PSMA Score 5

[Debelios]

My husband has a PSA of 0.97 following a prosatectomy 10 years ago and radiation. He is on Zytiga but PSA doubled in the last 6 months. He had a PSMA Scan this past week and came back with a Score 5. Wondering if anyone else out there has gotten this result and what the next line of treatment is. We haven't reviewed results with the doctor yet.

[Hidden]

PSMA does not use scores, as far as my last four show. Can you quote the statement that uses the number 5?

[Justfor_ in reply to Hidden]

I think that my eye caught somewhere they are on the way to establish a scale for PSMA imaging along the lines of PIRADS for mpMRI. It must be quite fresh.

[Debelios in reply to Hidden]

PSMA standardized reporting guidelines:

Score 1: Benign lesion without abnormal PSMA uptake.

Score 2: Probably benign lesion: faint PSMA uptake (equal or lower than background) in a site atypical for prostate cancer.

Score 3: Equivocal findings: Faint uptake in a site typical for prostate cancer or intense uptake in a site atypical for prostate cancer.

Score 4: Probably prostate cancer: Intense uptake in typical site of prostate cancer, but without definite findings on CT.

Score 5: Definite evidence of prostate cancer: Intense uptake in typical site of prostate cancer, with definite findings on CT

[MateoBeach]

Yes, he needs to discuss the results in person with the doctor (MO or RO). The scan is to show exactly where remaining cancer exists (sights and amounts that express PSMA and light up). That will clarify treatment options that may be appropriate. The lesions on the scan are graded in intensity of PSMA expression called SUVmax. Each lesion would have its own such score. He could also request the full report from the radiologist that read read the scan.

[j-o-h-n]

Greeting Deb, Can you please gives us more data regarding your dear Husbands bio. All information is voluntary but it helps us help him and helps us too. If you do, add it to his bio page. Thank you!

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/11/2023 6:49 PM EST - Honor our Veterans.

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

Clinical history: 53-year-old male with history of prostate carcinoma. Examination performed to evaluate biochemical recurrence.

Patient has a PSA value of 0.97. Following prostatectomy and local therapy patient had a PSA nadir was 0.19.

Early degenerative changes in addition to prostatectomy and pelvic radiation patient received hormone and is on oral chemotherapy Zytiga

Scan technique: Following IV administration of the F18-DCFPyL radiopharmaceutical, images were acquired using a Siemens Biograph PET-CT scanner. A low-dose CT scan was performed for attenuation correction and anatomic correlation only. If a comprehensive diagnostic CT is required, the Department of Radiology should be consulted for an adjunct CT study. Images were reviewed in the axial, coronal, and sagittal planes. For descriptive purposes, the maximum standard uptake value (SUV max) of radiotracer-avid tissues is reported in g/mL, unless stated otherwise. The image number corresponding to the CT series is provided in reference to findings

Tracer information: Measured (injected) dose: 8.3 mCi of F18-DCFPyL.

Injection site: Right Antecubital.

Anatomical region: The area imaged included the vertex of the head to the proximal tibia.

Comparison: Prior Axumin PET/CT April 2019. Bone scan February 3, 2022. CT scan chest abdomen pelvis to 3.2.

SUV maximum reference measurements:

Blood Pool: 2.1 max.

Liver 6.6 max.

FINDINGS:

F18 DCFPyL PET: Physiologic distribution of tracer is seen salivary and lacrimal glands, blood pool, liver, spleen, pancreas, ganglia, bowel, kidneys and urinary tract.

Evaluation of the prostate bed:

There is no focal PyL uptake in the prostate bed to suggest local recurrence.

Evaluation of lymph nodes:

Increased focal PyL uptake within the previously described enlarged left common iliac nodes. On the low-dose CT cuts obtained for attenuation purposes these are slightly smaller than February 3, 2022 exam and larger than the prior PET/CT 4/5/2019.

On the current CT obtained for attenuation purposes as well as prior diagnostic CT arcuate configuration of the elongated node is seen distending from the aortoiliac bifurcation to the left common iliac region extending in length on prior exam for 5 cm

Bidirectional measurement on CT image 3051.2 cm x 1 cm

*Proximal left common iliac node at the aortoiliac bifurcation, SUV maximum 8.9.

*Left common iliac node at the adjacent more inferior slice 3.8 .

Osseous assessment:

Region of sclerosis in the right iliac bone measures 1.8 cm, axial image 390 has mild focal PyL increased uptake with SUV maximum 2.4. Region of sclerosis seen on diagnostic CT of February 3, 2022 measures 1.5 cm. On prior PET/CT the sclerotic metastasis measured 1 cm.

Additional PET CT findings:

Left vocal cord paralysis with enlargement of the left laryngeal ventricle and left perform sinus. Atherosclerotic aorta. Coronary calcifications. Penile implant.

IMPRESSION:

1. Tracer avid uptake at the site of the arcuate-shaped enlarged nodal/nodes along the left common iliac chain. These are larger than prior exam in 2019. Corresponding nodal mass was similarly seen on diagnostic CT February 3, 2022

2. Increased tracer uptake at the site of enlarging sclerosis right iliac bone measuring 1.6 cm with standard uptake value maximum less than liver.

Score 5: Definite evidence of prostate cancer: Intense uptake in typical site of prostate cancer, with definite findings on CT

PSMA standardized reporting guidelines:

Score 1: Benign lesion without abnormal PSMA uptake.

Score 2: Probably benign lesion: faint PSMA uptake (equal or lower than background) in a site atypical for prostate cancer.

Score 3: Equivocal findings: Faint uptake in a site typical for prostate cancer or intense uptake in a site atypical for prostate cancer.

Score 4: Probably prostate cancer: Intense uptake in typical site of prostate cancer, but without definite findings on CT.

Score 5: Definite evidence of prostate cancer: Intense uptake in typical site of prostate cancer, with definite findings on CT

[j-o-h-n]

To Debelios, Re: Your dear husband's bio.

Thank you for your quick and detailed response. It would be a good idea to copy and paste it in his/your bio area in his/your home page. Keep posting here for information. God Bless.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/13/2023 9:46 AM EST