Help interpreting PMSA Pet scan

[hatecancer]

I'm more concerned with impression #1. Any thoughts on what this means?

IMPRESSIONIMPRESSION:

Compared to prior F18-Pylarify PET/CT dated 8/30/2022:

1. The patient is status post cholecystectomy. There is a subtle

focus of increased uptake inseparable from the anterior wall of the

rectum to the right of midline, corresponding to a subtle 4 mm nodule

on the CT images. In the setting of rising PSA, the possibility of

local/marginal recurrence of prostate carcinoma should be considered.

Further evaluation with contrast-enhanced MRI with particular

attention to this suspicious lesion is recommended.

2. Essentially anatomically and metabolically stable right external

iliac lymph node, probably reactive in nature.

3. Interval decrease in tracer uptake in the previously visualized

sclerotic T9 vertebral body lesion, probably representing treated

disease.

4. No new radiotracer avid lesions to suggest distant metastasis

[Tall_Allen]

Something on your rectal wall. There's nothing in your profile. What is your history? Any ECE? Prostate radiation? Spacer? Met at T9? Lymph node treatment?

[hatecancer in reply to Tall_Allen]

Diagnosed in 2014. Gleason 8 (4/4). Failed Prostatectomy in 2014. Mets to spine t5 and t9. Started on ADT and completed Chemo in 2014. Have been on ADT lupron since. ADT seems to have failed early last year and PSA started rising slowly, now at .08. Spot radiation to T9 in 2022 after earlier psma scan noted uptake on t9. No ECE. Spacer, or prostate bed radiation. Yearly monitoring of lymph node which has remained stable.

[hatecancer in reply to hatecancer]

Sorry, meant no ECE when diagnosed.

[Tall_Allen in reply to hatecancer]

Thanks. Do you know what the SUVmax was on the rectal nodule?

[hatecancer in reply to Tall_Allen]

Not shown for the rectal nodule, but states that All SUV values reported represent maximum SUV (SUVmax) unless otherwise specified.

[Tall_Allen in reply to hatecancer]

Ask for it.

[Cyclingrealtor in reply to Tall_Allen]

What are the uptake thresholds that are used for determining positive for PCa?

[Tall_Allen in reply to Cyclingrealtor]

Judgment, but significantly higher than liver, blood, or local background. Suspicion highest for sites known to have lots of local false positives, like around prostate, ribs, etc.

[NecessarilySo]

My first metastasis was in the rectum, and I probably don't have to tell you it was a pain in the you-know-what. I suspect it was caused by the biopsy.

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

ASS?

Good Luck, Good Health and Good Humor.

j-o-h-n

[j-o-h-n]

So you hate cancer? Take a ticket and get on that long long line....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Kittenlover50]

That there is a possibility of cancer. The nodule is seen plus something else and the fact that the PSA is rising is very suspicious. They are recommending an MRI which they often do for correlation.

and they are saying to have a MRI to correlate with it.