Latest psma pet scan , psa 0.12

[Merlin1960]

Can I have your thoughts on the results please …

[Justfor_]

SUV of 7.9 is the most serious one. PET time CT compared with previous MRI doesn't mean much. The two imaging technologies have different sensitivities on different body parts.

[Merlin1960 in reply to Justfor_]

Can you shed a light on the SUV 7.9 ? I am not familiar with it thanks

[Justfor_ in reply to Merlin1960]

SUVmax is the currently widely used metric for determining the intensity of cancerous cell concentration. It is very easily obtainable by the radiologist reader. What is now gaining acceptance in research and top tier institutions is the SUVmean. To derive this metric much more work is required by the radiologist and the use of specialized software. It is a metric that better illustrates the overall cancerous burden of the patient. To give you an example:

Your husband has two predominant spots of SUVmax 7.9 and 2.9. Some other may have 10 spots in the range of SUVmax 3 to 5. Which one is more advanced in the disease? SUVmean can clarify this as it integrates all affected areas in contrast to selectively picking up maximas. As artificial intelligence is gaining ground in reading imaging we will see such a metric gradually preliferating.

[Merlin1960 in reply to Justfor_]

Thanks for the explanation , his previous pet scan in 2018 didn’t go into that detail (or I don’t remember)

[Justfor_ in reply to Merlin1960]

Did the latest radiologist have access to the image files (or CD) of the 2018 scan if it was PSMA PET as well? Comparison between the two doesn't become evident from the report you posted.

[Merlin1960 in reply to Justfor_]

Unfortunately not .

[Merlin1960 in reply to Justfor_]

The first one found a spot on t12 that was radiated and a pelvic lymph node too .. he has now been off ADT for more than two years and psa is rising ..

[Justfor_ in reply to Merlin1960]

From earlier posts of yours I can see that he has gone through all the usual first and second line treatment steps. There is also an old post regarding his response to Bicalutamide (Casodex). My "Bicalutamide Maneuvers" post may give you an idea on how to keep his PSA within range for the interim period until something else gets needed.

[Merlin1960 in reply to Justfor_]

Thank you , I will take a look

[Tall_Allen]

The PSA was too low to detect anything. The focal uptake on "Dv.1" sounds like a false positive.

[Merlin1960 in reply to Tall_Allen]

That’s what I am trying to tell my husband but he has got himself in a panic , many thanks

[jazj in reply to Tall_Allen]

Those SUVMax numbers aren't that high. PSMA PET has been shown to only be 33% sensitive for PSA <= 0.2. At 0.1, it's going to be even less sensitive so my initial take is the same as @Tall_Allen. There is something that is termed PSA-negative cancer. However it is quite rare, occurring in 1% of patients based on this article. You should get a first and second opinion from an Oncologist as to next steps and possibly a second opinion from a Radiologist on the scan results.

discovery.ucl.ac.uk/id/epri....

[Merlin1960 in reply to jazj]

Thanks , the oncologist is on holiday and my husband and I are in different countries just now , it’s kind of difficult not really understanding the information and as usual my husband has his head in the sand …

[LearnAll]

Overall This is a very good report. It did not show any serious lesion/met. The 7.9 SuvMax lesion is also a faint lesion and stay dormant for a long time. SuvMax is a measure of intensity of PSMA uptake..higher the SuvMax ,more severe the lesion/met. Up to SuvMax 3.0 ,it is considered normal. 3 to 10 is mild. 10 to 20 is moderate. and above 20 is very significant.

[Merlin1960 in reply to LearnAll]

This is great information thank you

[tango65]

PC may have low PSMA expression, A SUV of 7.9 is close to the SUV of the liver and the lesion should be studied further. A 3 T MRI study may help to determine if there is normal bone marrow in this area of the SUV of 7.9 or if there is infiltration by the PC. I have been in this situation with a SUV of 3.5 and the 3T MRI was negative for cancer.

[Merlin1960 in reply to tango65]

Thanks … it’s worrying

[maggiedrum in reply to tango65]

Geez, I hate to try and interpret a PSMA PET scan report. But regarding the liver, I believe I have seen that minor uptake of the PSMA marker is not usually a cause for concern as the liver is designed to detoxify molecules circulating in the blood that it would consider abnormal. Same with the kidneys since they would try and excrete the chemical tracer and any metabolized chemicals from the breakdown of the tracer. So both the liver and the kidneys commonly show signs of the tracer which would be picked up in PET scan. Radiologists know this but always should note any PET findings. I would tend to trust your doctor who referred you for the PET scan to tell you if ANY findings are a cause for concern.

On the other findings, I had similar wording on my report. You definitely should quiz your physician/oncologist to tell you how serious the tracer findings are. Mine ranged from mild to moderate using a scale that I am not sure (but might) have been used by the radiologist. I definitely don't think they indicate the absence of cancer cells in several of your areas - inguinal, heart, others.

[tango65 in reply to maggiedrum]

The liver has a physiological SUV around 8 to 10. The SUV of the liver has been used in clinical trials to select patients who could benefit for LU 177 PSMA treatment.

If the patient has areas in bones, lymph nodes etc with a SUV similar to the liver or higher it has mets with enough PSMA expression to benefit for LU 177 treatment.

A bone area with a SUV value close to tto the SUV of the liver should be evaluated with MRI if they are doubts it is a metastasis.

I had metastases with SUV of 6 an 4.5 treated with LU 177. They were gone after LU 177 PSMA treatment.

[maggiedrum in reply to tango65]

I am not an expert, my research and my oncologist have said that the jury is very much out of the efficacy of Lu treatment anyway. It would be absolutely great is it works though and it may well.

From what I have seen an MRI would normally only be indicated if the CT results from the PET scan showed enough evidence that tumors might be present. For example, I have cancer in multiple lymph nodes but no indication of detectable tumor growth. An MRI would be negative in my case. Basically overkill at this point at high cost and no benefit - in my specific case.

The radiologists who read the scans are supposed to specifically look for tumors and note their findings in every report. I'm not trying to be contrary on this, just relating what I have seen and in specific discussions with my very expert oncologist. But every person with cancer is different.

[tango65 in reply to maggiedrum]

He has a suspicious bone lesion. MRI has different modalities to study a particular area of a bone and determine if the bone marrow is normal or abnormal. CT scan only shows size of the lesions,

[Merlin1960 in reply to tango65]

He had radiotherapy 2018 to t12 .. looks like ADT will start again soon ..

[Hidden]

Any way to rotate that picture?

[Merlin1960]

Thanks

[Seasid]

Why did he have the PSMA pet scan at PSA 0.12? Does he experiencing pain? At PSA 0.1 you have only 30% chance to find something. I personally would rather save myself from radiation and my money for later scans. Plus saving myself from the stress involved.

[Merlin1960 in reply to Seasid]

We moved to a new country and his psa was stable at 0.03 for 2 years after stopping ADT , I did query it but the oncologist said although he didn’t expect to see anything he would like a baseline scan..

[Seasid in reply to Merlin1960]

I can now understand the logic. Thanks.

[MateoBeach]

I am in agreement with Tango. The lesion at “D1” I am presuming means to the thoracic vertebra 1 (D for dorsal , but not conventional nomenclature).The SUV, which is the peak intensity of PSMA expression compared to some background level such as the blood pool or liver. 7.9 is not to be ignored or pushed aside as maybe or probably a false positive.

The high resolution 3T MRI scan to that lesion, and the atlanto-occipital lesion noted (Cervical vertebra 1, top of the neck), would be a good way to evaluate these, IMO. An RO consult would be valuable to consider treating them. Especially since there are no others which is the good news.

Research metastasis directed therapy for oligometastatic PC. Paul

[jjpeabody]

I had a PSMA PET scan with PSA at 0.12 and it showed "intense uptake posterior bladder adjacent to bladder neck" . My RO recently showed me the MRI of the tumor taken after the PET scan "floating around in the surgical bed". Good luck.

[j-o-h-n]

Flip it back, I still can't understand it.....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 06/30/2022 8:09 PM DST