Pulmonary Node revealed with PET scan not growing

[Eadgbe]

During my treatment for PC the first Pet scan showed a pulmonary node. There were no Mets beyound the prostate. Three DRs., Urologist, Oncologist and Pulmonary, did not attribute the node to the PC, since it was so far removed and there were no other mets revealed. A subsquent MRI 3 months later indicated that it seems to have grown a cm. The Pulmonary Dr. ordered a lung biopsy that went south and landed me in ICU. My most recent pet scan shows everything is clear in my prostate and that the node has not changed or grown but Drs. still believe it is an adenocarcinoma.

My main question is, since I have been on Eligard for 6 months - and finished that ADT last month - could that have interfered with the growth of the node if it is a carcinoma not related to the prostate ? Or could the lack of growth indicate it is a benign node.

The Pulmonary Dr. is recommending a "wedge resection" of the lung (with a deVinci machine) to pluck out that sucker. After two biopsys that landed me in ICU, I'm very reticent to jumping into a lung operation.

[Tall_Allen]

"Or could the lack of growth indicate it is a benign node." Not necessarily benign, but if it didn't shrink with ADT, it is probably not prostate cancer. Does it have a ground glass appearance? If so, it may be a primary lung cancer that you caught very early, fortunately. I'm sorry the biopsies were botched. Your other option besides resection is to just treat it with SBRT. It is non-invasive and equally effective. The only downside is you won't get a pathology report.

ncbi.nlm.nih.gov/pmc/articl...

thelancet.com/journals/lano...

thelancet.com/journals/lanc...

ncbi.nlm.nih.gov/pmc/articl...

[Eadgbe in reply to Tall_Allen]

Thank you for resoindng. It does say it has a ground glass appearance. What are the SE of SBRT on the lung?

One pulmonary Dr. said the resection is a "one and done" deal.

[Tall_Allen in reply to Eadgbe]

One of the links above gives the side effects of lung SBRT. My friend didn't have any side effects. If I recall, I think he had a single SBRT treatments of 21 Gy (but it was 5 years ago, so I may misremember). His ground-glass lesion showed up on a CT and an FDG PET, but not a PSMA PET. He hasn't had any problems since - he gets annual CTs to check it.

[Eadgbe in reply to Tall_Allen]

I have a Dr. friend (Hillel Benavi), who is a principal of the most prominent radiology firm in the area and seems to be the guru of reading scans. He is willing to look at everything and give me his opinion. I appreciate your attention to my question and will check out the links thoroughly.

[Tall_Allen in reply to Eadgbe]

You might ask for an FDG PET to assure it is cancer.

[Eadgbe in reply to Tall_Allen]

I just had the other so I'm not sure how long I have to wait for a FDG one.

[Tall_Allen in reply to Eadgbe]

It requires fasting, so you can have it the next day.

[Eadgbe in reply to Tall_Allen]

I just checked and it was an FDG pet.

[Eadgbe in reply to Eadgbe]

TA,

took the results of my pet scan and ran them through chatai to translate into layman's terms. This is interesting. I don't know the veracity of this but here goes:

Report: Lungs: Improved right lung consolidation compared to prior exam on 05/06/2024 without currentinfiltrate, likely reflecting post tissue sampling pulmonary hemorrhage.

*Unchanged right upper lobe groundglass nodule measuring 1.3 x 1.3 cm (image 19 series 2), most recently 1.3 x 1.4 cm on 12/19/2023 exam. SUV max 1.5, comparable to background level. Nodule lacks a soft tissue component as such it is below the resolution of PET for this reason.

Chat interpreted this as:

"Simplified: The nodule doesn’t stand out on a PET scan, which is a type of imaging test often used to look for cancer. It shows activity that is similar to the normal surrounding tissue (SUV max 1.5), meaning it doesn’t appear more active than the rest of the lung and is unlikely to be cancerous. Also, it’s too small and doesn’t have a distinct solid part that shows up well on the PET scan, making it hard to evaluate further using this type of imaging.

This summary essentially indicates that there's improvement in the lung's condition, and a small lung nodule that seems stable and not suggestive of cancer based on its current imaging characteristics."

I don't know what to think, yet. I'm too skeptical to buy into good news. I guess I have to hear a few more opinions and proceed. I just don't want to be looked at like the Dr's next house payment.

[Eadgbe in reply to Tall_Allen]

Another question: would SBRT take the surgery off the table if it didn't work or could I then do the surgery? Do you know?

[Tall_Allen in reply to Eadgbe]

I think you can always cut lung tissue. But the SBRT is ablative (very high dose) and as you see, it works just as well as surgery.

[Kestrel5]

First and only mets in the lungs are uncommon, but that was my circumstance. Five have been treated with SBRT (50 Gy total in five 10 Gy fractions each) - no side effects. So far, very successful. Over three years of undetectable PSA and no evidence of progression on CT scans.

[j-o-h-n]

Important note: If it should be lung Ca make sure you check with doctorS (note plural) to see if can be treated with immunotherapy meds KEYTRUDA. It works!!! (ask Jimmy Carter).

Good Luck, Good Health and Good Humor.

j-o-h-n

[elwoodpdowd]

Dear Eadgbe,

I am almost 74 years old and, if I've figured-out your name correctly, I am also a guitar player.

When it came time to treat my prostate cancer (I was on active surveillance for 10 years), I chose SBRT (cyber-knife) with Dr. Robert Meier at Swedish Hospital in Seattle, because my research confirmed SBRT was the best option and Dr. Meier was one of the top doctors in the country. I had 15 treatments in 2021 and was also on Eligard for two years until November 2022. During ADT, my PSA was undetectable. Unfortunately, in the last six months since suspending ADT my PSA has been doubling every three months and next week I will have a PET scan at the Fred Hutch cancer center connected to the University of Washington Medical Center in Seattle. I anticipate a resumption of ADT, some new drugs, possible salvage radiation, and perhaps participation in a trial study of a new cancer vaccine.

I have long been impressed with the wisdom of Tall_Allen shared here and will defer to him relative to the questions you've posted. It sounds like some of your treatment providers have not been the best. I don't know where you are located, but I live 3 hours from Seattle yet I have consistently sought "the best & the brightest" when it comes to cancer research and treatment, so I travel to the UW Medical Center and Fred Hutch. I'd be happy to share my cellphone number with you if you ever care to chat.

[Eadgbe]

Thanks Elwood. My prostate has been treated and am now in the waiting game as my T recovers from Eligard to see if the radiation successfully killed the cancer. The recent pet scan shows no mets other than that vague node in my lung.

I found out something startling today. After a discussion with one of the dads of a student of mine who is a profoundly venerated (and rightly so) radiologist who read my scans, he determined that the node shows no current growth and very little metabolism, if at all. But that wasn't the startling news.

I recovered from a lung biopsy that went bad and nearly killed me as I woke up a day later intubated and Borged out. (My wife nearly had a heart attack). My Dr. friend said that the biopsy was done in the wrong direction! (front instead of back) resulting in the needle having to go through about 4" of my lung instead of 1/2". He said if I need another biopsy again (a dry CT every 6 months to check for growth) that he would do it. So my life has turned around temporarily at least and I seem to have been given a reprieve for awhile. I shall make the best of it - trying to learn old rep. , go to the gym and let my wife know I'm here to stay for awhile.

Thanks for the reply and say hello to Harvey.