PSMA PET 7/17/2024 vs. Axumin PET 1/3/2024

[dhccpa]

I had my first ever PSMA PET run this morning, 7/17/2024. Here is the report, followed immediately by the report from my most recent Axumin PET run 1/3/2024.

Please give me your valuable feedback. Thank you!

Report from PSMA PET run 7/17/2024:

PROCEDURE(S): PET/CT TUMOR (PSMA)

INDICATIONS: Malignant neoplasm of prostate.

CLINICAL DATA: Patient has received a total of 2 CT and cardiac nuclear medicine (myocardial perfusion) studies over the

past 12-month period. This includes studies from the Radiology Information System and patient-provided radiological

history.

MEDICAL/SURGICAL HISTORY: Prostate cancer diagnosed with biopsy 07/2018. Gleason score 8(4+4). PSA 1.54ng/mL

03/14/2024, 1.27ng/mL 01/26/2024, and 1.37ng/mL 12/2023. Xgeva 01/2020-ongoing, stopped 2022-2023. Bilateral

cataracts. Tonsillectomy. Dethatched retina repair. Urethra surgery.

GCSF: none

COMPARISON: No prior exams available for comparison

TECHNIQUE: A wide field-of-view limited dose non-contrast CT was performed for the purposes of attenuation correction of

the PET data. 74 minutes after intravenous administration of radioligand, PET imaging from vertex to mid-thigh was

performed using a high resolution, orthosilicate detector PET/CT scanner with time-of-flight electronics and reconstruction.

DICOM format image data is available electronically for review and comparison.

DOSE: 5.8 mCi Ga-68 PSMA-11 Gozetotide (Illuccix) (administered). 5.0 mCi (ordered).

DOSE WASTED: 0.8 mCi

FINDINGS:

BIODISTRIBUTION: Normal. Liver SUVave 3.5

NECK: No abnormal accumulations of radioligand.

CHEST: No abnormal accumulations of radioligand.

ABDOMEN/PELVIS: No abnormal accumulations of radioligand.

PROSTATE BED: Extensive malignant uptake within the prostate gland basically the entire gland maximum SUV of 24.7

without involvement of the seminal vesicles.

NODES: No abnormal areas of radioligand binding. There are tiny lymph nodes in bilateral groin without any abnormal

uptake considered benign.

BONES: No abnormal accumulations of radioligand. Vague area of sclerosis L2 vertebral body on the right side without any

abnormal uptake most likely benign. Previously seen vague area of sclerosis T12 vertebral body with mild uptake

demonstrates no abnormal uptake additionally previously seen vague uptake right acetabulum demonstrates no abnormal

uptake..

The CT portion of the exam demonstrates chronic findings not related to the patient's oncological evaluation stable not

significantly changed. Coronary artery calcifications are seen typically seen with coronary artery disease and clinical

correlation and evaluation is suggested.

Name: CARPENTER, DONALD Exam Date: July 17, 2024

Patient ID: 1077529 Referrer: CHEW, BOON, MD

DOB: 6/26/1956 Exam Name: PET/CT TUMOR (PSMA) | 100157

Acc #: 7029363

CONCLUSION:

1. Significant malignant uptake involves the entire prostate gland without involvement of the seminal vesicles.

2. There are vague areas of sclerosis T12 L2 vertebral bodies without any abnormal uptake characteristic of treated

metastatic disease.

Here's the report from Axumin PET run 1/3/2024:

PROCEDURE(S): PET/CT TUMOR (AXUMIN)

INDICATIONS: Malignant neoplasm of the prostate. Rising prostate specific antigen following treatment for malignant

neoplasm of the prostate.

CLINICAL DATA: Patient has received a total of 0 CT and cardiac nuclear medicine (myocardial perfusion) studies over the

past 12-month period. This includes studies from the Radiology Information System and patient-provided radiological

history.

MEDICAL/SURGICAL HISTORY: Prostate cancer diagnosed 8/2018. Lupron therapy 11/2018, ongoing. PSA: 1.37ng/mL. Eye

surgery, urethra surgery in childhood, tonsillectomy.

COMPARISON: POI, PET/CT TUMOR (AXUMIN), 9/9/2021, 8/6/2020, and 1/16/2020. PET/CT bone scan 12/21/2018. MR

prostate 12/20/2022 and 9/17/2021

TECHNIQUE: A wide field-of-view limited dose non-contrast CT was performed for the purposes of attenuation correction of

the PET data. 3 minutes after intravenous administration of F-18 fluciclovine, PET imaging from mid-skull to proximal thigh

was performed using a high resolution, orthosilicate detector PET/CT scanner with time-of-flight electronics and

reconstruction. DICOM format image data is available electronically for review and comparison.

DOSE: 10.3 mCi F-18 fluciclovine (Axumin)

DOSE WASTED: 0mCi

FINDINGS:

BIODISTRIBUTION: Normal. L3 SUVmean 2.5 (prior 4.0)

NECK: Noabnormal accumulations of radiopeptide.

CHEST: No abnormal accumulations of radiopeptide.

ABDOMEN: Noabnormal accumulations of radiopeptide.

PELVIS: There is focal moderate peptide uptake in a short segment of the mid sigmoid colon with SUVmax 4.2. CT images

demonstrate focal narrowing of the lumen of the colon at this level with features suggestive of an apple core type lesion.

There is a moderate amount of stool throughout the right and transverse colon which is similar in appearance to prior scan..

PROSTATE: There is persistent moderately intense radiopeptide uptake in the central gland measuring 1.7 cm in size with

SUVmax 6.5 (prior SUVmax 6.3).

NODES: Persistent peptide uptake in a solitary left inguinal node measuring 11 mm, SUVmax 3.6 (prior SUVmax 4.0). No new

peptide avid nodes seen.

BONES: Again noted is moderate peptide uptake in the right supra-acetabular sclerotic lesion with SUVmax 3.8 (prior

SUVmax 4.5), and in the mildly sclerotic lesions of T12 and L2 with SUVmax 4.3 (prior SUVmax 4.7). No new peptide avid

osseous lesions seen.

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CONCLUSION:

1. Multifocal areas of Axumin uptake involving the central prostate, left inguinal node, and sclerotic lesions of the right

acetabulum, T12 and L2 persist and are similar in intensity when compared to prior Axumin scan in 2021 and 2020. This

suggests residual disease. Given the persistence of the findings for several years on Axumin scan, may consider performing a

PSMAPETscan as acomplementary characterization of the degree of active disease if such information would alter

treatment options.

2. Focal peptide uptake in the mid sigmoid colon with CT findings suggesting possible apple core lesion. If the patient has

not had a recent colonoscopy, may consider such.