Latest PSMA PET Scan Results - What to do next?

[groth12345]

Below is the report on my PSMA PET 2 days ago. Wondering what I can do next. Was thinking of radiation of remaining 3 mets and possibly the prostate again (finished 20 rounds on 5/4/22). Suggestions? Thank you.

TUMOR (known or suspected): Mild prostatomegaly which mildly impresses upon the posterior bladder base. The prostate now demonstrates significantly decreased PSMA uptake, as compared to prior PET/CT, now with low grade uptake (max SUV 2.7).

NODES (regional): The previously demonstrated retroperitoneal lymph node now has significantly reduced PSMA uptake, similar to the background. No new or enlarging lymphadenopathy.

METASTASES (known or suspected):

Redemonstrated minimally sclerotic left scapular lesion with minimal PSMA uptake (max SUV 1.3), similar to prior. Redemonstrated minimally sclerotic lesion within the anterolateral right fifth rib with mild PSMA uptake (max SUV 5.4) and CT occult lesion within the anterior left fourth rib with minimal PSMA uptake (max SUV 1.9), both of which are not significantly changed in comparison to the prior PET/CT.

[6357axbz]

What is your MO recommending?

[groth12345 in reply to 6357axbz]

Meeting with MO and 2 x ROs next week.

[Tall_Allen]

Your prostate is fine.

You seem to think that zapping bone metastases serves some purpose. There is no evidence for that and some evidence that it serves no purpose. Your focus should be on systemic therapy.

prostatecancer.news/2020/12...

[groth12345 in reply to Tall_Allen]

Thanks Tim. Appreciate your input.

[groth12345 in reply to groth12345]

Oh sorry,... Tall Allen. Will let you know what the drs. say next week.

[HopingForTheBest1 in reply to Tall_Allen]

The purpose it may serve, for certain patients, is to mitigate pain in a specific identified area?

[Tall_Allen in reply to HopingForTheBest1]

No pain was reported.

[TEBozo in reply to Tall_Allen]

Provenge?

[Tall_Allen in reply to TEBozo]

It's not indicated for hormone-sensitive patients.

[Hidden]

Be sure and talked with them on the likelihood of micro-metastatic spread.

GD

[groth12345]

Thanks everyone for your comments.

[slpdvmmd]

This review on LU 177 touch's on meaning of suv or lack there of. I may be of some help in you decision process. Treatment of oligometastatic disease is evolving as is its definition, there really is not standard of care at this point based on my read as the literature is a scattergram and as we know expert opinion is the lowest level of evidence. Link allows you to download a PDF. ncbi.nlm.nih.gov/pmc/articl...

[groth12345]

The Mets on the latest scan (8/15/22) are as follows:1. Right fifth rib - 1.9 SUV (previously 2.1 and 4.3)

2. Left fifth rib - 1.9 SUV (previously 2.0 and 3.6)

3. Left Scapula - 1.3 SUV (previously 2.4 and 1.5)

I'm meeting with my RO and MO this coming week. Hope they may suggest strategy to get rid of these mets entirely rather than just sit tight on ADT which is working well.