Is it normal to have high PSMA & lesions in MRI after 2 months of SBRT to spine mets, with PSA dropping on Enza that seems to be working?

[Manilo]

I had 4 oligomets in the spine, stable since a PET PSMA in November 2023 when I started Enzalutamide. Then treated with SBRT in march 2024.After 2 months, in May, a new PET CT PSMA shows SuvMax of 60 similar to 70 before the SBRT, and an MRI report says there are tumor lesions they same as in the MRI done before the SBRT. (Is the radiologist mistaking the radiation esclerotic lesions with tumor lesions?).

The PSA though dropped a lot.

Does PSMA Suv Max take long to dissipate? Like, dead tumor cells being eliminated slowly?

Or should PSMA SuvMax have dropped dramatically?

Thank you all.😘

Take care.

[Tall_Allen]

I agree with you. The sclerosis caused by the tumors doesn't go away after radiation, and the "zombie" cancer cells may continue to express PSMA for a while.

[Gabby643 in reply to Tall_Allen]

Thanks T A!

[Manilo in reply to Tall_Allen]

thank you, an oncologist told me "the SBRT did not work because the PSMA is still there", and also the radiologist said such thing concerning the sclerotic lesions in MRI, saying it is all the same as was.

but pain faded and PSA dropped.

I repeated blood tests and will see if PSA keeps falling, thank you.

[Manilo in reply to Manilo]

PSA keeps falling a lot. From 8 to 1.2 now, after 6 months ENZA and SBRT to all 4 spine oligomets with high SuvMax 25 to 70 in PET CT PSMA

I will now start BAT without bone pain and presumably no significant or no mets around.