Postponing SRT + WPLN due to new lung nodule

[jjpeabody]

I have been planning SRT + WPLN treatment for the new year, but on 11/11/21 my annual CT of chest showed a new 5mm noncalcified nodule in rt upper lung. I have sent copies of scan to Mayo clinic AZ and MD Anderson AZ for review. Mayo is currently handling my ADT treatments, Eligard 6mth shot, since 3/8/21. I have appts with pulmonologist on 2/3/22 and MO (PA) on 2/4/22 at Mayo. The ADT option is intermittent ADT with a holiday scheduled for 3/1/22. On 11/19/21 my PSA was <.03 and Testosterone <1. I have been in talks with MD Anderson to perform SRT since RO at Mayo woud not include WPLN (per PSMA PET and MRI on Feb and Mar 2021 tumor noted only in surgical bed). Met with PA in pulmonology at MD Anderson and plan for another CT scan on 3/1/22. Maybe needle biopsy at that time. I don't want SRT until I find out nature of lung nodule, probably not until Mar 2022. Another option might be to go on intermittent ADT until PSA climbs to about 0.5 and have another PSMA PET regardless of lung nodule finding. MD Anderson has called twice in 2 wks to schedule SRT Simulation but I explained my feelings re lung nodule on first call. Any thoughts on postponing SRT until understand lung nodule or ADT treatment? Thank you.

[tango65]

If the nodule is 5 mm in the CT, I would request a PSMA PET/CT {it could detect lesions 4 mm or larger} to see if the nodule is PSMA positive, unless the nodule can be easily biopsied.

If the nodule is PSMA negative or it is not PC in a biopsy, I would request whole pelvis radiation and 2 years ADT plus abiraterone.

If it were PC positive, the cancer is low volume metastatic and a systemic therapy with ADT and new antiandrogens could be be started .

[jjpeabody in reply to tango65]

Thank you for responding tango65. I will postpone the SRT until I meet with pulmonologist at Mayo in one month to see what she thinks, and MO the following day. A PSMA PET/CT instead of just another CT may be the way to go except for the timing of getting that scheduled and done quickly (remember my PSA 1 week after CT was <0.03, if nodule was PCa would the psa likely have been higher?). It sounds like the nature of the tumor will affect treatment options. If it were lung cancer and not PCa, I guess we would need to know which cancer to address first. Two other items: my Decipher score using 2019 RP samples was intermediate 0.56, 5yr metastasis 2.8% & 10yr 5.9%; I thought metastasis to an organ like lungs or liver is automatically considered "high volume" but I don't know. I’ve also heard differing opinions on type and time of ADT+ after SRT, but favor 1- 1 1/2 yrs vs only 6mths. Thanks again tango65.

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

Keytruda worked on my lung cancer due to a melanoma. Ask doc.....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 01/01/2022 3:19 PM EST

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

I appreciate that info j-o-h-n, I think it's good to hold off on SRT until I understand lung nodule. I will inquire with docs about Keytruda and update on board as this unfolds.

[Hidden in reply to jjpeabody]

Just because you have a nodule doesn't mean its cancerous. Seems like the very low PSA would be a better guide for you. Also, Mayo can do PSMA but they do a lot of Choline-11 because that is the direction they went some time ago. So that might end up being what you get. Check your insurance coverage.

[jjpeabody in reply to Hidden]

Thanks for your responses Anomalous, re Dr. Kwon (I agree) and my lung nodule situation. I left a post with T_Allen about these thoughts as a reply to his recent Pylarify post. I didn't know Mayo offered PSMA PET. I will see them in 30 days. Thanks again

[Hidden in reply to jjpeabody]

the next scan I get I think will be Pylarify. think its best to try different ones and see if they agree

[maley2711]

I had several "medium" size lung nodules identified on CT. Research showed this is not an uncommon finding, and that most, eg 95%, are non-cancerous.....yet still the 5%, and the risk that it could be PCa? The plan for me is to watch the nodules, ie more scans, during next year..... Docs did not discuss PCa treatment delay...but your question is on point I think!! We must also deal with fact that false positives are not uncommon for PSMA PET...at least my understanding...please correct me on that? On the plus side, false negatives are low for PSMA PET......so that would be the primary benefit of PSMA PET...relieving worry that such nodule is PCa..... don't know if there is any type of scan that is able to definitively identify lung cancer..biopsy required...ugh!!!

[jjpeabody in reply to maley2711]

Thanks for sharing your experience maley2711. I don’t know much about the false reading percentages of PSMA PET but I think it's a good test. There appears to be a FDG PET that may be able to detect lung cancer, but don't understand that test yet. I will be consulting pulmonologist early February and hopefully will learn more. At the moment it is 3mth wait and another CT on 3/1/22. Good luck