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Advanced Prostate Cancer
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18F-DCFPyL PSMA PET/CT Scan Result

The result (other than typical) from the 18F-DCFPyL PET/CT Scan on 12-21-2018 at NIH found:

Abdomen/Pelvis: Focal uptake in a right internal iliac lymph node consistent with PSMA overexpression.

Right bladder diverticulum also noted.

Next Steps: Biopsy of the node will be sampled in the next week or so and is expected to be positive for cancer. I will then meet with RO and discuss radiating all nodes in the pelvic area. 2 months of ADT prior to radiation and for another 2 years afterward in hopes of a long-term remission (or possible cure).

Any thoughts or comments are appreciated.

Here is my PCa Background/History:

Radical Prostatectomy in Mid 2011 (MedStar)

1st BCR (Recurrence) 06-26-2015 at 0.4 PSA

IMRT (38 Sessions of Radiation) to Prostate Bed completed 09/2015

PSA undetectable after IMRT.

2nd BCR 08-25-2017 at 0.2 PSA.

I am currently at 0.4 PSA (12-20-2018)

PSADT is 10 months per MSKCC online Calculator.

I am currently being treated at Johns Hopkins

I had Bone and CT Scans mid-October (Both Clear)

I have had no ADT, Chemo or other cancer medicines.

I have been Tested and have no abnormal Genetic disposition.

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Also, Thanks to Tall_Allen for current and past posts/recommendations for my possible treatment path. Much appreciated!

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Your result is very similar to mine, except that I had about 10 lymph nodes lighting up. I had brachytherapy in 2011 and extra-capsular recurrence in 2016 treated with cyber knife and ADT. With a PSADT less than two months, I am now under ADT2 (Casodex and Lupron) treatment at Penn Medicine.

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Were you able to test the LN's?

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Yes I had biopsy of one of the lymph nodes that tested positive for metastatic prostate cancer.

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Looks like you finally found the source of your PSA, the good news is that you still have curative options. I wish you the best with whatever treatment you choose and will pray for a full cure!

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Thanks Kevin! Hoping for your PSA to drop to 0!

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I have similar stats like yours but no psma test, my psa is .44 after failing surgery and IMRT. I am thinking of following the same path as yours. Please update us on your progress. Thanks

Happy new year

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Thanks Ahk1. The only thing I would maybe do differently is add ADT to the IMRT radiation on my first recurrence after surgery. I will update once next treatment path is chosen. I will discuss this my RO and my MO and together with the invaluable info learned on this forum will make the decision.

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Thanks mospy,

I made the same mistake by not including adt in the IMRT. The doctor didn’t tell me I need it and I didn’t know and when I asked why, it only adds 10% to success rate.

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Hi My RO said exactly the same thing. I was told to still do the axium by urologist. They both said the G8 PSMA is not accurate and waiting for the rest and not doing salvage radiation would be a mistake. Doctors both think the jury is out on how effective adding ADT to your radiation makes that much of a difference. Plus the hormone may be needed later. My head is spinning . I am rescheduling and getting the axium test done. U of P is not recruiting yet and still trying to get an answer from NIH to get whatever I need to be on waiting list. Again both my urologist and RO said the same thing as TA, waiting for these tests may make it incurable period. So much appreciation to TA, he was right on the money. RO is not agreeing about whole pelvic area. So is doing the lower bed only and then watching PSA again. Can you then do radiation again?? Sorry if this is a stupid question but I don’t know and grateful for all the knowledge here!!

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I am not really sure about doing the radiation again later. I am not experiencing in this sort of thing. I did the prostate bed only and it failed. I have not done the pet scans yet to see if nodes has cancer, so I didn’t investigate this approach but if I remember correctly that TA on another forum had told me it can be done but I am not totally sure.

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Radiating this met may be difficult since you already had IMRT radiation. Also, after the planned radiation new mets could show up at different places, which I consider very likely. With a PSADT of 10 months and just one met, you could safely just observe this for several years without any side effects.

Your situation is discussed in detail here:

europeanurology.com/article...

Citation: "More than half of nodal recurrences are located outside the true pelvis."

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He only had radiation to prostate bed. I am in the same situation and thinking of taking the same path if the psma found any node Mets. Is approach wrong?

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GP24, Thanks very much for the info (link).

The IMRT I received did not include LN's so I think we can radiate the affected node.

I believe my RO at Hopkins will agree with the preferred path forward being observation versus radiation for the QOL off of ADT.

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If you are determined to get that met radiated I recommend to radiate all the lymph nodes in the pelvis. See this study:

ro-journal.biomedcentral.co...

I decided against that since I considered the benefit to be too small for six weeks of radiation and its possible side effects. Plus I was asked to have adjuvant ADT with it.

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Agree with radiating all pelvic LN's and have been advised to go with adjuvant ADT (2 months prior to radiation and 2 years after). If you don't mind me asking, how long ago did you receive the PSMA and where are you now in your treatment? Thanks again.

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"did you receive the PSMA?" I am not sure what you mean by that. My last PSMA PET/CT I got four weeks ago. As far as I am aware I have five, maybe seven lymph node mets in the pelvis now.

As you may have read, I wanted to treat these with a PSMA treatment. I did not get that yet, this is now scheduled for next year.

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I meant how long ago did you receive the PSMA scan, I did not realize you have received more than one. What is PSMAtreatment entail?

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Maybe you get a first impression from this article:

targetedonc.com/news/novel-...

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I understand now, I did not know you were MCRP. Thank you very much for the education. Jim

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Agree with radiating all pelvic LN's and have been advised to go with adjuvant ADT (2 months prior to radiation and 2 years after). If you don't mind me asking, how long ago did you receive the PSMA and where are you now in your treatment? Thanks again.

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Moespy,

Are you doing the node biopsy at NIH or John’s Hopkins please?

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NIH. Part of the trial is to sign a consent to have them do the biopsy if you wish. I sent you a message regarding my experience getting into the trial.

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Read my profile and you’ll see that we have quite similar path but my recurrence was sooner due to poor pathology post RP at Johns Hopkins due presumably to Gleason 9 PCa. Doing all pelvic lymph nodes is important.

Good luck.

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Thank you Brother!

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