PSMA Scan and Primary Lung Cancer

[taylor123]

So as my father has a collapsed middle lobe with a potentially malignant lesion in his lung, so he is also under the care of a lung specialist. This lesion has been there for over 2 years now.

He has just reviewed my Fathers PSMA scan which showed high activity in the middle lobe, this led my Fathers prostate oncologist to previously assure us this was prostate cancer metastasis.

However we have just been told that primary lung cancers can also express high PSMA so he needs a biopsy on it now.

This node which we assume to to malignant has been there for over 2 years. It was previously looked at with bronchoscopy but they couldn’t even see anything to biopsy when they went in.

So it would be very atypical for this to be a primary lung cancer given it has grown only 2mm over the course of over 2 years, when lung cancers usually spread fast.

We’re hoping it’s just an infection, as infections can also present on a PSMA scan.

Will keep the group posted, but thought it was potentially interesting and useful info pointing to a potential pitfall in distinguishing between a prostate cancer metastasis and a primary lung cancer for those who have lung involvement.

[MichaelDD]

Taylor

Metastatic to the lungs happens. Last October after a University of California San Francisco trial PSMA scan my metastasis was found in both lungs. More then 10 nodules. Largest 9mm. I have NO other metastasis anywhere-yet. I do CT scans every 2 to 3 months to follow. Did one last Thursday. Review with my Oncologist today. Bone scan this Wednesday. Lungs only is rare, but lung mets can happen after bone or lymph involvement. Kind of a progression of this disease. Me they know it will be somewhere else too eventually. My progression is just different.

Keep up the fight.

[Grumpyswife]

Same thing for my husband. So far only lung Mets verified 18 year since diagnosis.

[monte1111 in reply to Grumpyswife]

18 years gets a wow from me. Keep on keeping on.

[tango65]

It seems primary lung cancer could be PSMA positive:

clinical-genitourinary-canc...

Keep us posted. Best of luck.

[taylor123 in reply to tango65]

Yes indeed.

However, very atypical to grow that slowly in two years, as even the lung consultant agreed.

Infections can also be PSMA positive, so that would be a very welcomed outcome here, although not expected.

[tango65 in reply to taylor123]

I agree , lung cancer has a fast progression. The collapsed lobe could be caused by bronchial obstruction. Let us hope bronchoscopy could detect the lesion this time .

Best of luck to you and your Dad

[MichaelDD in reply to taylor123]

Taylor ..my one Oncologist at UCSF is very well regarded in prostate cancer and trial. I was PSA persistent after my prostate removal 3 years ago. PSA rising/doubling every 3 to 5 months. 2 years of scans every 3 to 5 months found nothing. He feels that the mets in my lung were there as long ago as the removal. Just no way of detection until the GA68-PSMA trial scan found it. Maybe atypical but for me maybe it was...

[NPfisherman]

Taylor,

Please give a little more info--how big was the lesion when it was found 2 years ago and how big now.?? When they did a bronchoscopy 2 years ago, they could not find it and a growth of 2 mm is not much, so what is the plan for doing a biopsy?? You said he had a collapsed lung, and that is usually treated with a chest tube to allow the lung to re-expand...What are they doing for this issue? Is it, instead, atelectasis?

Additional information can help me formulate an answer for you...

Best of luck to you and Dad....

Don Pescado

[taylor123 in reply to NPfisherman]

Hi, thanks for helping.

Here is the exert from the CT scan report describing it. It has in fact grown by 4mm not 2mm. But the lung specialist said it would be atypical if a primary lung cancer.

Yes when they went to biopsy this mass in 2017 he said they couldn't find anything to biopsy. Go figure.

______

When compared to CTs from 2017 there continues to be a mass in the middle

lobe which measures up to approximately 9.8 cm, previously

9.4 cm and now appears more solid with less air bronchograms

than on the previous CT - on the delayed phase imaging there

can be seen dense mucus plugging within the mass.. There

continues to be a calcified granuloma associated with the

collapsed lung

[NPfisherman in reply to taylor123]

9.4 cm is a 4 inch nodule in diameter....how could they not see this?? The biopsy will provide the information you seek--here is some info from Medical College of Virginia and Respiratory Medicine Journal for you:

med-ed.virginia.edu/courses...

resmedjournal.com/article/S...

Good luck...

Don Pescado

[taylor123 in reply to NPfisherman]

Strange right. He was actually discharged after the initial CT and bronchoscopy. His GP refereed him for another CT of the thorax 2 years later to the present day due to an Xray showing a persistent collapse and an infection.

But I'm not even paraphrasing. The lung consultant said today, they couldn't even find anything to biopsy, but yet the 'mass' was there. They said before it was from infection.

My Father has a history of pleurisy and bronchitis.

[NPfisherman in reply to taylor123]

It may be an infection or from chronic issues plugging alveoli....they need to get that biopsy for an answer......Good luck....

Don Pescado

[taylor123 in reply to NPfisherman]

Thanks Don, really appreciate the comments.

[NPfisherman in reply to taylor123]

Your welcome.....keep us posted....I am very interested ....intrigued....

Don Pescado

[Tall_Allen]

Someone in my support group had primary prostate cancer and a primary lung cancer. His lung cancer was detected on the CT scan when he had a PET/CT for his prostate cancer. Fortunately, that "incidental" finding was very early and the lung cancer had not progressed. Like most cancers, lung cancer follows an exponential growth pattern, which means very slow at first, accelerating later. Fortunately, it was detected during this slow growth phase, before it had metastasized at all. It was confirmed by an in-bore biopsy (in a CT) by an interventional radiologist.

He had the choice of ablative SBRT (3 treatments of 19 Gy each) or surgery. He opted for radiation and 3 months later, it seems to be gone. In a way, he was fortunate to have had the full body CT because of his prostate cancer. Normally, such early phase cancers go undetected for many years because they are completely asymptomatic. By the time they are detected they usually have metastasized.

[taylor123 in reply to Tall_Allen]

What a strange unlucky but yet lucky turn of events.

However, the lung consultant himself said it was very atypical this lobe would only grow such a small amount in over two years if lung cancer, but he also said prostate cancer mets do not present in the lung like that.

Would be marvellous if it was was just an infection.

[Tall_Allen in reply to taylor123]

What I learned was that there is little experience about the very early growth of lung cancer. Unlike PSA for prostate cancer, there are no early biomarkers for lung cancer, so very few people are diagnosed at this early stage. Yes, I hope it's just an infection.

[taylor123 in reply to Tall_Allen]

Thank you Allen.

[dadzone43]

Valuable information. Best wishes for/to your dad.

[dentaltwin]

I would think the gold standard would be a needle biopsy by an interventional radiologist. Anything else (like making clinical decisions based on apparent slow growth) is just an educated guess.

Do they think the collapsed lung may be connected to the nodule?

[taylor123]

Lung infection / inflammation can mimic malignancy on PSMA scan

Exert below;

"Inflammation and infection may show increased PSMA uptake, thereby mimicking malignancy. We identified PSMA uptake in lung infection/pneumonia, atelectasis, and inflammation related to pleural plaques (asbestos) (Figure 5). Similarly, atherosclerotic arteries show linear diffuse mild PSMA uptake along their walls, which may be related to underlying inflammation"

ncbi.nlm.nih.gov/pmc/articl...

[j-o-h-n]

For the upteenth time... KEYTRUDA is working for my lung melanoma.

Apples or Oranges?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 08/20/2019 6:03 PM DST