F18 PSMA-1007 PET/CT Scan - Result

[Mooserj]

I previously posted about this scan and wondered about it's value. I had a rising PSA after robotic prostatectomy in April 2016 with a Gleason 4+3+T5 & pT2C, clear margins, appeared organ confined.

PSA climbed continuously since the procedure with current PSA of 0.87 with doubling time of 5 months. Had this whole body scan in Bangkok at the National cyclotron and PET Centre, Chulabhorn Hospital. Results showed "a single PSMA-avid lymph note at right internal iliac node; favour metastatic right internal iliac node".

Meet with uro oncologist and radiation oncologist to review the scan results. Options are various radiation approaches - IMRT to who pelvis with boost to avid lymph node, SBRT to avid lymph node alone & both options either with or without ADT. Case to be reviewed by Hospital Tumor Board next week with recommended options to be advised.

Spoke with second urologist and radiation oncologist where I had surgery with this result. Similar options discussed. SBRT to the avid lymph node seems to be a popular option for oligorecurrent status - with or without ADT.

I am keen to avoid ADT until necessary and research of articles and treatment for oligorecurrent Pca seems to suggest the option of SBRT to the one lymph node is a viable option. I realise there is the potential for other micrometastatic disease to be lurking in other nodes, that were not picked up on the scan.

Any thoughts on this clinical diagnosis and treatment options would be welcome.

[Grumpyswife]

I can empathize with you as my husband avoided ADT for 14 years and when he finally started quickly became resistant. Now he can’t be cured.

The spot treatment is controversial and supposedly unproven. Although spot treatment makes sense to me, the longer survival rates appear due to systemic ADT.

That said, I have two brother in laws that were cured, one with radiation to prostate only 17 years ago. The other with chemo only 7 years ago.

[George71 in reply to Grumpyswife]

What did your husband do for his treatment for 14 years? I am currently node positive from post surgery biopsy ( 2 years out from surgery) and only taking Avadart. current PSA 0.4 I would do radiation but don't want the ADT -- trying to avoid it also

[Grumpyswife in reply to George71]

He had RP first and that was ok for ~4 years, then radiation ok for 4 years, then brachytherapy, then metastatic to lungs started Lupron added Casodex . He tried to avoid ADT because of side effects.

[jdm3]

Others will chime in, but I think the verdict is still out on the spot treatment. The rebuttable presumption is that there are micro-metastases and there will be other spots eventually so you will be in the whack-a-mole mode.

I had SBRT to one bone met on my hip. I think I told you earlier that it's too soon to know if it worked though the laws of probability are in my favor. Avoiding ADT would be desirable because ADT sucks, but my MO recommended starting ADT in combination with the SBRT. Not only is radiation supposedly more effective while doing the hormone therapy, but he wanted to treat me systemically at the same time.

Wishing you all the best,

Josh