Can anyone tell me what this means?

[Clutch2026]

EXAM: PYLARIFY (F-18 piflufolastat or 18F-DCFPyl) POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY, SKULL BASE TO MID THIGHS  CLINICAL INDICATION/HISTORY: Prostate adenocarcinoma treated with prostatectomy and radiation therapy, ADT. Subsequent treatment strategy.  COMPARISON: Pylarify PET CT 5/9/22. Also PET/CT 12/8/2021 TECHNIQUE:  Radiopharmaceutical: 10.64 mCi PYLARIFY (18F-piflufolastat) IV.  Beginning 60 minutes after i.v. administration of radiopharmaceutical, PET imaging was performed from mid thighs to skull base. CT was performed just prior to PET, after administration of oral contrast only, to provide attenuation correction and anatomic localization/"fusion" for the PET. CT images acquired with PET are not standard diagnostic CT, limited, for example, by lack of i.v. contrast and respiratory motion. FINDINGS:  PET/CT:  Sampled SUV mean of blood pool activity: 1.4Sampled SUV mean of physiologic bone marrow activity (sampled at L3): 0.4Sampled SUV mean of physiologic hepatic activity: 6.6 No suspicious uptake at head or neck. Expected physiologic activity. There is focus of activity RIGHT third rib in the midaxillary line (63) without definite underlying CT abnormality. Max SUV 2.0. Not seen on previous Pylarify PET/CT but visible on previous FDG PET/CT 12/8/2021. Stable 4 mm nodule RIGHT upper lobe (59) since 7/20/2021 without increased activity. Tiny foci of activity and the retrocaval region described previously with Max SUV 0.9 and probably corresponding to lumbar vessels. There is a 4 mm preaortic lymph node with Max SUV 0.9 (121) also stable in size and previously max SUV 1.6. At the pelvis, the low attenuation fluid collections in the external iliac regions have essentially resolved-seromas or lymphoceles. Blood pool activity of vascular structures. No convincing lymph nodes showing increased activity. No recurrent activity at the prostatectomy bed. The distribution of radiopharmaceutical otherwise appears physiologic. No additional focal abnormal increased radiotracer uptake suspicious for prostate cancer is seen.  ADDITIONAL UNENHANCED CT FINDINGS: Granuloma LEFT lower lobe. No hypermetabolic activity at density anterior mediastinum measuring 22 x 19 mm in 2021 14 x 20 mm. No mass effect on adjacent structures. No hypermetabolic activity on PET/CT 12/8/2021. Umbilical hernia containing fat.   IMPRESSION Activity RIGHT third rib again seen, visible on a December PET/CT - might be metastasis although no definite CT abnormality. Trauma seems less likely. Could correlate with MRI if clinically warranted. No activity at a stable RIGHT upper lobe pulmonary nodule, probably benign. Tiny retroperitoneal lymph nodes appear similar to prior, without increasing activity, suggests benign etiology. Interval resolution of seroma/lymphoceles in the external iliac regions bilaterally. Density in the anterior mediastinum probably thymic rebound, although unusual at this age, and less likely thymoma. Not likely metastatic disease. Signed By: Sarah C Shaves, MD on 11/22/2022 8:49 AM 

[Tall_Allen]

Congratulations. Nothing definitive was seen. The slight rib activity isn't correlated with a lesion on CT, so it is likely a false positive. Why did you have that PSMA PET/CT scan?

[Clutch2026 in reply to Tall_Allen]

not sure why the Dr. Order a 2nd PSMA PET/CT. I completed 38 session of radiation to pelvic bed after which my psa has been 0.1.

[Tall_Allen in reply to Clutch2026]

Your doctor should not be ordering random tests without first explaining to you the possible difference it could make in your treatment.

[tango65]

I believe the study shows that there is not evidence of mets or recurrence of the cancer in the prostatic fossa.

If there is doubt about the rib findings , they could do a MRI to check if the bone marrow is OK at that point.

The SUV value in the rib is only 2 , most probable a false positive. This situation has happened to me a couple of times and the MRIs were always normal.

[Fightinghard]

clutch

No expert here. But my read it is generally great news. No new focal areas listed and several stable for over a year.

Keep on keepin on

[Adlon57]

Yes they like to make it sound complicated, have to read hard, between the lines, sounds encouraging👍

[jazj]

Just keep in mind, realistically, PSMA PET results are not definitive due to limited sensitivity. But they are more sensitive and therefore more useful for detecting areas having possible Prostate Cancer than an MRI or CT Bone Scan. So your results are encouraging.