Questions about recent scans

[dhccpa]

In Sept. I had an Axumin PET and an MRI of the pelvis/prostate. Last scans (same two) were in August 2020.

Diagnosed 8/2018. Gleason 8-9, PSA 200. Started Lupron Nov. 2018, Xgeva 1/2020. No other treatment, except numerous supps, cannabis, and off label meds.

PSA has been under 1.0 since beginning treatment, except for a few months in mid 2020 where it doubled then halved again. Low point 0.5 in April 2021. Last two readings 0.6, latest 9/14/2021.

My recent Axumin PET and MRI seemed to contradict each other. The PET covered from shoulder to mid-thigh and the MRI covered the pelvis/prostate area.

In the area they overlapped, the PET showed increased uptake all around, both general background and marrow, and also in the areas of prostate and bones where historically cancerous material or lesions have been noted. The report writer noted the increased general background uptake and seemed to conclude that offset the increased uptake in the tumors/mets areas.

However, the report for the MRI (my 5th or 6th), which has always found my largest met to be inside the right hip (super acetabular area) now says the latest MRI did not detect this lesion. The PET detected uptake there. The report also comments that the visible tumorous area of the prostate is much smaller and more heterogeneous than a year ago. As mentioned, the PET detects uptake there. I would welcome your comments on these results.

As a side issue, the PET detected uptake on a para-aortic lymph node outside of the pelvis/prostate area covered by the MRI. This is the first scan to detect this. Question: would an MRI of the area that includes that lymph node be useful in determining its true nature?

Another issue is that my PET scan in December 2018, as I was beginning treatment, showed mets in neck and ribs. A followup in January 2020 mentions those as well. However, no scans done since that time mention anything about those lesions. What happened to them?

My MO brushed aside the results, saying PETs are too sensitive and the MRI results didn't change anything.

I have an appointment with my RO who ordered the scans on October 28. However, I submitted about 10 specific questions to him, so he got with the radiologist who wrote the PET report and discussed, and then the RO and I discussed by phone. Unfortunately, my impression from that was that docs find it very difficult to know exactly what scans are showing, or even which scans are best for very specific determinations.

Thanks for your input.

[Tall_Allen]

I don't see the contradiction you see. Let the radiologist report be your guide. The job of your medicines is to shrink metastases.

[dhccpa in reply to Tall_Allen]

Could you elaborate on that? I asked because the two reports seemed to contradict each other (at least for the area they both covered). The reports were written by two different radiologists. I'm afraif I didn't understand your answer.

[Tall_Allen in reply to dhccpa]

I don't understand what you see as the contradiction. Background uptake is irrelevant- only the SUV max above the background is important. What are the conclusions in the radiologist reports that contradict?

[dhccpa in reply to Tall_Allen]

The main two are 1. This MRI, for the first time, shows no lesion inside right hip, but PET shows increased uptake from last year. 2. MRI shows significantly decreased area in prostate, but PET shows greater uptake than last year and larger area. Those seem contradictory to me.

Regarding the general issue of increased uptake vs background uptake, the PET summary states, "Interval increased tracer uptake favored to be technical since it is relatively similar to or less than increased background marrow uptake."

Do SUV max values measure the uptake over and above the background uptake? I don't see a value for background uptake, although the L3 SUVmean(4.0, up from 1.8 last year) seems to be referenced in the Biodistribution section as some indicator.

I've never asked about scan report terminology before, and no one's volunteered, so much of the terminology is new to me. Thanks for your ongoing help.

[Tall_Allen in reply to dhccpa]

" similar to or less than increased background marrow uptake." tells you that you should be ignoring it. You are not a radiologist and you are misreading the report. The only section of interest to you is the summary or impressions. Better yet, ask your oncologist.

[dhccpa in reply to Tall_Allen]

Yes, I've already spoken with my RO, who spoke with the radiologist who wrote the PET report. So a very indirect conversation. I'll be meeting with RO in a week so I'll follow up on the different results between the two scans.

How exactly am I misreading the report?

[Tall_Allen in reply to dhccpa]

I just explained that

[dhccpa in reply to Tall_Allen]

I don't see how. I'm dealing with the report(s) as written. I haven't drawn any conclusions. Thanks for your input.

[Tall_Allen in reply to dhccpa]

You are not reading the summary- you are reading details without regard to the SUVmax difference, which is the ONLY thing that is important.

[dhccpa in reply to Tall_Allen]

No, I've read both reports including summary. They're only 1-1 1/2 pages each. But I think we've beaten it to death, at least for this forum.

[Tall_Allen in reply to dhccpa]

What is the SUV max of the lesion? - what is the background SUV max?- Is the difference greater than at least 3.5, preferably a lot higher?

[tango65]

Could you get a Pylarify PET/CT in your area? This test is covered by Medicare now and it has a better detection rate than the Axumin PET/CT particularly with a PSA below 1 and it is probably better than the MRI for areas outside the prostate. Axumin PET/CT may have a large percentage of false positives.

[dhccpa in reply to tango65]

I don't believe it is available here yet, but I'll discuss it with my RO in a week or so.

[Shooter1]

Looks like you are doing very well with Hormone sensitive Pca which lupron is handling nicely..

[dhccpa in reply to Shooter1]

Does Lupron actually make lesions and the tumor material in prostate disappear?

[ctflatlander in reply to Shooter1]

Looks like you are doing well also. I may be considering Provenge after having a MRI in the C and T area. I see you recently had treatment. Did they require a driver to and from treatment. I may have a problem with that. Thanks

[Shooter1 in reply to ctflatlander]

When I needed a driver, they provided a Lincoln towncar and driver to pick me up at home and bring me home after treatment. 100 miles one way, so if you are closer they would probably be happy to give you a ride. Must be some profit for them.... For dhccpa-- yes, Lupron can shrink tumors.

[ctflatlander in reply to Shooter1]

Its 144 miles and 2 1/2 hrs. I'm going to inquire when I get an app'mt at the hospital.Thankyou

[dhccpa in reply to Shooter1]

Shrink but not kill, as chemo or radiation does. But so far so good.