Supraclavicular Lymph node Metastasis and Imaging Issues

[Linebacker75]

hey all, I have a couple questions and hoping for some input from the forum. My PSMA Pet scan showed psma avid nodes in my neck. There were three and are all around .6 cm. My MO is concerned that no other uptake was shown between my pelvic region up to my neck. Should I expect there are more areas to pop up soon?

I also have plenty titanium and chromium in my body to include both hips and titanium rods from my scrum to t-12 all tied in at each vertebrae with chromium screws. The problem is all that metal messes my scans up severely in those areas. The artifacting lights up the area like a mini lightning storm causing the Radiologist to say, we’ll maybe, looks like possibly disease but not definitive due to the severe artifacting. I have not asked my treatment team yet but will on Tuesday. I’d like to be a bit informed when I see them so do any of you have suggestions on a type of scan that will allow a good look around the spine and hips held together with the metal? I have pain in all those areas causing further confusion over it could also just be orthopedic related pain.

Last question, I have been on Lupron alternated 9 months on 9 months off for years with my test <3 yet I’ve lost 70# over the last 16 -18 months. I don’t count calories but I’d guess I consume 2000 to 3000 daily. No sugar added. No change in routine.

Should I be concerned?

thx,

gb

[Tall_Allen]

What was the SUV max?

[Linebacker75 in reply to Tall_Allen]

My SUV max was 4.9 with the other two at 3.9.

[Tall_Allen in reply to Linebacker75]

That’s marginal. Not a clear signal

[Linebacker75 in reply to Tall_Allen]

thank you TA. As always I appreciate your input and knowledge.

[alephnull in reply to Tall_Allen]

Tall, at what level does SUV max become of some concern?

[Tall_Allen in reply to alephnull]

It depends on what the background is and which radioindicator. But given Linebacker's peculiar location and low SUVmax, it may be a false positive

[tango65]

I would consider to add abiraterone or darolutamide if there are distant metastases.

[Linebacker75 in reply to tango65]

I see my MO next week and plan to pin him down on a few things. Thank you so much for the reply.

[tango65 in reply to Linebacker75]

Best of luck.

[awb1]

I might have more experience than anyone with supraclavicular nodes, and neck, and lungs. I have a head and neck cancer that always confirms as prostatic in origin. Choline, FDG, and PSMA scans have always accurately revealed suspected locations and needle biopsies confirm them, they are prostate cancer. I have had a four supraclavicular nodes irradiated without problems. I had one irradiated neck node that turned into a big mess of cancerous scar tissue which was surgically removed. I've learned there are delicate places that should not be irradiated, I opt for surgery now and chemo for a final rinse. Cryo and Microwave ablation in organs is an option. So, for me I use scans to locate any growth, confirm with a biopsy by a good interventional radiologist and either radiation or surgery depending the location. Don't be bashful with your ideas and instincts.

[Linebacker75 in reply to awb1]

thanks for the reply, awb1. You didn’t comment about any spine, rib or pelvic metastasis did your cancer skip over the more common areas on the way to your lungs and neck area? In my case that part is puzzling my Docs. My RO says it’s likely in those boney areas but currently too small for imaging to show or that all the orthopedic metal in my back and hips is shadowing/hiding mets with artifacts on the images. My MO says he can’t say for sure and we need to wait and see. My radiologist that read the imaging is calling 3 of my sc nodes mPCa even with the low SUV. I like TAs suggestion that they may be false positive but if they’re mPCa I want to have them radiated or removed asap. I’m having a head and neck ultrasound and Ct scan Dec 1st and hope they can get the biopsy accomplished then. Having a PSA/T blood draw, Lupron shot and follow up with MO this Tuesday so it’s looking like I’m in a holding pattern for answers until at least Dec

I appreciate your reply,

Keep up the good fight my brother (s)

Linebacker75/ GB

[awb1 in reply to Linebacker75]

I've had a number of nodules in my upper chest, neck, and lungs, never in the bones. I rely on biopsy confirmation to treat. 15 years ago, there was once a "suspected" node in my iliac, biopsy failed to confirm. My doctors are confused sometimes too. You don't have to biopsy every node, just one in the area. Good luck! Sorry you have so metal in your body. I'm guessing you had a lot of gridiron action from your name.

[Linebacker75 in reply to awb1]

hey awb, thanks for the info. Yes I did play some ball 🏈 on the defensive side of the line and continue paying the price yet still today. Those were my young dreamer days when I was just sure the NFL was in my future but alas no NFL for me. Nobody told me only the top .10% will get that call and then few are good enough to make a career out of it. Oh well, I got to hang with the cheer leaders.

Keep up the good fight and God bless brother.

[awb1]

My neighbor played 8 years as a starting offensive tackle on a super bowl winning team in the 1970s. He's a sweet and kind man but suffers from severe anatomical and brain damage. He can tell you about plays, games, team mates, coaches, and high school days but he can't remember anything from the last several years, or more than than the last 10 seconds of a conversation we're having. He's really good at faking it. I'll take my cancer to a brain injury, but we don't really get to make those choices. And your cheerleaders! Good luck with your medical care!

[Linebacker75 in reply to awb1]

That’s sad. Our equipment back in those days wasn’t too good at protecting the old noodle and those in that .10% I spoke of could hit you so hard we were cross eyed and our ears still ringing the next day. I agree this cancer is a better choice than what your neighbor is living today. No amount of prestige and money is worth how he has lived and will live out the rest of his days.

Good luck back at ya brother.