FDG uptake to cervical nodes

[mysticmini]

Diagnosed last October, stage 4A with spread to regional lymph nodes. Gleason 9 but with low PSA score. Being treated at MSK in NYC. RP is scheduled for the end of this month, and have been on Firmagon and Zytiga for 6 months. The plan is to have radiation treatment in another 6 months, after recovery from RP. The plan of having hormone treatment prior to surgery was to reduce the tumors as much as possible to provide more favourable outcome with surgery. Scans last week show "new FDG avid lower cervical and retrocrural nodes" Latest PSA test is also slightly increased (but still very low). 0.54 from 0.31. I'm panicking that this means cancer is already hormone resistant and the spread is no longer regional.

[Tall_Allen]

I don't understand RP knowing you will have SRT - why not just do it right the first time? Side effects are always worse with salvage radiation. This was at MSK?? Have you talked to a radiation oncologist there? Suggest Sean McBride.

The lymph nodes that show up with FDG may not be from prostate cancer. Suggest you have a PSMA PET to confirm.

[mysticmini in reply to Tall_Allen]

Thanks Tall Allen. Have sought multiple opinions from Mayo, John Hopkins and MSK. Have spoken to multiple medical oncologists, radiation oncologists and urologists. All recommended surgery, and salvage radiation if needed.

The concern is with potential spread to cervical lymph nodes and rise in PSA while on ADT.

[Tall_Allen in reply to mysticmini]

I don't understand, what has surgery to the prostate have to do with spread in cervical LNs and rise of PSA while on ADT?

[mysticmini in reply to Tall_Allen]

Absolutely nothing, was just giving context by providing the current treatment plan.

[tango65]

If there are metastases in cervical and retrocrural lymph nodes, the cancer is metastatic (those nodes are in the neck and in the inferior part of the mediastinum), far from the pelvis.

originalText

You should request a PSMA PET/CT or a biopsy if possible to see if those nodes are FDG positive because of PC. My understanding is that most PC metastases could be FDG positive, but the FDG PET/CT is not specific for PC,

If those nodes were PC, then the treatment plan should be reconsidered.