Sclerotic bone lesions are these a metastasis?

[Ralph1966]

I had Pelvic and Abdominal CT scan with contrast yesterday. And just got the results.

RRP surgery September 2017, PSA increased from undetectable to 0.11 ng May 2019.

August to October 2019 SRT with 6 monthly injections of Firmagon.

After first injection PSA < 0.008 (September 2019) Testesteton < 10.

Another test PSA the same results as above undetectable (10/30/2019).

Completed SRT with injections 10/10/2019 no big issues or change in urinary incontinence.

Now the oncologest said let's do CT scan with contrast because my PPO insurance may decline repeating Auxumin PET scan with low PSA.

Gleason 9 (4+5) with confined tumor within prostate capsule at time of surgery 2017.

First Auxumin PET scan March 2019 (when had BCR PSA of 0.11) was clear (no bone metastasis)

Please read the report, and give an advice, is this a metastasis? I am 53 now with 2 kids and life just start smiling to me but this report is really concerning.

[Tall_Allen]

Possibly, but if so, they are small. However, it is unlikely that they would appear while you were on 6 months of Firmagon. Can you get a bone scan/CT now? If you can, you can repeat in 6 months to see if they grew.

[Ralph1966 in reply to Tall_Allen]

Yes, I called my Oncologest and will have Bone scan next week. I checked my Auxumin PET scan (March 2019) and it shows the same sclerotic lesions as follow:

((There is a 0.9 cm sclerotic lesion of the right inferior pubic ramus, which is nonspecific and may represent a focus of enostosis(3/266). Additional punctate sclerotic lesions of the L1 right hemivertebra may represent bone islands (3/158). Multilevel degenerative change of the axial skeleton.)) yet they didn't mention any concerns of bone metastasis.

Thank you TA for your feedback...why Auxumin scan reading doctor at USC says these are non-specific lesions while the local Contrast CT scan reading doctor says concerns of metastasis??

[Tall_Allen in reply to Ralph1966]

My guess is that the sclerotic lesions showed up on the CT but not the Axumin PET (you had both at that time). The second radiologist could only see the CT.

[EdBar]

Sclerotic areas are scars left on your bones from where metastasis were. I still have these as well and my PSA has been undetectable for over 5 years now. I had thought they would heal and disappear over time but it’s not the case. Your undetectable PSA is very encouraging, hang in there, I was dx at age 55, Gleason 9, multiple mets, that was nearly 6 years ago.

Axumin scans are not accurate until your PSA reaches 2.0, I’ve been able to get several even with undetectable PSA because I was metastatic and my doctor justified them with insurance by saying he was testing for response to treatment.

Ed

[6357axbz in reply to EdBar]

What dose of metformin do you take?

[EdBar in reply to 6357axbz]

1000mg twice daily

[dentaltwin]

Were there previous scans available to the radiologist to compare?

[Ralph1966]

Aperantly they didn't have the CT scan that i had 1 year ago at the same facility. Also I don't think that they have the Axumin PET scan that I had at USC 9 months ago to compare.