Seeking feedback on PSMA Scan results after 6 chemo treatments

[Skifanatic]

Am at Mayo today for scans/bloodwork after 6 chemo (docetaxel + Carboplatin) treatments. My PSMA Pet Scan results are below. I was hoping for more dramatic improvement, but I am grateful for ANY improvement (or stabilization). I meet with my doctor early tomorrow morning. Eager to hear any insights & observations the group has, or questions I should be asking. I’m thinking that he might want to send me back for a couple more chemo treatments; might also be looking at Lutetium-177. Also, my somatic mutation (not sure I’m saying that correctly!) analysis came back positive for ATM, which appears to qualify me for Lynparza for treatment at some point. Any thoughts and/or suggestions welcome! THANK YOU.

IMPRESSION:

Further improvement in size and intensity of uptake in multiple nodal and osseous metastases. Numerous additional osseous and nodal metastases are not significantly changed.

miPSMA Expression Score: 3

COMPARISON: PET/CT 1/10/2023, outside PET/CT 9/26/2022, CT chest abdomen and pelvis 10/19/2022.

INDICATION: History of prostate cancer status post chemotherapy with docetaxel plus carboplatin, currently on antiandrogen therapy with darolutamide. Subsequent treatment strategy. PSA: 0

FINDINGS:

PROSTATE: Brachytherapy seeds within the prostate. Mild diffuse PSMA uptake throughout the prostate without abnormal foci of activity above background.

LYMPH NODES: Continued decrease in size and PSMA activity throughout previously identified bilateral common iliac and retroperitoneal lymphadenopathy. For example, an aortocaval lymph node now demonstrates SUVmax 10 (image 255), previously 27.5 with size 6 mm, previously 18 mm.

Overall decreased size and extent of previously seen mediastinal, bilateral perihilar, and supraclavicular lymphadenopathy. For example, a precarinal lymph node now measures 1.3 cm with SUVmax 27.6 (image 139), previously 1.7 cm with SUV max 36.3. A left supraclavicular lymph node demonstrates SUVmax 13 (image 112), previously 26.7. A few additional mediastinal lymph nodes demonstrate increased activity, however are not changed in size.

OSSEOUS DISEASE: Persistent radiotracer uptake throughout scattered osseous metastases, again involving multiple vertebral bodies and bilateral ribs. The greatest region of uptake is within in

the L3 vertebral body with SUVmax 12 (image 238), previously 25.7. Uptake is not significantly changed within the majority of the osseous metastases. A few osseous lesions, for example in the T10 and T12 vertebral bodies, demonstrating increased PSMA activity, without appreciable change in volume of uptake and without clear underlying anatomic lesion. No new foci of osseous metastatic disease.

OTHER METASTATIC DISEASE: No additional foci of metastatic disease.

[tango65]

It seems there was a reduction in the tumor load since several mets are smaller and new mets were not detected.

Since the SUV values of mets are higher than the usual PSMA of the liver you should request Lu 177 PSMA treatment .

High PSMA expression is associated with better response to this treatment. Consider to discuss about a 18F NaF PET/CT before doing Lu 177 PSMA treatment.

[Skifanatic in reply to tango65]

I also had an MRI done later in the day which basically supported the PSMA Pet Scan findings. The MRI report — excerpt follows — noted that there were no lesions on the liver.

FINDINGS: Tiny hepatic cysts. No suspicious liver lesions. Normal gallbladder, pancreas, spleen, and adrenal glands. Tiny renal cysts. Brachytherapy seeds in the prostate. Colonic diverticulosis. Small fat-containing inguinal hernias.

Did you mean to say “liver” in your note? I will talk to my doc about the Pylarify Pet Scan, thank you for the suggestion.

[max00]

Skifanatic, I sent a brief chat to you a few minutes ago. This is the first chat I've ever sent, so hopefully you've received it. !

Max00 (Terry)

[max00 in reply to max00]

You might also enter "Lutetium" or "PSMA scan" into the search box at the top right.

[Skifanatic in reply to max00]

Got it. Thanks! Just boarded flight home…will do some research on the way.