PSMA scan shows rib met

[John347]

Hi, as seen from the report of the PSMA scan there is a single spot on my 6th left rib that is suspicious of bone metastasis.I will be consulting with my MO in about 3 weeks time. In the meantime, I like to hear what you guys suggest is the best treatment choices I should pursue.

A little background info...

I had Gleason 7(3+4), opted for 20 sessions of IGRT, PSA decreased to 0.5 after RT last September and has since increased to 5.6.

I also had a 3 month shot of lupron last June.

Thank you for any advice.

[mrscruffy]

I have had the occaisional met in my spine radiated. For me, easy peasy

[John347 in reply to mrscruffy]

Thank you for your response. The MO did say before the scan that if only 1 or 2 met spots are found then targeted radiation is the likely treatment.

[Tall_Allen]

Low avidity rib metastases may be a false positive. If it disappears after going back on ADT, that will confirm, or you can biopsy.

[John347 in reply to Tall_Allen]

Thank you TA for your reply. The report said "moderately tracer-avid" not low. Anyway, will enquire from MO the possibility of false positivity.

[fmenninger]

Any reason why your psma pet scan report was conducted without contrast?

[John347 in reply to fmenninger]

No idea why the scan was done without contrast. I will check with the MO. Thank you.

[fmenninger in reply to John347]

Good question. is it possible to have the option of with or without contrast with radiologand IV injection?

[tango65]

You could request a 3T MRI of that rib to see if the met is confirmed.

[John347 in reply to tango65]

Thank you Tango, I will discuss the suitability of 3T MRI with my MO.

[EdBar]

I had a similar experience recently, my PSA became detectable again after a long stint of being undetectable. When it approached a level of 0.2 my MO Dr. Sartor, advised me to get a PSMA scan. It show a highly suspicious area of uptake on my 9th rib. I had 3 doses of SBRT to that spot back in January. The fist PSA result after radiation showed a 30% decrease in PSA. I’m due for the next PSA test in about two weeks. We’ll see if it holds there or shows further decline. It would be nice to get back to being undetectable or have PSA stabilized.

Ed

[6357axbz in reply to EdBar]

did you ever take an adt holiday?

[EdBar in reply to 6357axbz]

No, I was told that I could but if it works don’t fix it.

[dhccpa in reply to EdBar]

What's it like getting single Mets zapped? How long a process is that, and how burdensome?

[6357axbz in reply to dhccpa]

for me very easy. 3 short daily sessions on the zapper table. No prep needed. Zero SEs

[John347 in reply to EdBar]

Hi Ed, are you on ADT currently - lupron or something else? I'm hoping I don't have to go back on ADT cos of the SE.

[EdBar in reply to John347]

I’ve been on triple hormone therapy since the start - Lupron, Xtandi and Avodart.

Ed

[EdBar]

Very easy, one mapping session and three treatment sessions. SE’s were some pain at the site radiated for about a week after and some fatigue for a week or so. Treatment sessions were 20 minutes or less.

Ed

[John347 in reply to EdBar]

Thank you Ed. Was wondering how many sessions I have to undergo.

[Peace-to-you]

Find a very good radiation oncologist to look at the scan and recommend treatment…don’t just rely on your MO…do it simultaneously so you don’t loose time.

[John347 in reply to Peace-to-you]

Thank you for your reply. Will do that .

[j-o-h-n]

How are the Medical personnel in Singapore?.....We have a future 2 hour lay over there and I though maybe I can get a quick DRE in the airport...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/08/2023 7:09 PM EST

[John347 in reply to j-o-h-n]

Very professional and highly qualified. Comparable in standard to US or Australia at a fraction of the costs.

[fmenninger]

gotcha….I do know the cost of the 5cc radiotracer injection! $3K

[j-o-h-n]

Definition of a gross mistake, 143 Talented IT guys.....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/08/2023 9:41 PM EST

[j-o-h-n]

Of course, it's electric powered.....and pedals.....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/08/2023 10:31 PM EST

[John347]

So, it's a joke...I should have known...2 h stopover, DRE. 😂

[Dlanghorne]

I also had a PSMA/PET scan showed a spot on T11 rib at spine. MO scheduled radiation to "kill" it Had SBRT 5 times without any issues. Hope took care of it. Will scan again in future.

I would not ignore it but radiate to be sure it is ok.

[John347 in reply to Dlanghorne]

Thanks Dlanghorne for your reply. Did you have any other treatments to deal with the met, such as ADT?

[Dlanghorne in reply to John347]

Have been on ADT (Zytiga + Lupron + Prednisone) since 2019. The one spot on T11 (thoracic spine) shown in the PSMA/PET (January 2023) scan was radiated 5 times in February 2023. That was the only PC to show up? Will have another scan sometime in future to check again. Not sure when? Radiologist expected 80% kill on the T11 spot.

[John347 in reply to Dlanghorne]

Thank you Dlanghorne for your reply. I have read elsewhere that suspected rib mets often turn out to be false positive.

I am hoping, if the met is is confirmed, to just have the radiation therapy to the spot without ADT. May I know what side effects you have from the ADT?

[Dlanghorne in reply to John347]

Normal fatigue and hot flashes. But surviving for now. Felt SBRT to "guarantee" no issues. This was the ONLY spot on the PSMA/PET scam so felt it was important to kill it now. We will see in future scans?

[John347 in reply to Dlanghorne]

Thank you. Wishing you all the best for your future scans.

[deepika_agnihotri]

If this is painful, then local radiotherapy to the lesion will be an ideal treatment choice.