Fluciclovine PET CT Scan Results

[Rich_Rad]

EXAMINATION: PET CT SKULL TO THIGH PROSTATE BIOCHEM RECUR (YH LM)

CLINICAL DATA: Prostate cancer, post treatment, recurrence suspected. Per chart on Lupron with planned for radiotherapy. On University of Minnesota protocol.

COMPARISON: : CT chest and abdomen/pelvis and bone scan 12/31/2019.

Technique: Approximately 4 minutes following the intravenous administration of 8.16 mCi fluciclovine F18, a PET scan from the skull base to the mid thighs was performed using 3D acquisition. Transverse image reconstruction using an iterative algorithm was performed with reoriented tomograms displayed in the axial, coronal and sagittal planes. A CT scan was performed in the same region for attenuation correction.

Findings:

Reference values:

Blood pool SUV mean: 1.5

Bone marrow SUV mean: 3.1

Liver SUV mean: 6.7

Head and Neck:

Physiologic uptake in the salivary glands and mucosa. No suspicious mass or lymphadenopathy.

Chest:

No suspicious mass or lymphadenopathy. No lung nodules.

Abdomen/Pelvis:

Physiologic activity in the liver, pancreas, spleen, adrenal glands, and kidneys.

Increased radiotracer uptake is seen within the central/right central prostate gland, SUV max 3.9. Radiotracer uptake in bilateral inguinal lymph nodes are noted as well as a few external iliac lymph nodes below the blood pool. Small retroperitoneal lymph nodes, without significant uptake. Similar right pelvic sidewall fluid attenuation, photopenic collection, possibly postsurgical. Increased radiotracer activity at the distal rectum, SUV maximum 7.6. There is trace perihepatic ascites.

Musculoskeletal:

Physiologic activity in the bone marrow. Nonspecific, small sclerotic foci in the pelvis and femora, below PET resolution and may represent benign bone islands. Attention on follow-up.

Impression:

Radiotracer uptake within the prostate gland is highly suspicious for prostate cancer.

Increased radiotracer uptake in the distal rectum is nonspecific and could be physiologic or inflammatory. Direct visualization may be of benefit for further evaluation.

A few questions...

Physilogic activity in the various parts of the report suggest that uptake was related to the light exercise I did that morning. Should I be concerned about “Physiologic activity in the liver, pancreas, spleen, adrenal glands, and kidneys?” or “Physiologic activity in the bone marrow. Nonspecific, small sclerotic foci in the pelvis and femora, below PET resolution and may represent benign bone islands. Attention on follow-Up.”

Does “Increased radiotracer activity at the distal rectum, SUV maximum 7.6.“ suggest rectal involvement? Would this make using the spaceOAR unwise because then it would protect the cancer cells as well as my rectum?

I’m scheduled for that procedure on Monday, February 10.

EBRT Simulation on 2/20/20

Thanks,

Rich

[Tall_Allen]

I agree with you on avoiding SpaceOAR.

I'm not sure how exercise would affect anything.

Kidney uptake is from excretion. Many of the readings are background levels. Your oncologist should explain it to you.

[Rich_Rad in reply to Tall_Allen]

Thanks T_A!

I won’t meet with MO before appointment with urologist putting tracers in. So I appreciate your input.

Rich

[Tall_Allen in reply to Rich_Rad]

A friend had SpaceOAR and it apparently got into an unknown ECE, pressing it against the rectal wall and protecting the cancer from therapy. It has grown and is obstructing his rectum now, giving him no end of trouble.

[Rich_Rad in reply to Tall_Allen]

Thanks Allen

[Hidden in reply to Tall_Allen]

Horrible

[tallguy2 in reply to Tall_Allen]

Exercise is discouraged prior to the PET/Axumin. (I didn't ask why).

[Rich_Rad in reply to tallguy2]

The tech said that increased activity before the test could increase uptake in some organs???

Not sure how that works.

[timotur]

“Increased radiotracer activity at the distal rectum, SUV maximum 7.6.“ suggest rectal involvement?

That may be a benign uptake, should discuss with your RO.

This study done for colon cancer patients shows that your SUV range could be benign, especially since there is no mesorectal LN involvement.

The maximum SUV values of 43 patients with benign FDG uptake ranged from 2 to 11, and the mean values of diffuse group and focal group were 4.5±2.3 and 5.5±2.5, respectively, without significant between-group difference (p=0.20).

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

Also don’t be afraid of SpaceOar, TA keeps parroting a negative experience of his friend, but I can give you a positive experience with myself (see profile). Talk it over with your RO.

[Rich_Rad in reply to timotur]

Thanks Tim