Confusing CT scan results

[Jens99]

My PSA has been rising slowly after prostate removal two years ago. Was at zero months after and slowly rising at .02,.03. .05, .06. .09 and then .13. My doctor ordered CT and bone scans. Bone scan came back clear and then CT scan showed a few things in bones and a nonspecific mass outside the liver. Doctor confused and concerned this could be another primary cancer. Anyone else have had this happen to them? Doc ordering a PSMA test to see what is going on.

[LowT]

Get a prostate MRI with and without contrast.

My story is similar to yours and it discovered a new enhancing nodule in the prostate bed.

[Jens99 in reply to LowT]

Sorry to hear that. What is your treatment for that?

[Tall_Allen]

Let us know what the PSMA PET scan tells you. If it isn't in those distant locations, you can still have potentially curative salvage radiation.

[Proflac in reply to Tall_Allen]

Is PSMA scan at this PSA level useful. I think I'm a bit confused about when this scan should be employed. Any reading to help?

[Tall_Allen in reply to Proflac]

No, it will probably show nothing, which doesn't mean there is no cancer. It only means your doctor ordered the PSMA PET scan too soon. There is no reason to treat until PSA reaches 0.2.

[NanoMRI in reply to Proflac]

Are they useful at low PSAs? Acknowledging doc and patient opinions vary, I say absolutely based on my three experiences, despite all three being 'clear'. Note I am not on ADT/chemo therapies. Seven years ago this month, after my salvage RT to prostate bed had failed to get all remaining cancer (it had spread further than thought), at 0.10 I returned to Europe for the Ga68; it was already in use there and used with usPSA as low as 0.030 (the US was in trials at that time and I did not 'qualify'). That Ga68 imaging was clear whilst the nanoMRI identified five suspicious sites, confirmed by ePLND. Then in Dec 2021, with my usPSA slowing and incrementally creeping up, I had my second Ga68 at 0.030 followed by a Pylarify PSMA six months later for comparison. Both of those were done in Houston, TX and both were clear. I do not expect imaging to show all the cancer and I do not accept clear imaging means no cancer. For me, when not on ADT/chemo, clear PSMA imaging suggests one does not face a cancer that releases proportionally lower amounts of PSA. Clear also suggests to me that the cancer volume is currently insufficient to support threatening growth and spread. It is interesting to ponder Dr Kwon of Mayo Clinics discussions regarding not asking whether choline, fluciclovine , G68 or Pylarify are better, but rather, he shares he has found sometimes a patients cancer is identified by just one of the four and the big question is, which one? Last year, a very favorable 'blood biopsy', Guardant360, gave me additional comfort that my remaining cancer is holding stable and relatively 'idle'. I do appreciate my imaging efforts are well outside of current US clinical practice guidelines and many patients' general understanding. Hope this helps!

[NanoMRI]

Yes, happened to me, three times. My usPSA post RP was 0.050. We accepted cancer had unknowingly spread. I tracked it up to 0.11 and tried salvage RT. Post RT usPSA was 0.075 - again cancer had unknowingly spread. When it was back up to 0.10 I went for PSMA and 'even better' Ferrotran nano-MRI and pelvic lymph nodes lite up as suspicious. Salvage lymph node surgery confirmed cancer at my para-aortic nodes. My usPSA post that third treatment was <0.010 for two years. I test bi-monthly and have tracked it's rise through 0.01X into 0.02X and may latest, just today, 0.031. Hope this helps. All the best!

[LowT]

Statistically the PSMA PET will not show anything at the level of PSA.

I’ve been offered SRT +/- ADT. By 2 ROs

Presently doing what maybe called AS.

Each case is unique. I’m 82 and otherwise good health. Swim 1/2 mile three times a week.

Hesitant about RT as I have lymph edema both legs secondary to extensive lymph node dissection #24 at time of surgery which is controlled with suppose stockings so don’t want that to worsen. All nodes were negative

QOL is another concern with ADT as is worsening osteopenia.

If you read my previous posts you will see I have a very complex endocrine picture with marked elevations in FSH & LH that several endos are baffled by.

Most importantly I FEEL GREAT!!

And don’t want to mess with that at this point in my journey. .

I’m exploring doing a biopsy of nodule as it’s been seven years since my surgery.

If the picture begins to look more concerning I’ll possibly reconsider RT after assessing the multiple variables and then place my bet.

Presently long term goal is to die with the PCa but not from it.

In reality most men die with prostate cancer and don’t ever know it.

[maley2711 in reply to LowT]

Yes, but includes men with metastatic PCa?

[Fortran1958]

Don’t be surprised if PSMA does not reveal anything. I have had 5 PSMA scans when my PSA ranged between 0.2 and 0.33 with no definitive results. I am now at 0.44 with a slower increase and urologist wants to wait until 0.6 before next PSMA.

[dmt1121]

I had a similar result from an Axumin scan back in 2017. I was placed on Abiraterone and my PSA has been stable, though now mat be rising. The PSMA test was not available. That is the gold standard for prostate cancer scans.

Once you have that, then you will have a good idea.