PSMA PET Results - don’t know what to do next (more tests?)

[Cafu6]

Hi everyone,

For those who have been following my dad was diagnosed with PCa on Jan 18th, PI-RADS 5, Gleason 8, PSA 10.4.

He started 50mg of Casodex on March 8, and had Eligard 30mg injection March 26th.

He has had bone scan (nothing notable), CT (nothing notable), MRI showed one of his pelvic lymph nodes was lit up.

we just got back the PSMA PET and I am struggling to understand it, perhaps partially because I am a bit of a mess from what I do understand of the results (there are two liver spots).

My understanding is that metastasis liver from the start with no other metastasis (I.e bone) is rare. Can you help me understand the below? Any guidance (we are getting referral/second opinion to Princess Margaret)? Any places in the USA we can send our results for a second opinion online? Stories of hope? Clinical trials to look into?

PSMA PET Conclusions:

1. PSMA avid lesions within the right prostate extending from the apex to the base, also crossing midline consistent with malignancy (PSMA 3). There is PSMA evidence for extraprostatic extension into the anterior rectal wall on the right side as well as involvement of the right seminal vesicle and bladder wall on the right.

2. PSMA avid metastatic adenopathy involving the left external iliac and right prevesicular region (PSMA 2). Mild PSMA uptake noted within the small subcarinal/station 7 lymph node (PSMA 1), considered negative based on Promise criteria.

3. Liver metastasis involving segments 7, and 5/6 (PSMA 2). 2.9 cm focus within the subcapsular liver segment 7 (SUV max: 9.2, PSMA 2, Fused 146), and focal linear activity within subcapsular segment 5/6 extending over a craniocaudal length of approximately 4.2 cm (SUV max of 9.3, PSMA 2, fused 162).

4. No PSMA avid osseous disease.

[Tall_Allen]

Docetaxel may clear up the liver lesions. Discuss what to do about the rectal wall involvement.

Perhaps request a biopsy first to see what kind of prostate cancer it is. Has he had a genomic test?

[Cafu6 in reply to Tall_Allen]

sorry for the delay Tal_Allen. I’ve been pretty upset since finding all of this out, especially after reading so much about it on the internet.

We are getting an MRI in the US (we live in Canada) this week to confirm the liver lesions as we had another radiologist read the report and say they look very unusual (like maybe a potential glare). Also very unusual that these relatively large lesions (I think 2cm and 4cm in size) never showed up on abdominal ultrasound (he gets one every January - he’s celiac), nor the CT scan which he got in March.

He had a biopsy of prostate and it said Adenocarcinoma (I asked if there was a possibility that the biopsy was wrong). In terms of the genomic test, he has had it, but results still aren’t back (it was a month ago). Is there a specific test you recommend?

I’ll recommend my dad chat w dr about rectal wall involvement.

[Tall_Allen in reply to Cafu6]

Can they biopsy a liver lesion? If so, they can possibly do histology, IHC and genomics on it.