SBRT to three bone spots 10 months ago still showing on PSMA PET

[Steel67]

SUV started at 15 then 7 now 3. Has anyone experienced similar reduction time, did they eventually resolve completely? Concerned that they might still be hot and grow back.

PSA has been stable 0.08.

[Tall_Allen]

SUV of 3 is about your background level, isn't it?

[Steel67 in reply to Tall_Allen]

Blood pool 1.1/1.7- aorta

[Tall_Allen in reply to Steel67]

Pretty close.

[SeosamhM]

Your question is a valid one, and goes to the one of the key points on why radiotherapy isn’t approved as definitive care for bone mets (my RO would disagree, of course). Upon my initial diagnosis (almost 8 y.o.!), I was put on chemo and had concurrent radiation to 2 of the most dangerous bone mets in my spine - one at L4 and the other (my special companion) at C2. Both appear regularly above baseline for all types of PET (PSMA, FDG, NaF). I had another met in my shoulder irradiated last summer - this one actually grew during Pluvicto treatment and was PSMA+ (huh?). I fully expect this to show up on my next PSMA in August.

Most of my mets - treated and untreated - demonstrate increased uptake above baseline. Some non-cancerous lesions - like arthritis - show up. An SUV of 3 is a pretty good level (not actionable) - especially when baseline is <2.

Your PSA is great. As regards bone mets, it (generally) takes PSA rise + ALP rise + image confirmation before I ask “What are we gonna do and when are we gonna do it, doc?”

My C2 met has been glowing on images for years, but my PSA is low and my ALP is stable. I won’t say that I am not concerned, but I am okay between visits.

[Steel67 in reply to SeosamhM]

Thank you