Hello,
I have done MRI and 18F PSMA scans. MRI shows:
“Newly conspicuous 0.4 cm lesion in the left ischium, suspicious for metastasis based on MRI. This lesion is nonavid on contemporary PSMA scan”
But psma did NOT show anything. My MO says, he is not sure and this area is hard to biopsy so he is sending me to see a radiation oncologist
Has anyone encountered something similar with these two tests please?
Thanks for the help
PSMA PET/CT scans have a better sensitivity than MRI scans to detect PC metastases. There are PC that do not express PSMA. If they can not biopsy the MRI finding, they could get an Axumin scan. If it is cancer most probable that it will show in the scan.
Thanks tango, the thing is my psa is still low to be detected by auxim scan. It’s .6 at this time. I was surprised that my MO told me yesterday that there is no rush. I am not sure what he meant by that.
This met currently does not threaten your survival. So I agree with your MO that there is no rush. A PSMA scan will show better results at a PSA value of 2.0 ng/ml. I think you can savely wait till you reach that value. You had SRT, so all you can do is to start ADT and I consider this much too early at a PSA value of 0.6. Treating this met is not standard of care. If you want to do it anyway, wait until you can determine that it is cancer.
With a psa of 0.6 the psma pet scan has a sensitivity of around 50%. You will have to wait until the psa is above 2 to repeat the pet psma scan or get an axumin scan. The ischium seems difficult to biopsy, and even more difficult if the target is 4 mm. Perhaps you should talk with a doctor from interventional radiology.
I'm not sure if this is helpful but my husband had a PSMA in January this year which showed very little..just low grade activity in his auxiliary nodes which was almost indiscernible. However, in early April when his PSA had risen from 1.7 to 2.7 in three months his specialist ordered a new type of PSMA which is more sensitive and gave a very different picture which I've detailed elsewhere.
It's been a few weeks...how are things going??
Fish
Great, thank you for asking. Ron's commenced the 28 days of tablets about 10 days ago and had his first injection last Tuesday. I know the side effects take a few weeks to materialise but as yet there have been none. Emotionally, he's coping so much better and I think that's because he now knows what's going on. The girls are keeping him engaged about the trip away...one in particular inundating him with emails and text messages so that too is giving him something to take his mind off his own problems. He starts with the exercise physiologist that's a part of the Man Plan in mid May and has 18 exercise sessions and can book more if he wants to. The tablets to prevent diabetes suppress appetite so he's also losing weight. So... a great improvement. You must be off on your Israel trip very soon. Hope you are also going well and have a very Happy Easter.
I am so glad to hear this for you and Ron...Your message even sounds more relaxed... LOL...That is great news..... We are off to Israel in mid to late May and excited... Will go to the Wailing Wall and the Church of the Holy Sepulchre and pray for us all... Fabulous news... Enjoy Paris....
All the best,
Fish
Yes it's been a huge relief now that things are definite and I don't have to keep asking the specialist, when the PSA kept going up, about when hormones should commence. Lifted a load.
The MRI lesion may not be cancer - a biopsy will be definitive.
Thanks Allen but what do you think it might be please?
Only one way to know.
A Google search on ( false positive mri prostate cancer ) will return a great many hits on this subject. As with the various types of x-ray scan, MRI can show features in a person's body that are not typical in other bodies, but they're just light or dark spots in the images.
In your case the radiologist who interpreted the MRI said it was "suspicious" for metastasis and that it was "newly conspicuous", which I presume means that it wasn't there in a previous MRI, so it's not some kind of old wound.
If there are no other indications of metastasis in your body you may be lucky in having only one. Treating it with radiation might be worthwhile. Also, it appears to be in an area that is not near any vital organs, so the radiation may be low risk.
I think your MO is doing a good thing referring you to a Rad Onc.
Alan
Thanks, Alen. I do appreciate your response. You are correct, I did another mri in August last year and it didn’t show anything in that area. the only difference is that this mri was done at NIH and the one from last year was done at MSK. Thanks again
One question I have though, can we radiate it without being biopsyed? Am afraid of biopsy.
That's a good question for the Rad Onc. I don't know the answer. I suppose that if the radiation is no more dangerous than the biopsy, no extra harm is done by skipping the biopsy, unless the biopsy gives information that is not in the MRI and which the Rad Onc needs to plan the targeting.
But I don't know if it's true that the radiation does no more harm than the biopsy. The RO should know.
Best of luck with it.
Alan
Hi There. I am an Integrative Oncologist and specialist in PET/CT imaging. Several of my clients post in this forum so I follow along periodically to help answer their questions when I see them in my clinic - I do not typically post. I hope you do not mind me chiming in. I know this is a very valued and special space for PCa patients and comments from doctors may or may not be appreciated here.
Your situation is one I see frequently and is understandably frustrating. Advanced imaging with PET has come a long way in the last few years, but it is not perfect. As noted by others here, PSMA imaging at this level of PSA (0.6) has about a 50-60% detection rate. Also in up to 10% of folks PSMA will not be positive regardless of the PSA level due to the lack of the PSM Antigen in some cancers. I would not consider Axumin as the more recent experience with this is showing that it fails about 50% of the time overall and probably has only a <20% detection rate in the lower PSA range. C11-Choline (at Mayo in MN or AZ) may be another option, but as pointed out by another post, the PSA needs to be higher, closer to 2.0. In this situation, a NaF PET bone scan may be helpful as may it help decide on the nature of the ischial bone lesion, but it may help find additional bone metastases - in which case radiating the ischial lesion make less sense. If the NaF scan is negative, then it may give you reassurance in continuing to monitor, assuming the PSA is not rising at a very rapid rate.
Hope you find this helpful.
TO dr. fabio
WELCOME WELCOME AND WELCOME.
"I do not typically post. I hope you do not mind me chiming in"
Hey Man we need helpful people like you. Chime in all you want. We appreciate all the information we can get especially from professionals who specialize in Pca (as long as you don't bill us). We also appreciate anyone who adds a little humor to this site, so please indulge yourself.
I thought this was interesting: In Italian the meaning of the name Fabio is: Bean farmer. Derived from the Roman clan name Fabius. (Google).
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 04/18/2019 5:53 PM DST
Thank you very much drfabio. I truly appreciate your response and definitely I welcome anything you feel like adding. It will help me make a decision and I think for other too. Thank you again.
Thanks again drfabio. I just forgot to say I did a full body bone scan on 2/1/2019, very recent and here are the report of that scan:
SCINTIGRAPHIC FINDINGS: There are no focal abnormalities to suggest osseous metastases.
Uptake suggestive of degenerative joint disease is seen in multiple joints including
shoulders, knees and additional extremity joints. Activity overlying the LEFT inguinal
region may be artifactual due to contamination. There is NO abnormal soft tissue activity.
Physiologic excretion is seen in the kidneys and urinary bladder.
IMPRESSION:
1. Suspected contamination in LEFT inguinal region.
2. Degenerative changes.
3. Otherwise, NO evidence of osseous metastases.
Thanks for clarification
Here is my history of misdiagnosed scans:
Very recent "Pelvic MRI detected a "New right proximal femoral osseous metastatic lesion with the patient at risk for pathologic fracture", in other words a nasty leg bone met. Had 4 PHD doctors of different specialties look at it give an opinion. All said dont do anything right now. Bone scan later showed nothing. They now think perhaps it was one of those MRI errors.
in 2012, scans showed activity on 3 ribs ribs and a doctor recommended radiation. I ignored him because I remembered 6 years before I broke those ribs. Turned out to be osteoporosis fractures, because scans 3 years later showed nothing on those same ribs.
In 2005, fracture of the sacrum was diagnosed a "pathological fracture". Because of my LACK OF KNOWLEDGE about prostate cancer, I allowed Kaiser to do radiation. I WAS NOT ON THE PROSTATE CANCER FORUMS. I AM SURE HEALTH-UNLOCKED WOULD HAVE HAD SOMETHING TO SAY ABOUT THIS. My PSA was 0.4 so I later realized it was not cancer. Radiation was a MISTAKE. It was a fracture due to long time overuse use of Fosamax drug for osteoporosis. Radiation made my sacrum weaker and inow more brittle and more susceptible to other fractures. My PSA continued to go up after radiation.
This HealthUnlocked Forum is your best friend. Always confirm scan results with other scans and a possible biopsy before rushing into radiation.
As a one who have done 4 PSMA PETCT within 2years and first lesion in the spina iliacă was first found by MRI and later confirmed by 18F PSMA,I agree with TallAllen.....false positive. PSMA PETCT is very sensitive at a PSA of 0.6.
Good luck.
My husband had Auxium Scan which let up lymph node at .2 PSA. This was after RP surgery ... we went to Mayo in Rochester and had Cryo on this one lymph.
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