Halfway through chemo, new scans, seeking advice

[Skifanatic]

Have now completed 4 of 6 Docetaxel/Carboplatin treatments and went to Mayo in Rochester for PSMA Pet scan (Ga-68, see results below). My PSA remains undetectable (<0.05), which, given my historically low PSA, is probably not the Most reliable indicator but I assume means the Lupron and Nubeqa might be working and at least some of my PCa is castrate-sensitive? My doctor says the results are what he would hope to see at this stage: reduction in size of existing tumors, no new sites and comparatively less SUV scores (even with more sensitive scan technology at Mayo than prior scan). I will complete treatments February 27 and return to Mayo for more scans on March 30, then consider Lutetium-177 if warranted. Wondering if I’m missing anything in my reading of these scan results and if anyone has any other thoughts or advice or for me at this point in my treatment plan. Thanks!

IMPRESSION:

Interval mild reduction in size of some of the previously seen widespread metabolically active nodal disease, although significant PSMA avidity still remains both in the previously seen nodes as well as multifocal osseous metastasis.

miPSMA Expression Score: 3

COMPARISON: 09/26/2022

FINDINGS: Compared to prior examination, and allowing for differences in technique, there is mild interval treatment response with primarily reduction in size of the PSMA avid previously seen retroperitoneal lymphadenopathy. For example, one of the previously seen and a larger left periaortic lymph nodes measured 1.2 x 1.2 cm and now measures approximately 9 x 9 mm, though still demonstrating intense PSMA localization (SUV max 10.1). Similar mild improvement is also noted within the other nodal basins previously involved including the bilateral iliac, subcarinal, bilateral hilar, pretracheal, prevascular, and bilateral supraclavicular nodes. Persistent radiotracer uptake is also noted within the multiple scattered osseous metastases, most prominently involving C2 vertebral body (SUV max 12.2), T10, L1, L2, and L5 vertebral bodies as well as multiple ribs and involving the pelvis. The the largest osseous metastasis continues to be in the L3 vertebral body filling almost the entire vertebral body (SUV max 25.7).

[Tall_Allen]

Pluvicto is a good choice, but you may want to look into the following non-randomized clinical trial which is currently occurring at Mayo Rochester where you are being treated:

clinicaltrials.gov/ct2/show...

[Skifanatic in reply to Tall_Allen]

Thanks TA. I will definitely ask about it.

[JaM6252005 in reply to Tall_Allen]

can a psma pet scan pick up psa at 0.05

I thought it needed to higher?

[Skifanatic in reply to JaM6252005]

One can definitely have low/undetectable PSA (bio marker circulating in blood, as I understand it) and high amounts of PSMA (bio marker on PCa cells). PSA for me has always been a very unreliable indicator of the presence and growth of my cancer, which is why the PSMA PET scan has been so helpful. I wish I had been able to get one earlier in my cancer journey, but grateful for the view it’s providing now!

[Clays711 in reply to JaM6252005]

I have PSA <0.02. PSMA PET pics up my bone mets. They have low PSMA values. How they are evaluated between Cleveland Clinic and Mayo is different in the radiologist's opinion section of the report. Cleveland Clinic says the bone is healing and Mayo says it's stable.

[Tall_Allen in reply to JaM6252005]

You are right. For most men, a PSA of at least 0.5 is required. The notable exceptions are when PSA is increasing rapidly (e.g., PSADT<3 months) or if you have a very rare low-PSA subtype.