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.
Written by
Peppertree602
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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.
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".
The silly rule is based on clinical trial evidence and it's the probability of showing something, which is not very high. Given the cost of these scans, why incur an expense when the probability of cancer showing up is not very high at such a low PSA.Without knowing the translation of "concerning" to the probability of a positive result, it's hard to assess what the scan actually found.
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?
Well. Most don't live in your neck of the woods. Multiply that by several 100 scans and that is wasted. Scans should be obtained when treatment decisions are needed...not to satisfy a curiosity. What treatment decision would happen at .05 PSA? None
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.
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.
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.
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.
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.
"... 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.
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.
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.
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......................................
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.
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!
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Started Xtandi mono therapy 2 months ago but after dropping PSA from 3.3 to .82 its now up to1.360. Continue with SBRT to 4 spots next week?
radiotherapy
Positive results, Pluvicto
SBRT failure , PSMA results 
