Help with understanding Psma pet scan I don’t understand what this means abiraterone stopped working psa is increased to 3.30

[Nirman]

Clinical history: Known case of metastatic adenocarcinoma of prostate, on

hormonal therapy since 2017. Serum PSA level 1.7 ng/ml dated 26.11.2020.

SUVmax was calculated based upon body mass. S. Creatinine level: 0.6 mg/dl

Comparison Study: Whole body Ga68 - PSMA PET-CT scan 29.08.2017

Findings:

Physiologic tracer distribution seen in lacrimal gland, salivary gland, gut, liver,

spleen, kidney and urinary bladder.

Head:

Both cerebral hemispheres are normal. Ventricular system and basal cisterns appear normal.

Cerebelum and brainstem appear normal. No evidence of subdural, extradural or

intraparenchymal haemorrhage is seen. Skull vault appears normal.

Neck:H

Oral cavity is normal. Oral tongue, base of tongue and floor of mouth is normal. Nasopharynx,

oropharynx and hypopharynx are normal. Larynx is normal.

No evidence of lymphadenopathy on either side of neck. Both side parotid and submandibular

glands are normal. Paranasal sinuses and both orbits are normal.

Major neck vessels are normal. No significant abnormality is seen in thyroid gland.

Chest (HRCT Scan):

Few fibrotic strands are noted in right lung apex.

Both lung fields are clear. No evidence of mediastinal lymphadenopathy.

No evidence of pleural effusion.

Abdomen and Pelvis:

High grade PSMA avid heterogenously enhancing lesion is noted involving base

and mid zone of right lobe of prostate gland with extra -prostatic extension,

infiltrating posterior wall of urinary bladder involving right VU junction. No

evidence of hydronephrosis. The lesion measures 29 x 23 x 34 mm (SUVmax 5.1).

Mesorectum, anorectal junction and bulb of penis are uninvolved.

16 x 9 mm calculus is noted in left pelviureteric junction with mild left

hydronephrosis. Another small calculus is noted in left lower renal calyx.

Non PSMA avid 16x 11 mm simple cyst is noted in left lobe of liver. Few benign bilateral

renal cysts. No evidence of PSMA avid abdominal or pelvic lymphadenopathy.

GB, spleen, pancreas, both adrenals are normal. No evidence of ascites is seen.

Bone and Soft TisSue:

PSMA avid sclerotic skeletal lesions - D8, right 8th and 10th ribs, sacrum, left

ischium, and proximal metaphysis of right femur (SUVmax 12.6 in right femur

lesion).

Few non PSMA avid small sclerotic lesions are noted in bilateral pelvic bones -

unchanged.

IMPRESSION:

Known case of metastatic adenocarcinoma of prostate, on hormonal therapy since

2017. Serum PSA level 1.7 ng/ml dated 26.11.2020 -

As compared to previous PSMA PET-CT scan dated 29.08.2017,

> NeW appearance of high grade PSMA expressing malignant primary lesion in

right lobe of prostate gland with extra-prostatic extension involving posterior

wall of urinary bladder and right VU junction.

No evidence of PSMA expressing abdominopelvic nodes.

> Increase in PSMA expression and size of sclerotic lesions involving left

ischium and right femur. Rest of the variable grade PSMA expressing

metastatic sclerotic skeletal lesions as mentioned above are new findings.

(CO-RADS GRADE 2- abnormalities other than COVID -19)

[Tall_Allen]

It means you've had progression in bones since your last PSMA PET scan. Some of the old bone metastases (L ischium and R. femur) got larger, and there are some new bone metastases (D8 of spine, right 8th and 10th ribs, sacrum ).

You seem like a good candidate for Xofigo.

The cancer in your prostate is growing too. You can discuss prophylactic prostate SBRT before it gets to be a nuisance.

It's benign, but you have a kidney stone that is starting to block urine flow- you may want to get it checked out.

[Nirman in reply to Tall_Allen]

What about chemotherapy lu177psma and xtandi ? As you said xofigo first okay than what other options remains afterwards?

[Tall_Allen in reply to Nirman]

All of those are good too.

[Nirman in reply to Tall_Allen]

So it means it’s not too late for him and he can survive few more years?

[Tall_Allen in reply to Nirman]

I have no idea how long he will survive. Deal with what is in front of you now. The future will take care of itself.

[Nirman in reply to Tall_Allen]

Okay I understand thank you for the prompt help and reply

[Nirman in reply to Tall_Allen]

We already did steroid switch after abiraterone stopped working the same day this scan came so I guess it’s not in option anymore or should be wait until it shows some results?

[AlanMeyer]

I'll add a comment on kidney stones to Tall_Allen's expert information.

If you have a kidney stone it can become really painful but, if it's not too large, it can be easy to treat. Drinking large quantities of water is important and if you can combine that with a prescription for tamsulosin you may be able to pass the stone quickly and easily. You'll want to urinate into a jar so you can see if the stone (typically a little black stone like object that may be several millimeters in diameter) came out and can take it to your health care provider to get it analyzed.

Best of luck.

Alan

[Nirman in reply to AlanMeyer]

Thank you

[j-o-h-n in reply to Nirman]

Somethimes besides drinking plenty of water jump up and down and that motion may dislodge the stone....

Use a strainer when you urinate to find the stone. Calcium stones come out easier (smoother) than Uric acid stone which are generally jaggered.

When you pass a stone they usually scratch your urinary tract and you may see blood in your urine which could last for a few days.

Me <----<<< had a few (left and right sides)....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 02/16/2021 7:16 PM EST

[Nirman in reply to j-o-h-n]

Okay thank you dear J O H N

[rscic]

I am a retired Radiologist & might be able to give you some back-round here.

In the body of the report the Radiologist will discuss findings (what they see on the images) both expected, benign and suspicious.

In the IMPRESSION the Radiologist will discuss what they feel are the important findings. I will break down the Impression.

IMPRESSION:

Known case of metastatic adenocarcinoma of prostate, on hormonal therapy since

2017. Serum PSA level 1.7 ng/ml dated 26.11.2020

---This is just back-round info and the study date. The Radiologist is stating this is what they know about the patient .... if more info is important the MO can contact the Radiologist & ask them to again look at the imaging with this additional information in mind.

As compared to previous PSMA PET-CT scan dated 29.08.2017,

----this study is being compared to a previous study & the Radiologist is stating which study this one is being compared to .... this is stated for 2 reasons,

----1st to let the MO know how you are progressing &

----2nd, if there is another study the Radiologist does not know about which the MO wants this study compared to, the MO would realize this & direct the Radiologist to that study

> NeW appearance of high grade PSMA expressing malignant primary lesion in

right lobe of prostate gland with extra-prostatic extension involving posterior

wall of urinary bladder and right VU junction.

----this is new suggesting/indicating progression of disease

No evidence of PSMA expressing abdominopelvic nodes.

----so no visible disease here .... there might be disease here, especially microscopic disease, but the Radiologist can not see it .... the Radiologist is informing the MO they looked specifically for this.

> Increase in PSMA expression and size of sclerotic lesions involving left

ischium and right femur.

----probable progression of disease at this site

Rest of the variable grade PSMA expressing

metastatic sclerotic skeletal lesions as mentioned above are new findings.

----these are new evidence of probable disease

(CO-RADS GRADE 2- abnormalities other than COVID -19)

----this is a "shorthand" classification system used by the Radiologist to put your disease level into a particular category. The MO will read this & make sure the Radiologist category corresponds to what they are seeing clinically.

You have some kidney stones (calculi/calculus) with some evidence that there is some mild compromise of urine flow. There is NO evidence of hydronephrosis (hydyonephrosis would indicate kidney function compromise & would be compared to blood test results by the MO .... IF you had hydronephrosis your MO would likely refer you to a kidney specialist ..... they might refer you anyway for evaluation & to avoid a future problem).

----I would have put this in the impression as well .... some Radiologists will put it in while others will say it is not related to the primary problem, not compromising the kidney significantly & deserves to be in the body but not related to the primary problem so not in the impression. This finding is benign but should be discussed with a Doc & should be at least monitored. This is why reports need to be read completely .... reading the complete report is not always done by busy Doc's which is why it is wise for you to get the report and do a "deep dive" into the results to make sure everything which might need to be addressed is.

I hope this helpful. There are many very good responses already here.

GOOD LUCK,

Rick

[Nirman in reply to rscic]

I don’t have enough words to thank you

[rscic in reply to Nirman]

You are your best advocate to get the best care .... you appear to be doing this .... keep on keeping on. GOOD LUCK