ON PET SCAN THEY FOUND 3 stating not psma avid on MRI stating they are psma avid
How bad is this ?
PSA went from in a month 0.77 to 3.61
PSA
al Range
May 2, 2024 3.61 ng/mL
3.61ng/mL <=3.99 ng/mL
<=3.99 ng/mL
Apr 4, 2024 0.77 ng/mL
0.77ng/mL <=3.99 ng/mL
<=3.99 ng/mL
Mar 7, 2024 0.4 ng/mL
0.4ng/mL <=3.99 ng/mL
<=3.99 ng/mL
Feb 2, 2024 0.22 ng/mL
0.22ng/mL <=3.99 ng/mL
<=3.99 ng/mL
Jan 4, 2024 0.46 ng/mL
0.46ng/mL <=3.99 ng/mL
<=3.99 ng/m
CARCINOEMBRYONIC AG
Normal value: <=3.0 ng/mL
This type of information cannot be graphed.
Data table
Date Value Normal Range
May 2, 2024 <0.5 ng/mL
<0.5ng/mL <=3.0 ng/mL
<=3.0 ng/mL
Aug 8, 2023 <0.5 ng/mL
<0.5ng/mL <=3.0 ng/mL
LDH
406U/LHigh 118 to 230 U/L
118 - 230 U/L
Apr 4, 2024 300 U/L This value is High
300U/LHigh 118 to 230 U/L
118 - 230 U/L
Mar 7, 2024 216 U/L
216U/L 118 to 230 U/L
118 - 230 U/L
Feb 2, 2024 206 U/L
206U/L 118 to 230 U/L
118 - 230 U/L
Jan 4, 2024 147 U/L
147U/
Liver Biopsy on Monday Morning
Chromagin A test not back
CEA Test Low <0.05
A smoker is 0.05
I should did radiation to prostate bed
And ignored the MO not to radiate and just stay on systemic therapy
My prostate bed tumour went from 2cm x 2cm to 5cm x 3cm
It looks like it seeded back to my liver and lungs, , I may of had 3 to 8 or more years, listening to MO not radiating was a huge mistake it may of shortened my already pca stage 4 shortened life
My wife begged me to radiate my prostate bed after Radical Prostatectomy with LNR
This is a crime with 2 lytic lesions
MRI Below
Narrative & Impression
EXAM:
MRI OF THE ABDOMEN WITHOUT AND WITH INTRAVENOUS CONTRAST
CLINICAL HISTORY:
Prostate cancer, follow up Prostate cancer, treated, rising PSA level
TECHNIQUE:
MR of the abdomen with and without intravenous contrast.
Contrast type: Eovist
COMPARISON:
04/24/2024 PSMA PET-CT
FINDINGS:
Liver: Smooth in contour. No segmental atrophy or hypertrophy. No signal loss on opposed phase imaging to suggest steatosis. Multiple (around 40) bilobar rim enhancing liver lesions highly suspicious for metastatic disease, corresponding to PSMA avid lesion seen on recent PET-CT.. For reference, segment 7 lesion measures 3.1 cm (series 14, image 38). A segment 2 lesion measures 3.3 cm (series 14, image 32) an additional segment 2 lesion measures 3.5 cm (series 14, image 34).
Portal and hepatic veins: Patent.
Biliary system: Gallbladder is unremarkable. No biliary calculi or ductal dilatation.
Pancreas: Unremarkable.
Spleen: Unremarkable.
Adrenal glands: Unremarkable.
Kidneys: Simple cysts in the left kidney measuring up to 14 cm.
Bowel: Unremarkable.
Lymph nodes: No lymphadenopathy.
Abdominal aorta: No aneurysm.
Inferior vena cava: Unremarkable.
Peritoneum: No ascites.
Osseous structures/soft tissues: Expansile heterogeneous lesion in the right iliac bone unchanged. Induration in the ventral abdominal wall, unchanged. Small ventral hernias.
Lower chest: Unremarkable.
IMPRESSION:
Multiple (approximately 40) bilobar hepatic lesions compatible with metastatic disease.
Electronically Signed By:
Scans on Order
Scan on 5/2/2024 6:30 PM
Result History
MR Liver Advanced with + without IV Contrast (Order #709934684) on 5/3/2024 - Order Result History Report
Images
Show images for MR Liver Advanced with + without IV Contrast
PET Scan below
EXAM:
PET-CT SKULL BASE TO MID-THIGH
CLINICAL HISTORY:
Metastatic prostate cancer, rising PSA
TECHNIQUE:
PET/CT skull base to thigh-subsequent treatment strategy
F18 PYL dose: 10.00 millicuries
Injection site: L AC
Time of injection: 17:00
Time of emission scan: 18:06
Oral Contrast: No
Intravenous Contrast: None
Intravenous Lasix: None
The low-mAs CT Protocol used for this PET/CT study is designed for attenuation correction
and anatomic localization of PET abnormalities.
The standard uptake values (SUV) reported below are maximum values within a region of interest,
expressed in gm/ml.
COMPARISON:
02/02/2024
CORRELATION:
None
FINDINGS:
Mean liver SUV: 5.9, previously 5.2
Mean blood pool SUV: 1.7, previously 1.6
Mean right parotid gland SUV: 18.3, previously 24.7
HEAD/FACE: Physiologic PSMA uptake is seen in the lacrimal and salivary glands.
NECK: Physiologic PSMA uptake is seen in neck muscles.
CERVICAL NODES: No abnormal PSMA uptake.
MEDIASTINUM/HEART/GREAT VESSELS: Physiologic PSMA uptake in the mediastinal blood pool. Coronary artery calcifications.
LUNGS: Small azygous lobe. No abnormal PSMA uptake.
*New non PSMA avid 0.3 cm solid pulmonary nodule in the right upper lobe (image 122)
*Newly appreciated non PSMA avid subpleural ground-glass opacity in right lower lobe (image 147)
Biapical scarring. Unchanged bandlike opacity in the left anterior upper lobe, probably residual mucoid impaction and subsegmental atelectasis. Unchanged emphysematous changes.
PLEURA/PERICARDIUM: No abnormal PSMA uptake.
THORACIC NODES: Unchanged mild PSMA uptake in bilateral axillary lymph nodes, for example:
*Right axillary 1.2 x 0.9 cm, SUV 3.0 (image 117), previously 1.2 x 0.9 SUV 2.3
*Left axillary 1.3 x 0.9 cm, SUV 2.2 (image 110), previously 1.3 x 0.7 SUV 2.1
*Subcarinal (image 196) SUV 2.9, previously 2.5
HEPATOBILIARY:Multiple new non-avid hypodense hepatic lesions. For example:
*Segment 5, 2.8 x 2.2 (image 125)
*Segment 7/8, 2.7 x 2.5 cm, (image 155)
*Segment 2 (image 169) 3.2 x 2.6 cm
SPLEEN: Physiologic PSMA uptake.
PANCREAS: No abnormal PSMA uptake.
ADRENAL GLANDS: No abnormal PSMA uptake.
KIDNEYS/URETERS/BLADDER: Excreted physiologic PSMA activity is present. Redemonstrated photopenic large left renal cysts.
ABDOMINOPELVIC NODES: Unchanged non PSMA avid abdominopelvic lymph nodes, for example:
*Left common iliac 0.8 cm SUV 1.4,
*Right external iliac 0.8 cm SUV 1.8
BOWEL/PERITONEUM/MESENTERY: Physiologic PSMA uptake in the small bowel and colon. No abnormal PSMA uptake.
PROSTATE GLAND/SEMINAL VESICLES: Increased in size of heterogeneously PSMA avid irregular enlarged prostate gland with low attenuation necrotic and solid components. For example, PSMA avid left side solid component extending into left pelvic wall, 5.2 x 3.2 cm, SUV 6.1 image 42), previously 2.1 x 2.1 cm, SUV 5.6. Increased intensity of posterior border of necrotic component abutting the anterior rectal wall SUV 8.5.
Increasing left pelvic lymphocele 4.8 x 4.0 cm, previously 4.3 x 3.4 cm.
BONES/SOFT TISSUES: Unchanged PSMA avid osseous lesions, for example:
*Right iliac SUV 2.4 (image 256), previously SUV 2.4
*Right lower hemisacrum SUV 1.3 (image 271) SUV 1.2
OTHER FINDINGS: None.
IMPRESSION:
Since February 2, 2024,
1. Increased size of heterogenously PSMA avid prostate lesions abutting the rectum and left pelvic wall.
2. Multiple new non-PSMA avid hypodense hepatic lesions, indeterminant. Differentials can include metastatic prostate (dedifferentiated), new primary neoplasm, or non-malignant process. Recommend MRI liver protocol for further characterization.
3. Unchanged minimally PSMA avid bilateral axillary and abdominopelvic lymph nodes.
4. Unchanged osseous lesions.
5. Non PSMA avid new subcentimeter solid nodule and ground-glass opacity, nonspecific. Attention on follow-up imaging.
The following terms are used to convey the radiologist's level of certainty for a given interpretation.
Consistent with > 90%
Suspicious for/Probable/Probably approx 75%
Possible/Possibly approx 50%
Less likely approx 25%
Unlikely < 10%
Electronically Signed By:
Scans on Order
Scan on 4/24/2024
What now, coach? (PCa has spread to liver within 3 months of starting Eligard.)
Latest PSMA PET Scan Results - What to do next?
Cabazitaxel not working anymore seems, PSMA Scan & PSA shows progression
