PSMA PET Scan Shows no mets?!

[groth12345]

I have/had Stage 4, Gleason 8/9 prostate cancer now for 2 years. 5 mets including 4 rib and 1 shoulder blade. Possible lymph node involvement.

Went on Lupron and Zytiga. Radiation of prostate after 8 months of ADT. I've had now 4 PET scans. The latest was yesterday, as reported below.

It says now there are no mets or lymph node uptakes. My MO says there could be microscopic cancer cells lurking. I would like to get off ADT at some point soon.

Does anyone else have experience with this situation?

Thanks,

Steve

FINDINGS:

Reference SUV max:

Blood pool SUV: 1.4

Parotid gland SUV: 8.7.

Liver SUV: 4.7

TUMOR (known or suspected): Patient carries a history of prostate cancer. Mild prostatomegaly with impression on the bladder base. Low-grade radiotracer uptake is again seen within the prostate gland, SUV max 2.8, similar in extent and distribution from prior study.

LYMPH NODES (regional): None

METASTASES (known or suspected): None

OTHER ONCOLOGIC AND/OR ACTIONABLE: Patient has history of previous osseous metastases.

Low-grade radiotracer uptake within the anterior left fourth rib without CT correlate (SUV max 2). Additional previously identified osseous lesions are without radiotracer uptake.

ADDITIONAL FINDINGS: Cardiomegaly. Coronary artery calcifications. Stable bilateral parapelvic renal cysts. Retroaortic left renal vein.

IMPRESSION:

History of prostate cancer.

Persistent low-grade radiotracer uptake within the prostate gland without focally increased radiotracer uptake. No definite local tumor recurrence. Continued attention is recommended on subsequent surveillance studies.

No hypermetabolic lymphadenopathy or distant metastatic disease.

Low-grade radiotracer uptake within the anterior left fourth rib which is CT occult and nonspecific. Attention recommended on subsequent surveillance imaging studies.

END OF IMPRESSION

[Tall_Allen]

This may help:

prostatecancer.news/2023/04...

[groth12345 in reply to Tall_Allen]

Thanks. Very confusing which way to go. I guess I'll leave it up to my local MO and second opinion RO at MSK.

[Tall_Allen in reply to groth12345]

It's a decision only you can make.

[addicted2cycling in reply to groth12345]

They advise - YOU decide.

[groth12345]

I agree. Only bad side-effects of ADT for me are lack of muscle tone, fatigue (usually in the mid-afternoon) and of course no sex. Otherwise fine. My local MO suggested on the last scan to continue ADT indefinitely as long as it's working. I guess I could live with that. I am taking Calcium supplements and having blood draws 1x/mo.

[EdBar]

I agree with your MO, your cancer could be suppressed and entered a dormant stage due to ADT. I don’t know what your PSA is but if it is undetectable or extremely low that would lessen the chance of anything showing up on a PSMA scan.

Ed

[groth12345 in reply to EdBar]

Right. PSA and Testosterone are undetectable and have been for at least a year.

[EdBar in reply to groth12345]

No need for PSMA scan with undetectable PSA. I’d stay on ADT though. I was undetectable for about 6 years but it didn’t mean I was cured, cancer was in dormancy.

[groth12345 in reply to EdBar]

So are you still in dormancy? How would you or I know if/when we are cured? There is a small chance of that but no way to tell. Are you on Lupron/Zytiga? I wonder if I can get off Zytiga and stay on Lupron.

[EdBar in reply to groth12345]

last year I became resistant and PSA started to rise although still low. I got a PSMA scan when PSA reached 0.2 and it showed a highly suspicious spot on my rib. Treated it with SBRT and PSA is in decline. Hopi I can reach undetectable again. Just continue to monitor your PSA if it increases that means cancer is no longer dormant and is resistant. Don’t play around with metastatic cancer.

[groth12345 in reply to EdBar]

I agree. Don't want it to get in control. BTW, what hospital is treating you? I asked URMC (Rochester, NY) to treat the rib mets and they were reluctant. MSK however said that could. As it turns out, I had no pain since very low volume and they went away on their own (shrunk).

[groth12345 in reply to EdBar]

I see that you are being treated by Dr. Sartor in NOLA at Tulane Medical Center. Good luck with your continued program. I am wondering if you have tried Lu-177?

[EdBar in reply to groth12345]

Yep Sartor is great although he has recently joined Mayo in Rochester MN. I plan on traveling up there for a visit this summer. When he was at Tulane I’d see him twice a year and he would coordinate with my local MO. I want to hold off using Lu-177, you’re running out of bullets at that point, hoping to try BAT next if necessary.

[groth12345 in reply to EdBar]

Thank you for your input. Best of luck.

[rsgdmd]

Did previous PSMA PET scans show more SUV?

[groth12345 in reply to rsgdmd]

Yes, prior PET scan 10 months ago showed 4 mets. One before that was 5 mets and possible lymph node involvement. Now no detectable mets or lymph node findings.

[rsgdmd in reply to groth12345]

That's a great response to treatment!

[groth12345 in reply to rsgdmd]

Lower SUV. Now nothing detectable except small residual possibly in 4th rib and prostate.

[dhccpa in reply to groth12345]

Those are great results. But most knowledgeable folks on this forum say that merely means the treatment is working. You stop it, it stops working.

[groth12345 in reply to dhccpa]

Yes, I understand. I wonder if there is any chance of someone who has/had Stage 4 can be cured?

[dhccpa in reply to groth12345]

I'm Stage 4 with multiple Mets, 5 years now. No cure according to current wisdom. Many, including many on here, do numerous "alternative" things to supplement (not replace) treatment, including me.

Those include radical changes in diet, supplements, and regular sustained exercise.

[groth12345 in reply to dhccpa]

I haven't changed my diet much, although I plan to get rid of the 5 pounds I've gained over the past 2 years since diagnosis. I exercise a lot which helps. I also take Calcium/D3, Iron, Glucosamine Chondroitin and Magnesium supplements.

BTW, my PSA never went above 1.90 at diagnosis. I was on Finestride which lowered the number somewhat.

[dhccpa in reply to groth12345]

You'll hear all kinds of info on here.

[groth12345 in reply to dhccpa]

Right. Everyone's different.

[joeydashoe]

Same situation GL9 mets to Lymph nodes after 2yrs lupron,zytiga,pred. got clean scan Mo is keeping me on meds.

[groth12345 in reply to joeydashoe]

Thanks. I think I will go by the MO but it's good to get everyone's opinion.

[Derf4223]

" Coronary artery calcifications" do you take D3, K2, magnesium and collagen peptide supplements?

One needs to be acutely aware most men with PCa succumb to heart/coronary disease...

[groth12345 in reply to Derf4223]

Understood. I do take Calcium with D3, K2. Also Magnesium. No collagen peptide supplements. What is the latter good for?

[Derf4223 in reply to groth12345]

Collagen is the other major structural element of bone matrices, and critical to many other body areas. My wife and I went vegan/vegetarian shortly after my PCa Dx, and later we both got bone scans showing osteopenia. My MO put me on Prolia immediately upon seeing my DEXA results. Vegan/vegetarians do not get a lot of collagen from food.

[groth12345 in reply to Derf4223]

I see, thanks. I am not a vegetarian and my Dexascan was OK a year ago.

[lowT163]

you will never get an answer for that one. If it’s out it’s out and we will never know when it will return. My mo is in the group that says 18 months of adt either gets it or it never will. I was started on a 24 month schedule then they decided 18 was just as good so that’s where they stopped. Right or wrong who knows. It’s been 3 years and my psa goes up and down with the Testosterone . Still have my prostate also .

Testosterone hit 300 once and psa went to .12. Testosterone goes down to 150 where it is now my psa is .07. Before testosterone of 150 it stayed at .04 for almost 30 months. Off ADT is better than on for sure but without testosterone not much.

Good luck

[groth12345 in reply to lowT163]

Thank you. Hard to know what to do.

[groth12345]

I met with my MO today. He suggested reducing the Zytiga dosage from 1000mg/day to 500mg/day. Has anyone else tried this successfully by keeping the PSA/Testosterone undetectable?