Findings consistent with osseous metastatic disease in the left iliac crest, right anterior 4th and left 10th ribs, T5 spinous process and L3 vertebral body.
Narrative
EXAM
PET CT, SKULL BASE TO MID THIGH, AXUMIN-8/6/2020 3:42 pm
HISTORY
biochemical recurrence prostate cancer
COMPARISON
CT ABDOMEN /PELVIS WITH IV CONTRAST WITHOUT ORAL dated 7/6/2015; BONE SCAN INJECTION dated 7/6/2015
TECHNIQUE
PET-CT from the pelvis through the skull base was performed 4 minutes following intravenous administration of 10.56 mCi F18-fluciclovine. Non contrast CT images were obtained for localization and attenuation correction.
FINDINGS
PROSTATE BED: There is minimal low level uptake in the prostate gland centrally with SUV max of 3.57.
PELVIC AND RETROPERITONEAL LYMPH NODES: No abnormal uptake.
BONES: There is abnormal uptake in the left iliac crest, right anterior 4th rib, T5 spinous process. There is a sclerotic lesion in the left T10 rib without abnormal uptake concerning for metastatic disease. There is a sclerotic density in the L3 vertebral body with slight increased uptake concerning for osseous metastatic disease.
OTHER PELVIC FINDINGS: Bladder is within normal limits.
HEAD AND NECK: No abnormal uptake. No enlarged cervical lymph nodes.
CHEST: No abnormal uptake. Mild physiologic myocardial uptake. No pericardial effusion. There are several tiny pulmonary nodules in the lingula and right lower lobe ranging in size is from 3-5 mm. Coronary artery calcifications are present. No focal consolidation or pleural effusion. No mediastinal or hilar adenopathy.
ABDOMEN: Physiologic uptake in the liver and pancreas. No focal adrenal nodules. No hydronephrosis. No acute findings in the bowel. No other abdominal lymphadenopathy.
MUSCLES: Mild diffuse physiologic muscle uptake.
Written by
Chris52981
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Next would be docetaxel + Lupron, followed in about 4 months by Lupron + Zytiga. He could do it the other way around, but I think doing docetaxel earlier is better.
Yes, those are the standard of care. He should also get one of the bone metastases biopsied. There may be something there that can enable him to benefit from a tailored therapy.
Lupron is only one ingredient. He needs both. Two major clinical trials found that survival is longer and time to castration resistance is longer too whn both chemo and Lupron are given at the same time.
Survival may be longer but what is the quality of life during that time? If the treatment side effects are so debilitating that life cannot be enjoyed what is the purpose of surviving longer? Hoping for a cure.
Most patients enjoy an improvement in their quality of life because of the treatment. It is important to use actual facts, and not imagination, drive decision-making.
Ok so because my dad stopped taking Lupron and now it metastized that doesn’t not mean Lupron will not work- he could have had the Mets for years but the scans maybe weren’t sensitive enough to show
Question Tall Allen. When I was diagnosed with 3 mets, I did chemo and lupron and quickly added Zytega. If I remember correctly, you seemed reticent For me to do all three because no studies proved it to be a benefit. Has your thinking changed or did I misunderstand you last time?
My MO Dr. Scholz went with Provenge at the beginning, Followed with Lupron/Zytiga, SBRT to the mets, with the Docetaxel coming approximately 6 months after my last infusion. FYI- My insurance company is Anthem Blue Cross/Blue Shield, and they approved the Provenge without a need for appeals.
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