PSMA Pet Scan results

[traversetom]

Diagnosed with prostate cancer with 1 lesion Gleason 7 (4+3). Have had MRI, biopsy and just completed PSMA Pet Scan. I see my doctor next week. I received the results and surprised to show some uptake in a lymph node.

There is focal avid uptake noted in the anterior

peripheral zone of the prostate image number 291, SUV max 7.9. physiologic

uptake noted in the left celiac ganglion is noted image number 192, SUV max 4.0.

Minimal uptake is noted in rounded left periaortic lymph nodes, for example a 4

mm short axis lymph node seen image number 209, SUV max 2.6. No other

suspicious uptake seen in the abdomen or pelvic soft tissues.

IMPRESSION:

1. Avid uptake in the anterior peripheral zone of the prostate consistent with

known adenocarcinoma.

2. Rounded nonenlarged periaortic lymph nodes with mild radiotracer uptake

measuring between mediastinal blood pool and hepatic parenchyma, equivocal for

metastatic disease. (PSMA-RADS 3A). No other evidence of metastatic disease.

Curious for any input on what kind of treatment he would recommend now for that, if any.

[Tall_Allen]

That's not above background uptake.

[traversetom in reply to Tall_Allen]

What does that mean?

[Tall_Allen in reply to traversetom]

It means there is no clear signal that there is cancer there.

[GP24]

I would get surgery with extended lymph node dissection. Then the dissected lymph nodes can be analysed to see if they are already affected.

[ron_bucher in reply to GP24]

I would too if I was less than 75 years old.

[London441 in reply to ron_bucher]

I would not do that at any age, under any circumstances.

[NanoMRI]

Sharing from my experiences with 4+3 and RP that did not get it all. I found second opinions of mpMRI and PSMA findings critical (excellent you have had both prior to treatment); and accept imaging is unlikely to identify all cancer. Imaging also provided high confidence I was a good candidate for surgery with minimal risk of the dreaded side-effects. If I could have a do-over, I would have the procedure done during my third treatment, salvage extended pelvic lymph node surgery, done during my RP. Knowing I faced possible spread, first remove common iliacs with immediate frozen biopsy procedure. If cancer were present, as it was in my salvage ePLND, then go for all the pelvic lymph nodes possible. If cancer not present in common iliac, then surgically work back to prostrate gland and of course take the gland. I am post RP, salvage RT and ePLND - been six years since latter and doing very well. My focus all along has been to, if it comes to it, defer ADT/chemo/CR as long as possible.All the best!

[Justfor_ in reply to NanoMRI]

Your "do-over" sequence is just a masterpiece. Only downside is that the hourly pay-rate of surgery in the US wouldn't leave much room for it. As of that, the average number of nodes resected in Europe is double to triple that of in the US. And of course, there is associated fear mongering to distruct the patient, i.e. risk of lymphedema.

[RoseDoc in reply to Justfor_]

"Hourly pay rate of surgery"? Exactly what is that? We are paid by the procedure and diagnostic codes, not by the length of time spent doing the procedure.

[Justfor_ in reply to RoseDoc]

Ok, let's get into the economics of it. You have a Davinci suite in a hospital building and a group of support personnel on fixed salaries. Amortization of the equipment, space cost, all short of running and maintenance cost and supporting manpower are time driven. If such a suite can accommodate 2, 3 or 4 procedures per working day, do you still think that the cost per procedure is only the lumpsums surgeon and anesthiologist get? Is the pathologist that will perform the frozen sections a fixed per procedure cost? The pathology lab doesn't incure an hourly cost by just being there?

PS: reading again, I think I spotted the point that caused your confusion. It is the word "pay" I used. In my text is in the active voice. Someone is paying for the surgery (insurance, public healthcare system, patient, whoever). You interpreted in the passive voice i.e. the surgeon gets paid.

[garyjp9 in reply to Justfor_]

I had just 3 LNs removed (2 cancerous) and still developed a large lymphocele that was a bitch to heal and for which my surgeon refused to accept any responsibility for fixing.

[Justfor_ in reply to garyjp9]

And my guess is that you hadn't frozen sections. Am I right? From the time the gland is sent to the pathology lab for rapid biopsy, until the results are communicated back to the operating room, there is a compulsory half an hour (give or take) break that a responsible surgeon uses for dealing with the finer details of the procedure at their ease, i.e. not rushed on.

[garyjp9 in reply to Justfor_]

Right, I think I did not. I was an added-on last surgery on a Friday before a holiday weekend, at a major teaching hospital. Given the litany of issues that arose, I suspect the professor-surgeon got an early start on his holiday and left me in the hands of a resident.

[NanoMRI in reply to Justfor_]

I understand and agree with your subtile nuance on hourly pay-rates. Recently, I learned none other than the US Mayo Clinic is offering salvage lymph node surgery including frozen section biopsies - and also doing these with RP; but will insurance/Medicare pay? I was well aware of the fear mongering around these procedures - fortunately I have no adverse issues (fears are exaggerated). I chose this procedure over ADT/chemo because ADT absolutely has fearful side effects, especially and for a man of my otherwise healthy young age. IMO, if it comes to it, the longer I can defer ADT/chemo/castration resistance, the better.

[Sagewiz]

I have the same Gleason # but my tumor covers most of the prostate. Even though CT and Bone scans came back negative, there is an assumption of metastisis to adjacent tissue even though it cannot be confirmed.

I did 6 weeks of external radiation and the HDR (temporary brachy) surgery and am on the hormone suppression Stampede protocol for 3 years (quarterly Lupron injections, daily Zytiga and Prednisone).

I am also doing aggressive diet and supplements.

My PSA was initially 26 prior to any treatments, it spiked to 29 and with diet and supplements I got it to 20 prior to treatments. After 6 months my PSA is now <.01 and all is as good as it can be for the time being. Unfortunately, there is no real way to assess the efficacy of the radiation treatments other than the PSA numbers.