About a month ago I posted the results of my Prostate MRI and got some very good advice through this forum. The Prostate MRI report recommended that I get a PSMA PET/CT. I had the Pet Scan done at City of Hope and received the results today. The ONCOLOGIC AND POTENTIALLY ONCOLOGIC FINDINGS are as follows:
1. The prostate is present and contains brachytherapy seeds. There is a mildly F-18 PYL avid focus in the region of the right seminal vesicle with SUVmax of 4.85. No other abnormal F-18 PYL avid focus is noted within the prostate although there is a low level of the diffuse activity.
2. There is an intensely F-18 PYL avid node in the left mid to low lateral pelvic region quite suspicious for nodal metastasis, with SUVmax of 17.3 and greater linear dimension of 3 mm.
3. There is question of a mildly F-18 PYL avid focus in the central portion of the liver with SUVmax of 8.5 without CT correlate."
4. No other abnormal F-18 PYL avid node, soft tissue lesion, or focus of visceral involvement is seen.
5. No pulmonary nodule or pleural effusion is identified.
6. No abnormal bone lesion is noted on the PET or CT portion of the exam.
7. INCIDENTAL FINDINGS
There is faint coronary calcification along with borderline to mild cardiomegaly.
Mild sigmoid diverticulosis.
Reference values:
Mediastinal blood pool activity: SUVmax=1.9
Background hepatic activity: SUVmax=6.4
I have an appointment with my urologist on Monday and with my oncologist at City of Hope on Tuesday to go over this information. My goal for these meetings is to have an understanding of the pertinent information presented in the PSMA/PET scan report, and the right questions to ask. Currently I have a very vague understanding of the report, except that it scares me, and therefore no questions to ask. I will be thankful for any assistance that anyone can provide (Tall Alan).
Written by
Jimbo47
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Hi Jimbo. I am not a doctor. I put your question to ChatGPT and here is a simplified translation of each finding: FWIW :Incidental Findings simply means we weren't looking for these things but found them anyway - they may or may not be important but rarely related to the reason you're getting the scan:
here's a simplified version:
Prostate Check:
The prostate is there and has some tiny seeds from a treatment called brachytherapy.
We found a small active area near the right seminal vesicle, which is part of the prostate. It's not normal, but it's not very worrisome.
Other than that, the prostate looks okay, but there's a bit of general activity throughout.
Pelvic Node Check:
We spotted a highly active node in the left lower pelvic area. It could indicate the spread of cancer to nearby lymph nodes.
Liver Check:
We noticed a possibly active spot in the middle of the liver. It might be something, but we didn't see anything strange on the CT scan.
General Observations:
We didn't find any other unusual nodes, lumps, or areas of concern elsewhere in the body.
Lungs Check:
Lungs seem clear. No weird spots or fluid buildup.
Bones Check:
Nothing unusual found in the bones. They look normal on both the PET and CT scans.
Extra Findings:
We saw a little bit of calcium buildup in the heart's arteries and the heart itself seems slightly enlarged.
Also, there's mild pouching in the sigmoid colon, which is called sigmoid diverticulosis.
Reference Values:
The normal upper limit for blood pool activity in the chest is 1.9.
The typical background activity in the liver is around 6.4.
Thank You. Worried about the nodal metastasis. Last time I talked to the urologist he said we don't want it to go into the lympth nodes. I don't know exactly know what he was getting at. But to me, this sounds serious.
The small amount of PSMA avidity in the liver (without correlate) is probably just a false positive. Talk to Kishan about salvage to the seminal vesicle, which has an MRI correlate.
It's more than the one lymph node. If cancer is seen in one LN, you can be sure that it's in a lot of them in the region. You will also need 3 years of ADT with that, 2 years with abiraterone. Maybe that can be reduced, which is experimental.
An alternative would be to radiate the visible mets with SBRT and then get intermittent ADT to stop the invisible micromets from growing. Then you are done with five radiation sessions or less and avoid the potential side effects caused by radiating the whole pelvis.
When imaging identified five pelvic lymph nodes suspicious for cancer, at usPSA 0.13 (post salvage RT and no ADT; (similar PSA to yours it seems?)), no doc suggested to me that the cancer was surely in a lot more. In fact, at such a low usPSA, the thinking was likely represented most of the cancer as imaging results indicated NED outside of the pelvic bed. After many consultations I chose salvage extended pelvic lymph node surgery; that was six years ago this month and that ePLND yielded a nadir of <0.010, no ADT. All the best!
Thanks. I'm meeting with a surgeon on Tuesday. My urologist recommended that I see him when we got the results of the Prostate MRI. I was thinking that an MO or RO might be more appropriate. But meeting with the surgeon won't be a waste. I'll ask him about this approach.
IMO what is appropriate is a personal decision and overall individual health and age are key factors. IMO making this extra tricky are all the diagnosis and treatment disparities we face. There is not a lot of support for prostate cancer salvage pelvic lymphadenectomy in US. (I traveled to Belgium for my ePLND after imaging in Netherlands). I choose to defer ADT/chemo for as long as possible. I appreciate, as one commented in another post of yours, HealthUnlocked steers away for urologist to RO's and MO's - personal decisions. I am simply sharing experiences to be considered or discarded. All the best!
I appreciate your candor and willingness to share. I look at what you have said as information not a recommendation. I realize we all have to chart our own path. I admire you for thinking outside of the box. All the best to you too!
A further share. The ePLND procedure first involved the removal and immediate frozen biopsy section of the common iliac nodes (often thought of as common crossroad). If cancer was found, as in my case, the surgical reach would be extended to as many lymph nodes as possible. A total of 31 total nodes removed, six were metastatic, including one para-aortic node; again usPSA 0.13. Some say six is a lot - I say 25 were clear. If cancer was not found in the common iliacs, the surgical reach would be back towards the pelvic bed.
I also had 29 pelvic nodes removed. None were positive. two years later, I developed lymphedema. have been dealing with that ever since. Just saying this to let you know every action has an equal and opposite reaction
Of course - all treatments can have side-effects. Six years post my ePLND I have not had one episode of lymphedema; I did have six cancerous nodes removed. My decision was based on positive imaging - so we knew I had positive pelvic mets and I chose the risk to have the cancerous nodes removed. Prior to and after I consulted with lymphedema therapists. I did one year only on bicalutamide after the ePLND for 'added insurance'. In my case, severe side-effects. In some regards we need to pick our poison - All the best to all of us fighting this beast.
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