PSA and CT Questions -- 15 Months Following Diagnosis

[Merlot1]

I would appreciate your feedback on whether the recent small increase in PSA from 0.06 to 0.08 ng/mL for my 90-year-old dad is potentially significant. He is one year into ADT. Also, a CT abdomen/pelvis scan conducted yesterday revealed "sclerotic bony lesions". There was no mention of sclerotic bony lesions in his 12/2021 CT. The bone scan and CT abdomen/pelvis summaries seem contradictory to me. See below for exact wording from report. Dad has an appointment to discuss results with his doctor on 2/9. See profile for treatment and other details.

PSA levels: 10/13/21 -- 1,130 ng/mL, 1/28/2022 -- 15.67, 4/4/2022 -- 0.67, 10/18/2022 -- 0.06, 1/10/2023 -- 0.08 (0.05 free PSA). Free PSA not previously measured.

1/9/2023 CT abdomen/pelvis impression: 1. Decrease in size of the prostate gland and right-sided pelvic adenopathy without new adenopathy. 2. Numerous sclerotic bony lesions likely representing metastatic disease increased in size and number since prior CT examination.

1/9/2023 bone scan impression: Redemonstration of multiple foci of abnormal radiotracer activity involving the right humerus, sternum, ribs, spine, sacrum, pelvic bones, and proximal femurs, which has decreased in intensity compared to 12/9/2021, particularly with prominently decreased rib activity. No definite new abnormal foci of radiotracer activity.

Thank you in advance! Andrea

[Tall_Allen]

The PSA is low, and no cause for treatment change.

You wrote: "There was no mention of sclerotic bony lesions in his 12/2021 CT. " But profile indeed says "12/9 nuclear whole-body bone scan and pelvic/abdominal CT scan revealed enlarged prostate with possible invasion of bladder, mets to pelvic lymph nodes and bone (spine, ribs, sternum, sacroiliac joints, femurs, humerus, scapulas and skull)." What is the contradiction?

[Merlot1 in reply to Tall_Allen]

Thank you, Tall Allen for your prompt response. Glad to hear that about the PSA. The CT said that sclerotic bony lesions likely representing metastatic disease increased in size and number since prior CT examination while the bone scan said that everything decreased in intensity since the 12/2021 scan. One seems to imply things are going in the wrong direction while the other says the opposite. Or at least that's how it reads to me. Please explain why that isn't the case. Also, why is the term sclerotic bony lesions used now when it wasn't used before? Is there any significance to that?

[Tall_Allen in reply to Merlot1]

OIC - IDK why size and number increased but uptake didn't. No significance to "sclerotic" mention on bone scan - they were sclerotic both times - that's what bone scans detect. CT can show non-sclerotic lesions, but they would have mentioned it if there were any (non-sclerotic is uncommon with PCa)

[Merlot1 in reply to Tall_Allen]

Thank you. Very helpful information.