PSMA PET SCAN

[baseball29]

My husband got back the results of his PSMA PET scan & we don't see the doctor for a few weeks. There's so many things I don't understand. He's had prostatectomy in 2019, 35 treatments of radiation & 6 mos. of Eliguard. His PSA has been undetectable for 1-1/2 years until March. It's risen slightly since then to 0.35.

I don't understand this. I'm leaving out where's there's nothing seen in most areas . Help if you can.

"Bladder is not well distended for evaluation but grossly unremarkable. There is no concerning uptake in the prostate bed. No ascites seen. There are small nodes with increased uptake above background located in the right retroperitoneum near the uncinate process of the pancreas and in the bilateral distal common iliac regions. The most intense is a distal right common iliac node with a max SUV of 18.7 roughly measuring 1.0 x 0.6 cm in size (see series 3, slice 241). Musculoskeletal: There are no suspicious bony or muscular foci identified. Degenerative changes are seen. An anchor is seen in the right humerus. IMPRESSION: Findings are suspicious for metastatic nodes in the right abdomen/pelvis."

[Tall_Allen]

He probably has cancerous lymph nodes in the lower abdominal area. If he did not have whole pelvic radiation before, he can have it now along with 2 years of ADT and abiraterone. If he already had whole pelvic radiation, he should have permanent ADT along with abiraterone, enzalutamide, or apalutamide.

[tango65]

The right common iliac node with a SUV of 18.7 is a metastasis. If that area area was not irradiated before he could have it irradiated and start ADT plus abiraterone for 2 years.

If the common iliacs lymph nodes were not irradiated before you could discuss to have those nodes irradiated at the same time if that is possible.

To qualify what they found in the retroperitoneum one needs to know the SUV values of those lesions along with the SUV value of the blood pool (background). The radiologists qualified those nodes as suspicious, so they do not know for sure if they are mets.

I have had lesions in the bones with SUV values above the brackground ( SUVs values around 3) which were not metastases when they were studied with MRI and they did not appear again in subsequent PSMA PET/CTs.

You need to consult with a RO to see if the radiation of the common iliac nodes is possible and if the radiation oncologist believes the lymph nodes in the retroperitoneum are metastases and if they could be irradiated.

[TJGuy]

I believe typically ADT is not used with stereotactic radiation to see the effectiveness of the radiation on PSA. This while playing wack-a-mole.