What does my dads PET scan results mean?

[Bighawk11]

My fathers cancer has returned. What do these results mean?

Hello everyone,

I’ll try to keep this short — This is my (29m) first time posting here. My father (63 years old now) was diagnosed with prostate cancer 5 years ago. He had it removed and then went through radiation therapy. It ended up metastasizing and spread into his chest and possibly lymph nodes (I’m not 100% sure). He has an inoperable spot in his chest where radiation isn’t an option either. All has been well and the treatment he was doing was working, PSA number staying almost undetectable. We just received news that his numbers are up, meaning it has returned. He had his pet scan or psma scan a few days ago. Not sure which, I just know he had to drink some stuff that would show up in his system to indicate the cancer.

As is normal, I’m completely freaked out and can’t imagine my life without him. Hearing it has returned hit my whole family like a knife in the stomach. We received the results from his doctor but aren’t sure what to make of it. He has an appt with his doctor next week to discuss the results and hear the game plan, but I’m impatient.

I was wondering if anyone here has the experience or knowledge to breakdown what these results mean? I figured this would be a good place to start. See results below:

FINDINGS: Overall, the PET and CT image quality and intermodality registration aresatisfactory..

Head/brain and Neck: There is physiologic salivary and accessory salivary gland activity.Nonenlarged left supraclavicular lymph node with mild radiotracer activitywith max SUV 2.3 (image 242).

Chest/Thorax: There is no PET evidence of PYLarify avid adenopathy in the mediastinum, hilarregions, or axilla. Review of lung window imaging shows no PET evidence ofPYLarify avid pulmonary nodules. Coronary artery calcifications are present.Bilateral gynecomastia is present.

Abdomen/Pelvis: Tracer activity in the liver, spleen, and the pancreas is within normallimits. Both adrenal glands are unremarkable. Incidental note is made of aduodenal diverticulum. The gallbladder is surgically absent. Approximately 3.7cm hyperdense lesion involving the anterior mid/lower left kidney, measuring attenuation compatible with a benign hyperdense cyst.

Few PYLarify avid left retrocrural lymph nodes are present, including image169 with max SUV 5.2 and image 162 with max SUV 4.9 (image 162). Possible minimally radiotracer avid right retrocrural lymph node, max SUV 2.2 (image176). There is a large heterogeneous PYLarify avid soft tissue mass last lymph node conglomeration within the left para-aortic region, measuring up to 8.1 cm craniocaudally with max SUV 15.3 (image 160). There are regions of minimal radio tracer uptake within the lymph node conglomeration specifically withinthe lateral aspect, likely due to necrosis (image 153). No definite suspicious radiotracer avid lymph nodes within the pelvis.Postsurgical changes of radical prostatectomy. No definite abnormal focalradiotracer uptake at the prostatectomy bed to suggest local recurrence.

Musculoskeletal: Unremarkable.

IMPRESSION:1. Large PYLarify avid soft tissue mass within the left para-aortic region,likely representing a lymph node conglomerate, compatible with reportedhistory of nodal metastasis.

2. Two PYLarify avid left retrocrural lymph nodes, suspicious for additionalnodal metastases.

3. Mild radiotracer uptake within a left supraclavicular lymph node, which isnot enlarged by size criteria. In light of the focal radiotracer uptake,suspicious for additional nodal metastasis. Recommend attention on follow-up.

Thank you all in advance.

[Justfor_]

This is the most important finding: "Large PYLarify avid soft tissue mass within the left para-aortic region...". In absence of this everything else would had been at the level of "suspicious-lets-watch-it". If your father, at this time, is receiving hormone treatment than something more powerful will be prescribed. If not, he will be soon started on. There are many treatment routes to follow from here, others are more capable than me to draw-up.

[Bighawk11 in reply to Justfor_]

Thanks for your reply! He is currently on hormone treatment so it will be some other form of treatment. We’re just not sure what forms of treatment are left aside from chemo at this point.

[Justfor_ in reply to Bighawk11]

Keep an open eye on Lutetium PSMA (Pluvicto). It will be considered as too early for him, but there are trials (in Europe) trying to evaluate whether earlier is better. SUVmax of 15 is a good target for said radio-pharmaceutical and it may swing the disadvantage to an advantage.

[Tall_Allen]

The para-aortic and retrocrural lymph nodes can be irradiated, but there is no point in doing that if the supraclavicular lymph node is indeed a met (which is uncertain). You should talk to your radiation oncologist.

pubmed.ncbi.nlm.nih.gov/356...

[j-o-h-n]

Follow Tall_Allen's posts........ we feel your anxiety....... since we all have some..... Just keep researching, posting here, take notes when doctor visits or treatments, ask doctor's questions and get answers. Make a log of notes and anything else. Remember God is on your side.....(where are you located city/state?)....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 07/16/2022 6:06 PM DST

[j-o-h-n]

Oops, almost forgot..... make sure your Dad has a good freaking Medical Oncologist............

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 07/16/2022 6:11 PM DST

[Bighawk11 in reply to j-o-h-n]

Thank you for the reply! My mother is usually the one who goes to appt’s with my dad, unfortunately I can’t due to work. We’re in Michigan, in the metro Detroit area. We’re very happy with his oncologist — from what his urologist told him she is one of the best.

I’m trying to remain positive and have faith that everything will be okay.

[j-o-h-n in reply to Bighawk11]

Thanks and good to hear.........your dear Mom is a DEAR MOM.... keep posting here.........

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 07/17/2022 2:18 PM DST