PSMA Scan , help with findings

[DMohr011]

Last PSMA and CT scans 4/2022 showed zip, notta, undetectable.

PSMA scan today shows: 1. New borderline asymmetric uptake of the left seminal vesicle, potentially malignant. 2. New uptake feature of the left aspect of L5 superior endplate and right aspect of L5 inferior endplate with corresponding sclerosis.

I was removed from Keytruda due a colitis reaction, and have been on nothing else.

What do you smart one's think about these findings? Ductal form was the pathology report from DX in 2020.

Meet with my MO on Monday.

Maybe a good time to go fishing...

Dave

[Tall_Allen]

What was the SUV max?

[DMohr011 in reply to Tall_Allen]

3.6 on the first, 2.9 on the second.

Thanks TA!

[Tall_Allen in reply to DMohr011]

Those are very low - may be false positives.

[DMohr011 in reply to Tall_Allen]

Whew! Glad to hear and thank you TA!Dave

[Wyldhare22 in reply to Tall_Allen]

Out of curiosity, what would significant SUV max numbers start around?

[Tall_Allen in reply to Wyldhare22]

It depends on background uptake, but 10 is certainly significant.

[dhccpa in reply to Tall_Allen]

Interesting. Hell, that may call into question most or all of my scans. I'll have to dig deeper.

[Tony666]

I had a false positive on a rib. They Did a follow up wit a NaFl scan which is better at detecting cancer in the rib and it didn’t show up anything.

[Tall_Allen in reply to Tony666]

I am a big fan of NaF PET for bone metastases - did your insurance cover the cost?

[Tony666 in reply to Tall_Allen]

It was part of an NIH trial. So they picked up the costs but didn’t even ask about insurance.

[Tall_Allen in reply to Tony666]

That trial changed my thinking entirely, so thank you! They found that NaF is twice as sensitive as PSMA in detecting bone metastases. As you learned, it can also be used to detect false positives in bones. Unfortunately, Medicare stopped approving NaF. Fortunately, it is one of the least expensive radioindicators.

[Dett in reply to Tall_Allen]

Why did Medicare stop approving NaF PET? Do you know if Carefirst approves it? How widely available is NaF PET (in terms of places that offer that form of testing)? Thanks.

[Tall_Allen in reply to Dett]

I have no idea, sorry. It is widely available.

[dadzone43]

Always a good time to go fishing!

[MateoBeach]

Cannot assume they are false positives without supporting confirmation. I understand that smaller lesions (lower volume) have lower SUVmax values and still be PCa. Better get a high resolution imaging, MRI or CT, for further evaluation. Important in that it shows the cancer is no longer just spreading with local invasion, but seeding metastasis. And because they are in lumbar vertebra, may want to have them treated with SBRT to protect your supportive skeleton. Are you on a bone protective regimen? Just some considerations to discuss (soon) with your doctors.

Now, Go Fish!

[DMohr011 in reply to MateoBeach]

Thanks for the info and good to know. I see my MO on Monday for blood work and review of these results. I imagine more pictures today, and more later to compare. Dave

[Spyder54]

Dave, didnt think we would see you back here so soon ! Sorry Man, thought you were possibly Scott Free.Interesting about the diff in G68 PSMA and NaF PET. Almost as if G68 will replace MRI, and NaF will replace Bone Scan. The evolution continues.

Please let us know what comes out of your MO meeting tomorrow.

Best to you and yours, Mike