Explain my PSMA PET SCAN Please..

[God_Loves_Me]

PSMA PET/CT from the skull base to midthigh demonstrates:

1. Worsening of skeletal metastases.

2. Multiple sclerotic lesions without activity represent treated metastatic disease.

3. Status post orchiectomy.

4. No abnormal uptake of tracer within the prostatic bed.

EXAM: PET CT PSMA

CLINICAL INDICATION: Clinical stage IVb prostate cancer. Multiple skeletal metastases. Status post radiation therapy. No PSA values available. PSMA PET/CT for subsequent treatment strategy.

TECHNIQUE: The patient received an IV injection of 9.2 mCi F18 Piflufolastat in the righthand. After an initial uptake phase of approximately 60minutes, a CT scan with oral contrast, without IV contrast was acquired. . Subsequently, positron emission tomography images from the thighs to skull base were obtained. CT, PET and fused images were reconstructed in transaxial, coronal, and sagittal projections and interpreted from a workstation.

COMPARISON: Outside PET/CT from 12/8/2023.

FINDINGS:

Parotid SUV mean: 14.6

Liver SUV mean: 3.9

Aortic Arch SUV mean: 1.56

In the head and neck, physiologic uptake of tracer seen within the salivary glands and lacrimal glands. Visualized paranasal sinuses and mastoid air cells are clear. Nonspecific uptake of tracer is seen within the region of the uvula. SUV is 6.3. Mild focal uptake of tracer is seen within the left mandibular condyle. Focal uptake of tracer activity is seen in the right hand side of C4. This is new. Physiologic uptake of tracer is seen within the vocal cords. No focal abnormality is seen within the thyroid gland.

In the chest, no worrisome pulmonary nodules or infiltrates are identified. Central airways appear patent. Sequelae of CABG procedure are noted. Coronary artery calcification is present. No FDG avid mediastinal or hilar adenopathy is appreciated. Mild uptake of tracer seen within the distal esophagus. There is no pericardial effusion or pleural effusion present. No axillary adenopathy is identified. A new focal area of increased activity is seen in the seventh left rib laterally.

In the abdomen, heterogeneous distribution of tracer activity is seen throughout the liver and the spleen. No discrete focal abnormalities are noted within the liver, spleen or gallbladder. Physiologic uptake of tracer is seen within the stomach and pancreas. No focal abnormalities are noted within the adrenal glands or kidneys. No FDG avid adenopathy is noted within the abdomen or pelvis. No abnormal uptake of tracer is seen within the prostate or seminal vesicles. External genitalia demonstrate post orchiectomy findings.

In the pelvis, skeletal lesions are seen predominantly in the pelvis.

In the visualized extremities, there is widespread sclerosis and the entire skeleton. Some lesions have lytic foci within them. There are some new lesions identified.

In the osseous structures, A lytic focus in the left posterior acetabular column is increase in activity. SUV is 20.7 versus 7.7 previously. Increased activity is seen diffusely within the sacrum. A new focus of activity is seen in the posterior aspect of the right iliac bone, best seen on slice 295. SUV is 21.0. There is worsening in activity in the lumbosacral spine. A new focus in activity is seen in the posterior aspect of L4. A new focus of increased activity is seen in L2 on the left. A worsening focus is seen in T11. Mild uptake of tracer seen in several ribs. Intense uptake of tracer again noted in T5. New activity is seen within the cervical spine as described above. Persistent activity is seen within the proximal clavicle on the right. Finally, new focus of increased activity is seen within the left iliac bone on slice 303.

[MoonRocket]

I believe the report is self explanatory. You have worsening skeletal Mets. I'm not sure what treatments you had to date but maybe chemo is next if you haven't had docetaxel otherwise onto Pluvicto. You should probably get the metastasis biopsy to see if you have any actionable mutations or biomarkers present.

[God_Loves_Me in reply to MoonRocket]

Agree also thinking go for docetaxel.

[God_Loves_Me]

please read bio for 12/8 PSMA pet scan

[Tall_Allen]

Progressive bone metastases are noted. Some new lytic mets. Most bone mets for PCa are sclerotic, meaning the cancer causes bone overgrowth. Lytic mets, meaning bone tissue is dissipating instead of overgrowing, is less frequent, but the mixture often occurs. I assume mention of "FDG" are mistakes by the radiologist.

You may want to biopsy one or more lytic bone metastases and have histology, IHC, and genomics on that tissue.

[God_Loves_Me in reply to Tall_Allen]

Tall here is my biopsy that I did 8 month ago.

2

[God_Loves_Me in reply to Tall_Allen]

main

1

[Tall_Allen in reply to God_Loves_Me]

Looks good. But was the left iliac bone lesion one of the lytic bone lesions identified on the PSMA PET/CT?

[God_Loves_Me in reply to Tall_Allen]

Yes ok I will done its biopsy

[God_Loves_Me in reply to Tall_Allen]

my genetic test was negative that I did 8 month ago

[God_Loves_Me in reply to God_Loves_Me]

I also completed SBRT base on previous reports. I completed SBRT on 3/29 and this is first PSMA PET Scan within 20 days.

[Gabby643 in reply to Tall_Allen]

Thanks T A!