First PSMA Scan after 3 months radiation to lymph nodes

[Wloi]

Since my PSA rose from 0.18 (2 months post radiation) to 0.22 (3 months post radiation), I have another PSMA scan before starting any further treatment. Pre-RT PSA is 0.5.

The report wrote, as compared to the PSMA done in Jul22:-

After RT, the prior small node has improved. The other tiny node shows no obvious uptake.

A pre-existing small left paraaortic L3 level node shows new subtle update (SUVmax = 2.7). Nature is indeterminate. Monitoring is recommended.

My doctor said given the position of the node, radiation is not recommended, but he will consult his partner (clinical oncologist) to be sure.

Other areas are clean.

I am very disappointed of the new finding.

I was given a shot of Enantone today and the next shot will be in Apr.

I would appreciate if any experience that you can share on the prognosis of my situation.

[Tall_Allen]

Is your PSA rising while you are taking ADT?

[Wloi in reply to Tall_Allen]

Hi TA, No. My first ADT shot was done yesterday. It seems that the light PSA rising comes the L3 LN. The LN position is as high as my belly button.

[MateoBeach]

A newly identified node at L3 expressing PSMA is presumptively cancer. I would seek SBRT to treat it now and not wait on it. (Read my prior posts, I did exactly that in April 2022.) if there is difficulty targeting it with adequate margins, treatment tumor volume of radiation due to nearby organs at risk, then discuss referral to a more precision treatment center with MRI guided VMAT technology (MRIdian VMAT).

I then chose to go to GenesisCare Dr. Nat Lenzo in Perth for two injections of Lu-J591, two weeks apart, to go after any unseen but like.y remaining micro metastases. Virtual consult available via TheranosticsAU and can send him CD or online access to your PSMA scans. See my posts over past 8 months for more details, if interested. Paul

[Wloi in reply to MateoBeach]

Hi MateoBeach,

Thanks for sharing. My MO will assess the possibility of radiation. As the position is as high as my belly button and so close the aortic, I am not sure if this is doable and also afraid of the long term SD. Based on your experience, it seems Lu-J591 might be a good choice to treat micro cancer cells after radiation. I will check with my MO too. TBH, it is very frustrating to see the report that another small LN is metastasized right after pelvic radiation.

[MateoBeach]

You are low volume, metastatic LN only and mHSPC. Same with myself.