Scan positive, biopsy negative?

[Flydoggy]

So I had lymph node dissection...5 nodes removed from the pelvic bed (following rad prostatectomy in Jan 2016 after rapid PSA increase from 8-18 in 6 weeks. Gleason 9/10 diagnosis...followed by 33 sessions of radiation. PSA rose again to 4)

Gallium 68 PSMA pet scan presented cancer in one of the 5 nodes prior to surgery. I looked at SBR and surgical options and decided to go with the surgery. I started Zolodex 1 month pre surgery. The post surgical biopsy of the node that showed up in the pet scan was negative??? Could the Zolodex have obliterated it to that point or could it have been a false positive? Any feedback on this would be much appreciated. I won’t get another true PSA reading for a few months until the effects of the Zolodex wears off.

[Tall_Allen]

I want to respond, but I don't think I understand the sequence of events...

My understanding is you had a PSMA PET scan that showed one cancerous LN. Then you had Zoladex starting one month before surgery. They did a limited PLND during surgery and took out only 5 LNs, including the one that showed up on the PSMA PET scan. You stayed on Zoladex through salvage radiation. Did the radiation field include all the pelvic LNs? Do I understand correctly?

[Flydoggy in reply to Tall_Allen]

No, sorry for the ramble in the post. Initial RP in Jan 2016, followed by salvage radiation (radiation stopped just below the presenting LN) in Nov. 2016. PLND occurred in Sept , 2018, following PMSA Pet scan in July, 2018. Does that clear it up?

[Tall_Allen in reply to Flydoggy]

Yes, I think it does, thanks. And I assume the Zoladex started before the salvage radiation and continued for about 2 years before the PLND. So yes, that is exactly what Zoladex is supposed to do - shrink cancer. It is also possible that the laparoscopic PLND missed it. Either way, a PSMA PET scan has a very low false positive rate. Have you discussed radiation to the node string?

A friend in my support group is having this done. He previously received radiation up to the common iliac LNs, but an Axumin scan found one just above it in the para-aortic LNs. So he will get a second chance with IMRT to the paraortics, with a boost of SBRT to the known enlarged node. He has just started on Lupron + Zytiga which he will take for 2 months before the radiation, and continuing for 2 years.

[Flydoggy]

Sorry for the incomprehensible post...I did try to clarify in my response to Tall Allen.

[tango65]

All the PET/CT scans have false positives, some more than others. The Ga 68 PSMA PET/CT is one of the scans with few false positives. If the SUV (standardized uptake values) value of the node was single digit it could have been an over reading by the radiologist.

[Crmp55]

Hi Flydoggy, had a similar occurrence, bone scan showed Mets to hips, ribs and spine. Had biopsy on spine , came back negative but psa remained high. Doc said I definitely had those bone Mets, nobody could explained the negative results of bone biopsy. That was five years ago. Today I remain in remission with four monthly injection of Lupron and monthly injection of Exgeva. Guess Doc knows what he is doing. So.......give it hell Harry as Truman would say. Look forward to a lot more years, I know I am and I’m 84

[johnscats]

Hi nalakrats this has nothing to do with flydoggy I have a problem u might be able to help me with I was diagnosed last Nov 2017 with pda psa464 Gleason 9 from biopsy put on firmagon monthly in Dec 2017 Feb 2018 psa 54 first pet scan and c.f. scan in Nov 2017 revealed nodule right lung Mets femour pelvis spine I 2 places left rib lmphnodes local had a c.f. scan with contrast 25th July pelvis and femour undectable lung undectable pelvis undectable and lmphnodes returned to normal size pda undectable prostrate returned to just below normal size smooth with no nodules . After reading maxs supplements on this forum I started with 4MU 400mg three times a day and milkthistle 2 tabs a day using life extension brand psa has been tested every 2 weeks science October 2018 averaged between 2.16 and 2.29 not sure what to do next have cut rso oil to half a gram a day science August 2018 my doctor says he hasn't seen a result from firmagon like mine ever in your opinion have you heard of firmagon by its self able to remove pca like that in a few months my doctor who is an Irish oncologist as I live in Ireland doesn't believe in diets and any supplements I'm actually thinking of changing him I would like to know if you have any advice I understand you are not a doctor but you may have heard on the forum what firmagon can do on its own and what type of scan should I try for next and can I add anymore supplements best wishes Jack's cats.