Pet Scan Below, Does Non Avid PSMA Liver Lesions mean possible Neuroendocrine Cancer

[Shorehousejam]

EXAM:

PET-CT SKULL BASE TO MID-THIGH

 

CLINICAL HISTORY:

Metastatic prostate cancer, rising PSA

 

TECHNIQUE:

PET/CT skull base to thigh-subsequent treatment strategy

F18 PYL dose: 10.00 millicuries

Injection site: L AC

Time of injection: 17:00

Time of emission scan: 18:06

Oral Contrast: No

Intravenous Contrast: None

Intravenous Lasix: None

 

The low-mAs CT Protocol used for this PET/CT study is designed for attenuation correction

and anatomic localization of PET abnormalities.

 

The standard uptake values (SUV) reported below are maximum values within a region of interest,

expressed in gm/ml.

 

COMPARISON:

02/02/2024

 

CORRELATION:

None

 

FINDINGS:

Mean liver SUV: 5.9, previously 5.2

Mean blood pool SUV: 1.7, previously 1.6

Mean right parotid gland SUV: 18.3, previously 24.7

 

HEAD/FACE: Physiologic PSMA uptake is seen in the lacrimal and salivary glands.

 

NECK: Physiologic PSMA uptake is seen in neck muscles.

 

CERVICAL NODES: No abnormal PSMA uptake.

 

MEDIASTINUM/HEART/GREAT VESSELS: Physiologic PSMA uptake in the mediastinal blood pool. Coronary artery calcifications.

 

LUNGS: Small azygous lobe. No abnormal PSMA uptake.

*New non PSMA avid 0.3 cm solid pulmonary nodule in the right upper lobe (image 122)

*Newly appreciated non PSMA avid subpleural ground-glass opacity in right lower lobe (image 147)

 

Biapical scarring. Unchanged bandlike opacity in the left anterior upper lobe, probably residual mucoid impaction and subsegmental atelectasis. Unchanged emphysematous changes.

 

PLEURA/PERICARDIUM: No abnormal PSMA uptake.

 

THORACIC NODES: Unchanged mild PSMA uptake in bilateral axillary lymph nodes, for example:

*Right axillary 1.2 x 0.9 cm, SUV 3.0 (image 117), previously 1.2 x 0.9 SUV 2.3

*Left axillary 1.3 x 0.9 cm, SUV 2.2 (image 110), previously 1.3 x 0.7 SUV 2.1

*Subcarinal (image 196) SUV 2.9, previously 2.5

 

HEPATOBILIARY:Multiple new non-avid hypodense hepatic lesions. For example:

*Segment 5, 2.8 x 2.2 (image 125)

*Segment 7/8, 2.7 x 2.5 cm, (image 155)

*Segment 2 (image 169) 3.2 x 2.6 cm

 

SPLEEN: Physiologic PSMA uptake.

 

PANCREAS: No abnormal PSMA uptake.

 

ADRENAL GLANDS: No abnormal PSMA uptake.

 

KIDNEYS/URETERS/BLADDER: Excreted physiologic PSMA activity is present. Redemonstrated photopenic large left renal cysts.

 

ABDOMINOPELVIC NODES: Unchanged non PSMA avid abdominopelvic lymph nodes, for example:

*Left common iliac 0.8 cm SUV 1.4,

*Right external iliac 0.8 cm SUV 1.8

 

BOWEL/PERITONEUM/MESENTERY: Physiologic PSMA uptake in the small bowel and colon. No abnormal PSMA uptake.

 

PROSTATE GLAND/SEMINAL VESICLES: Increased in size of heterogeneously PSMA avid irregular enlarged prostate gland with low attenuation necrotic and solid components. For example, PSMA avid left side solid component extending into left pelvic wall, 5.2 x 3.2 cm, SUV 6.1 image 42), previously 2.1 x 2.1 cm, SUV 5.6. Increased intensity of posterior border of necrotic component abutting the anterior rectal wall SUV 8.5.

 

Increasing left pelvic lymphocele 4.8 x 4.0 cm, previously 4.3 x 3.4 cm.

 

BONES/SOFT TISSUES: Unchanged PSMA avid osseous lesions, for example:

*Right iliac SUV 2.4 (image 256), previously SUV 2.4

*Right lower hemisacrum SUV 1.3 (image 271) SUV 1.2

 

OTHER FINDINGS: None.

 

IMPRESSION:

Since February 2, 2024,

1. Increased size of heterogenously PSMA avid prostate lesions abutting the rectum and left pelvic wall.

2. Multiple new non-PSMA avid hypodense hepatic lesions, indeterminant. Differentials can include metastatic prostate (dedifferentiated), new primary neoplasm, or non-malignant process. Recommend MRI liver protocol for further characterization.

3. Unchanged minimally PSMA avid bilateral axillary and abdominopelvic lymph nodes.

4. Unchanged osseous lesions.

5. Non PSMA avid new subcentimeter solid nodule and ground-glass opacity, nonspecific. Attention on follow-up imaging.

 

The following terms are used to convey the radiologist's level of certainty for a given interpretation.

 

Consistent with > 90%

Suspicious for/Probable/Probably approx 75%

Possible/Possibly approx 50%

Less likely approx 25%

Unlikely < 10%

 

Electronically Signed By:

[Shorehousejam]

Tall_Allen Does non psma avid liver lesions mean Neuroendocrine cancer?

Getting a MRI Thursday and Biopsy Monday

[Shorehousejam in reply to Shorehousejam]

Why do they say prostate gland, when my prostate was removed 03/2023

[Tall_Allen in reply to Shorehousejam]

They discuss growths into the pelvic wall and rectal wall.

[Tall_Allen in reply to Shorehousejam]

No. There are many more types of PCa that are non-NE that don't express PSMA than there are NE subtypes. Only a biopsy can distinguish.

[MoonRocket]

Hypodense spots DO NOT mean cancer. Your PSMA scan...is this the pre-RP scan? Otherwise I don't understand the reference to you prostate and seminal vessels.

[Shorehousejam in reply to MoonRocket]

I had my RP, prostate removed, this makes it sound like it’s still there

[Still_in_shock in reply to Shorehousejam]

necrotic components?

[Shorehousejam]

My wife and I are praying it’s not Neuroendocrine cancer

[Shorehousejam]

it’s not looking good for my wife and myself

I stayed on aberitone zytiga which causes morp into Neuroendocrine, also ezulaminde does as well

My wife and I asked to change to Nubeqa, months ago, request was talked in circles and ignored

Non avid psma lesions are most like morphed pca to Neuroendocrine

Especially with mutations like myself

[skiingfiend in reply to Shorehousejam]

You're not sure what you have yet. It is easy to image the worst case.

You need to get the diagnostics (liver biopsy,...) to determine where you stand.

Good luck, I hope you get an all clear, well from NEPC/SCPC anyway.

[Shorehousejam in reply to skiingfiend]

Thank you

[StayingOptimistic in reply to Shorehousejam]

I asked my doctor about the fear of my pc turning into NEPC because of treatment and he said “ I caution you from that because it only happens to 20% of patients. You should stay on treatment”. It’s hard to prove where it came from unfortunately and I am scared as hell from it.

[Shorehousejam in reply to StayingOptimistic]

Well

Dr Google states this:

What is the most common primary for liver metastasis?

The most common types of cancer that spread to the liver are:

colorectal.

lung.

breast.

pancreatic.

stomach.

esophagus.

melanoma.

neuroendocrine.

[StayingOptimistic in reply to Shorehousejam]

Does neuroendocrine in this context mean prostate cancer?

[Shorehousejam in reply to StayingOptimistic]

Neuroendocrine cancer is a work around of adt it’s deadly poor prognosis and fatal

[skiingfiend in reply to Shorehousejam]

The biopsy will determine the source of the cancer. It is possible that you have a secondary cancer but it is more likely that this is an extension of your PCa since this is the type of cancer that you already have.

[Shorehousejam]

not looking good

[spw1]

Have you had your chromogranin A tested in blood? Liver biopsy can tell you more about this kind of a tumour but it is unpleasant. The advantage is that it can give possible treatment options.

[StayingOptimistic in reply to spw1]

I had mine tested and it is with range but all the way at the upper limit. Is this bad? Does it indicate NEPC?

[spw1 in reply to StayingOptimistic]

My husband's was 52-57 ng/mL and his biopsy of the liver met did not show NEPc. We also measured LDH which rose as cancer progressed. Both can be useful indicators. We measured these on and off so we had a baseline. I cannot now remember what the range is. But several factors should be considered. The biggest thing is not to worry especially about the chemistry of the body. It can be very complex. My husband did not look at the numbers at all; I did. I wanted to do the best for him as the system does not think of individuals unless you have a private consultant. I did the research etc. so that he could keep being truly optimistic and live his life as fully as possible.

[Shorehousejam in reply to spw1]

PSA rising, did pet scan, non psma avid liver Mets are/ may be indicative of small cell and/ or neuroendocrine cancer.

Per zoom meeting with MO this morning. Tumour on prostate bed seeding by not radiating most likely morphed.

. Having a mri and biopsy on Monday

Praying it’s not small cell or neuroendocrine

Listen to your gut and hit it hard, many Medical Oncologist are numb and laxed

[MoonRocket in reply to Shorehousejam]

So..when I met with the MSK oncologist I asked him how do I monitor METS. His answer was a High Definition CT scan.If you haven't had a hi resolution CT scan..ask for one

[spw1 in reply to Shorehousejam]

Wish you all the best.

[Bestdays]

Please don’t panic, wait for results. Did you see the post about CU-67 Sar from God_loves_me?

[Shorehousejam in reply to Bestdays]

No, can you put link below, please

[Bestdays in reply to Shorehousejam]

Here it is a link for the trial: classic.clinicaltrials.gov/...

I've attached the link to the post I was referring to below.

[Bestdays in reply to Shorehousejam]

Here is the post link from God_loves_me;

healthunlocked.com/advanced...

[Shorehousejam in reply to Bestdays]

Thank you

[lokibear0803]

The report calls out possible non-malignant process. That’s where mine ended up - it was eventually determined to be hemangioma.

Get the MRI, get the biopsy, find some activity to distract you. Lifting, walks, hiking, cycling, running; read a good novel, watch some TV, hang with friends. Whatever’s gotten you thru life so far, rely on that.

[Shorehousejam in reply to lokibear0803]

I’m

Still working went back 6 months ago to keep health insurance

Spoke with MO on zoom

The tumor bed seeding

Talked in circles where it came from

I also mentioned that Zytiga with Prednisone cause high liver enzymes that the cancer looked for a weakness to seed

Skyrizi for psoriasis adds to this

That’s on the past now

So sorry listened to him about Not radiating

Since on adt and had pc cancer

The bed seeded liver looking for an organ

Also trying to seed lung

As I also have lumg nodules now

Medical Oncologist is leaning toward

Mixed, small cell or neuroendocrine as it’s not psma avid

Not looking good

thinks there are many more mets to liver not just 3 and on mri now in my post there are over 40 liver lesions

Of course he is against surgical options or radiation

Ablating the liver

Only talked chemotherapy

I go every 30 days for lab and Firmagon and this all was missed, let go

Phucking furious

[lokibear0803]

Read thru this post, perhaps Cu-67 is an approach if you find out the mets are malignant but are PSMA-negative:

healthunlocked.com/advanced...

But you don’t know that yet.

[Shorehousejam in reply to lokibear0803]

Thank you, great information

[God_Loves_Me]

see Radiation oncologist and see what are radiation options

[Shorehousejam in reply to God_Loves_Me]

Absolutely, going to check all options, Thank you

[dhccpa]

That's the best-written PET scan report I've ever seen. The writer put some effort into it.

[Seasid]

Where is your cancer? Is your PSA rising? Could you get abdominal ultrasound? Could you get liver fibro scan? You could better see in real time what is happening with ultrasound and the liver fibro scan.

You shouldn't radiate yourself often with the high resolution CT scan. I get rid of my Lung nodules in 10 days with 200 mg doxycline per day. They wanted to do a lug biopsy before that. It was my idea to start with doxycline. After doxycline treatment no more Lung nodules to biopsy.

[Shorehousejam in reply to Seasid]

My wife believes in the cancer oncology protocol, and using off labeled meds with and without chemotherapy. Of course I’m hesitant and haven’t, being a good boy with MO SOC, like the idiot I am, but she is a risk taker as you seem to be and it paid off.

She is in chemotherapy for stage 2 triple negative breast cancer and added Turkey tail tincture to coffee and who knows after her first session her breast tumor was unfindable, , not able to be located.

She found the original tumour in November, had to wait on mammogram to/ in January, stage 2 no lymph node involvement

but from this stress they can’t get her blood numbers up, needs a blood transfusion. She needs red meat.

She is tough as nails…

Yup, our house is the cancer house, good grief for Phuck’s sake