Help with Results

[Peppertree602]

I just updated my Bio and just received my PSMA Gallium scan results. Appointment is tomorrow to review but from what I see even with a low PSA of 0.052 a lymph node lit up which is rare. Is this correct and given this my guess SOC is whole pelvic adjuvant radiation and higher dose to lymph nodes or??? Anything else this reveals? I know we have really a TON of knowledge in this group!

Order: PET CT Illuccix Initial Ordered On: 03/19/2024 Collected On: 03/19/2024

Result 3/19/2024

Sarasota Memorial Health Care System

Procedure: IPT - PET CT Illuccix Initial

Reason: C61 MALIGNANT NEOPLASM OF PROSTATE

Procedure Date: 03/19/2024

PET Scan with PET/CT Fusion

History:Prostate cancer diagnosed in 2020 status post prostatectomy.

Technique: Following the intravenous administration of 5.32 mCi Ga 68

PSMA delayed PET images were obtained from the canthomeatal line to the

groin. Additional noncontrast CT Neck, Thorax, Abdomen and Pelvis were

performed, with PET-CT Fusion. Mediastinal blood pool SUV max 1.1,

Name Resulted

Background liver SUV max 4.5. Comparison: None

Discussion:

There is asymmetric soft tissue in the right posterior nasal cavity.

Recommend correlation with clinical symptoms and direct visualization as

clinically warranted.

Left subcentimeter internal iliac nodes measure up to 0.2 cm SUV max 5.8

(image 231).

Impression:

1. Metabolically active left subcentimeter internal iliac nodes concerning for metastases.

2. Asymmetric soft tissue in the right posterior nasal cavity.

Recommend

correlation with clinical symptoms and direct visualization as clinically

warranted.

[Tall_Allen]

The SOC for pelvic lymph nodes is 3 years of ADT + 2 years of abi. IDK why you thought 6 months would be adequate.

[Peppertree602 in reply to Tall_Allen]

that was initial recommendation of Onco prior to scan results when I started with 0.021 in Sept and then slightly rising to 0.052 and assumption was scans would be negative but it lit up of course. What is abi?

Also Decipher was .41 and not sure if that matters.

My PSA as of yesterdays test came back at 0.056

Tx

[Peppertree602 in reply to Peppertree602]

Found it (Abi) just forgot after tooooooo much reading today

[Still_in_shock in reply to Tall_Allen]

TA, where can I find that quote from STAMPEDE? I know where you stated it, but would like my MO to read from the source.

I want to show my MO, have not seen the one at Sunset yet, doing to change eventually, we're butting heads.

[Tall_Allen in reply to Still_in_shock]

Here's the STAMPEDE trial:

ncbi.nlm.nih.gov/pmc/articl...

[Still_in_shock in reply to Tall_Allen]

Thx

[Justfor_]

Rare, definitely not. Ignorant/lazy docs only take notice of the PSA, when it is widely known that at low PSA PSADT is equally, if not more an important factor, for estimating the probability of a positive PSMA PET/CT detection. With your PSADT of 5 months, out the top of my head, your said probability was north of 30%. You were lucky enough that your doc doesn't subscribe to silly rules of the kind: "Bellow PSA of 0.5, PSMA scan will show nothing".

[jazj in reply to Justfor_]

The only one benefiting from doing PSMA PET below 0.5 is the clinic's profit line. Could he have made a typo and meant 0.52 not 0.052 as I would think no insurance company in their right mind would cover the scan at that PSA level? Even if that isn't a typo, just because his scan turned something up doesn't justify doing PSMA PET scans at super low PSA levels. The data based on many patients indicates a large portion of PCa patients with very low PSA levels like that can have metastatic disease that the scan will not show because the lesions aren't large enough yet.

[Justfor_ in reply to jazj]

If you are in for a serious discussion:

1) Show us the "data based on many patients",

2) Assign a numerical value on: "large portion" and

3) Debunk with counter arguments my old post here: healthunlocked.com/prostate...

FYI, a couple of years ago, when the PSMA PET/CT was not offered in your country, there had to be a "story" to cover up for this. The story was a modern remake of Catch 22, i.e lower than PSA of 0.5 detected nothing, but if one waited for PSA to rise that high it would be already too late for a "cure", hence useless. But, since that time water has passed under the bridge and today "typos" like the one from the OP grow like mushrooms after the rain.

[NanoMRI in reply to jazj]

well, I have had three over past six years, at or below 0.13. Useful to me the patient too. I do know at 0.13 I had cancer in common iliac and para-aortic nodes - thing is Ga68 did not pick 'em up while the Ferrotran nanoparticle MRI did.

[GP24]

With 0.2 cm this is a very tiny affected lymph node. I would just observe for now. Maybe it turns out to be a false positive and will be gone on the next PSMA PET/CT.

[vintage42]

"... a lymph node lit up... my guess SOC is whole pelvic adjuvant radiation and higher dose to lymph nodes..."

I did that. In 2021 I had IMRT to prostate. In 2023 rising PSA led to a scan that showed met in a pelvic iliac node. So I had IMRT to whole pelvis with high dose to that node. No side effects from any of the IMRT.

[Hawk56]

I saw TA's comments. In my case, when my PSA started rising and a Plarify scan showed a single PLN 3-4 CM, my radiologist recommended SBRT and six months ADT. My oncologist initially recommended 24 months ADT plus an ARI as potentially curative.

He and I discussed "curative" as I felt given my clinical history, my PCa is not curative, rather manageable. He and I agreed to 12 months ADT, Orgovyx, labs and consults every three months, add the ARI only if Orgovyx did not drop the PSA to undetectable within the first three months, revisit the 24 months at the 12 month point.

That 12 month point is coming up, labs on 2 April, consult with he and my radiologist on the 4th. I'm leaning towards stopping treatment and doing what I've always done, actively monitoring, labs and consults every three months, if my PSA (well, when..) rises again, scan, treat, rinse, repeat.

From the responses I see general agreement on the WPLN with boosts to the identified PLN. The "disagreement" is the length of ADT. I have a very rapid PSADT also,

That's something you will have to decide in concert with your medical team. It is the quandary we all face given the plethora of options.

Kevin

Clinical History

[Justfor_]

So for you "nothing", "rare" and "not very high" are one and the same thing.

[VanHalen84]

I suggest reading the stampede trials. I had RP and then PSA of .055 afterwards. Started orgovyx immediately 8/15/22 (which dropped PSA to undetectable), then radiation Jan/feb 23. Then added Zytiga (Abi) April 23 with the plans to keep Abi until I have completed 2 years of orgovyx 8/15/24. Side effects are bad but I've been told this is a possible cure. My decipher was .93 from surgery... scary.

[Peppertree602 in reply to VanHalen84]

I read several and my head started to buzz a bit, and some other place I read that adding entazalutamide or xtandi to orgovyx and staying the path for 2-3 years is possible curative. I start Orgovyx next week and then radiation on April 12th. Then look at adding on. So the fun begins......................................

[VanHalen84 in reply to Peppertree602]

Be careful with Abi, at first I wasn't stringent in waiting an hour before eating. I had bad side effects. Eating within an hour can put 4x as much into your blood stream.

[dhccpa in reply to VanHalen84]

Many are using a 1/4 dose with food, instead of 4 on empty stomach.

[Justfor_]

You throw a parade of vague notions to make an ill case appear valid. I am a retired engineer and prefer numbers to words. So, if there is a 30% probability for a positive detection and the cost of imaging -in my neck of the woods- is 1500 Euros, it all boils down to whether one would value 1500/0.3=5000 Euros for such a piece of information. For me is money well spent, for you?

[Justfor_]

User nanoMRI is one example that "None" is just your personal opinion. But, I am not surprised, I have already noticed that you treat: "none, nothing, rare and not very high" as equals. In my neck of the woods it is bed time now. Goodnight.

[NanoMRI]

As I share, I went for salvage pelvic lymph node surgery over ADT/chemo, at usPSA 0.13. Cancer confirmed in six pelvic nodes, including common iliacs and para-aortic. That was six years ago. All the best to all of us!