GA 68 PSMA PET SCAN RESULTS

[GMan-62]

My PSA reading 3 months after RALP was 8.11. I started Cosadex on June 1st, and Eligard 30mg 4 month injection on the 13th. I just received the results of my PSMA Pet Scan.

1. Hypermetabolic nodules/lymph nodes in the mid pelvis, consistent with sites of residual/recurrent viable disease. The most suspicious nodule/lymph node is seen on the left. (11 mm soft tissue nodule located in the posterolateral left pelvis SUV max is 13.8. and a similar 7 mm nodule in the posterior right lateral pelvis with a faint radiotracer with an SUV max of 2.2)

2. Benign postsurgical changes within the pelvis in keeping with prior prostatectomy and lymphadenectomy. Probable bilateral seroma/lymphocele.

3. Curvilinear radiotracer activity at the tip of the penis, probably the result of activity within the distal urethra and some contamination artifact. Correlation with focused physical exam findings necessary. Normal bio=distribution within the liver, spleen, urinary system, and low-level activity in bowl.

4. Single suspicious site of focal osseous uptake within the lateral border of the mid left scapula. SUV max is only 2.1, but this is clearly visible above background. No suspicious focal radiotracer uptake appreciated elsewhere in the osseous structures. No corresponding CT abnormality identified.

5. No suspicious focal uptake in either lung. No LOCAMETZ-avid mediastinal, hilar, axillary or cervical adenopathy. Normal bio-distribution within the lacrimal and salivary glands.

During my June 1st appointment my Dr. indicated that most likely I would need whole pelvic radiation, but was concerned about there being bulky systemic disease and if that was the case would either plan on abiraterone or enzalutamide at that point.

Tall Allen, I read the SPPORT Trial you sent me and if I understand correctly it looks like the next line of treatment should be RT to the pelvic bed and the lymph nodes, possibly administering Apalutamide vs. abiraterone or enzalutamide. Keep in mind the only ADT I have had at this point is the Cosadex for 15 days and my first Eligard injection yesterday morning. It also looks like we may have to address possible RT to the left scapula?

I'm scheduled to have another PSA draw on the 24th and then will meet with my Dr. on the 29th (1 month since last appointment) to go over the results and discuss the next step in my plan of care.

[Tall_Allen]

I think the low-uptake locus on your scapula is probably not a met, especially since you have no other bone metastases. They can try to biopsy it to be sure, but since there is no CT correlate and it is likely very small, it may be impossible to do that. Your other choice is to ignore it for now, go ahead with your salvage RT plans, and recheck it in a year.

I may have sent you this already:

prostatecancer.news/2021/05...

[GMan-62 in reply to Tall_Allen]

Thanks for your reply. At least for now it doesn’t appear to have spread outside the local area and hopefully RT and ADT will keep it at bay.

[GP24]

Single sites of osseous uptake or often false positives. I would not radiate that, just observe.

[GMan-62 in reply to GP24]

Thanks GP24,Now we talk to the Doc and discuss.

[tango65]

I have some personal experience with low SUV (<3) single bone spots. They were always false positive. They did not appear in subsequent PSMA PET/CTs or concurrent MRI studies showed no lesions in the area of the PSMA "lesion".

[GMan-62]

This may be a dumb question, but can you have castrate resistant PC when the only treatment has been RALP, 2 weeks of Cosadex, and the Eligard shot yesterday? I was under the impression the cancer cells had to change/mutate to survive without testosterone.

[GP24 in reply to GMan-62]

No, you just started ADT and you will not be castrate-resistant yet.