Advanced Prostate Cancer

PET Scan results - interested in feedback and comments on path forward

Pet Scan results

INDICATION: 59-year-old man with prostate cancer diagnosed in

2014 with rising PSA. Subsequent treatment strategy.

RADIOPHARMACEUTICAL: F-18-fluciclovine

DOSE: 10.0 mCi

TECHNIQUE: Approximately 3 - 5 minutes following IV tracer

administration via a right antecubital fossa vein, positron

emission tomography was performed from the vertex through the mid

thigh. Non-contrast helical CT imaging was performed over the

same range without breath-hold for attenuation correction of PET

images and anatomic correlation, but not for primary

interpretation as it is not of standard diagnostic quality. For

the CT portion of the study, the recorded CTDI volume was 3.69

mGy and DLP was 314.62 mGy*cm.

COMPARISON: None

FINDINGS:

HEAD AND NECK: There is no suspicious lymphadenopathy. There is

no tracer-avid malignancy in the imaged portions of the head and

neck.

CHEST: There is no tracer-avid malignancy in the chest. There is

no axillary, supraclavicular, mediastinal or hilar

lymphadenopathy. There is no pleural or pericardial effusion.

There is no air-space disease or suspicious lung nodule. Coronary

artery calcification.

ABDOMEN/PELVIS: There is a tracer avid 12 x 10 mm left internal

iliac node on axial 232. Tracer avid 6 x 4 mm right perirectal

node on axial 235. Increased tracer uptake in the posterior

aspect of the prostate gland bilaterally. Brachytherapy beads in

the prostate. Colonic diverticulosis. Mild calcification of the

aorta and its branches.

MUSCULOSKELETAL: There is no tracer-avid or destructive bone

lesion.

Mild tracer uptake associated with cutaneous thickening in the

anterior abdominal wall, recommend direct inspection.

IMPRESSION:

1. Tracer uptake in the prostate gland is suspicious for local

recurrent prostate cancer.

2. Tracer-avid left internal iliac node and right perirectal

node are suspicious for regional nodal recurrence.

2 Replies
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My interpretation of this report is that you have hormone sensitive metastastic prostate cancer and a recurrence of the cancer in the prostate or it is the original tumor that never went away. No previous study for comparison.

In general the initial treatment would be ADT with lupron or similar or castration plus abiraterone (Zytiga).. Along the road could be other treatment options such enzalutamide , chemo and immunotherapy with Provenge.

The tumor and the metastasis may be susceptible of local treatment with some form of radiation, IMRT or stereotactic radiosurgery. You should consult with a radiotherapist besides your oncologist. Theoretically they could be also treated with surgery. All points to discuss with your oncologist.

If the cancer is PSMA positive (PSMA is a protein present in the inside and surface of the cancer cells) it can be treated with Lu 177 PSMA which is a nuclear medicine therapy developed in Europe mainly in Germany and very effective in some patients with metastatic disease.

There are at least 3 clinical trials going on for castration resistant metastatic prostate cancer.

clinicaltrials.gov/ct2/resu...

The first things is to determine if the metastasis are PSMA positive.

A Gallium 68 PSMA PET/CT will identify metastasis is they are PSMA positive with a PSA of 0.2 or more. There is an ongoing study a UCLA got Ga 68 PSMA PET/CT:

clinicaltrials.gov/ct2/show...

I was treated with Lutetium 117 in 2016. I had a multitude of metastasis in the lymph nodes in the pelvis and abdomen . After 1 treatment the metastasis were gone.

The treatment kills cancer cells castration resistant and hormone sensitive in the bones and in soft tissues. It is a systemic therapy. Very well scientifically documented treatment.

Your PSADT is more than 15 months so I believe you will have a good response with a systemic therapy or a combination of local and systemic therapy.

Anything please let me know.

Raul

4 likes
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Dr. Raul,

As I said before you're so RAD.

j-o-h-n Wednesday 02/14/2018 2:34 PM EST

(Valentine's day)

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