSMA PET scans. I have never seen it so am only using this as an analogy
Right now the technology, nor the experienced human eye can detect abnormal cells that only express a little PSMA from healthy prostate cells that express even less. As it is, the whole prostate should light up dimly if you produce PSMA.
That raises another issue Dr. W does not mention. Not all men express PSMA - we think around 20% of men are not PSMA avid i.e. don't express PSMA.
There is one thing that Dr. W does not bring out that may help clarify why PSMA PET scans are not more widely uses for AS and low/intermediate disease currently.
All prostate cells express PSMA, whether healthy or cancerous. The more cancerous and less healthy these prostate cells are, the more PSMA we think they produce. If you like, healthy prostate cells have a low PiRads and cells with more advanced abnormalities (cancer) show up much more intensely, the equivalent of a higher PiRads. Just a note - I am not sure they use PiRads scoring on PSMA PET scans. I have never seen it so am only using this as an analogy
Right now the technology, nor the experienced human eye can detect abnormal cells that only express a little PSMA from healthy prostate cells that express even less. As it is, the whole prostate should light up dimly if you produce PSMA.
That raises another issue Dr. W does not mention. Not all men express PSMA - we think around 20% of men are not PSMA avid i.e. don't express PSMA.
Hope this adds to the understanding.