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.

Exam Date: July 17, 2024

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

PSMA PET scan as a complementary 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.

[Seasid]

As I already said you need to radiate your prostate and see what will happen. The last thing what you want is to let the cancer metastasize from the prostate. The prostate has a high DHT environment therefore you should have a radiation therapy of your prostate or even better a surgery to remove it and to get rid of the prostate cancer for good.

[Seasid in reply to Seasid]

I didn't let them to radiate my pelvic lymph nodes because I have a terminal illness and not curable and didn't want to kill my bone marrow and immune system and T- Lymphocytes etc. After radiation therapy of your prostate only you can watch your PSA level to drop and in one year after radiation therapy you could have an another PSMA pet ct scan. I myself made a mistake that I didn't star Bicalutamide earlier, as soon as the PSA started to rise from the nadir. My nadir was 0.25. I successfully bread out to the radiation most resistant strains of the prostate cancer by letting the PSA rise from 0.25 to 2.5 to start with Bicalutamide. I suggest you to have a parametric MRI also and see how the cancer correlates with the PSMA pet ct scan results. Find out your PIRADS score from the parametric MRI and do intensification of the radiation beam where they can see more cancer. My SUV Max was only 14 and I also had 95% of my prostate covered by the cancer.

[Seasid in reply to Seasid]

They did radiate my both seminal vesicles although only one had a cancer according to the PSMA pet ct scan with contrast.

According to professor Emmett the PSMA pet scan what you just had is the best and most accurate pet scan.

[Seasid]

What was your PSA at the time of your PSMA pet ct scan?

[Seasid in reply to Seasid]

My PSA was 1.1 at the time of my PSMA pet ct scan and the PSA was 1.4 at the time of the SBRT radiation therapy to my prostate. In six months my PSA dropped from 1.2 to zero point twenty five. That was my nadir after the SBRT radiation and I stayed on Degarelix injections. Now I believe that I had to start Bicalutamide parallel to degarelix when my PSA just started to rise from the nadir after the radiation.

[Seasid]

You may want to become familiar with the Nano knife procedure. It is said to be a minimally invasive procedure but still could result in permanent urinary retention:

healthunlocked.com/advanced...

[Seasid in reply to Seasid]

If permanent urinary retention occurs after the NanoKnife (Irreversible Electroporation) procedure, the best solution would depend on the specific cause and severity of the retention. Here are some of the most effective long-term solutions:

1. **Intermittent Self-Catheterization (ISC)**:

- **Description**: Patients periodically insert a catheter to empty the bladder.

- **Pros**: Maintains bladder function and independence, reduces risk of infection compared to an indwelling catheter.

- **Cons**: Requires patient training and compliance.

2. **Surgical Interventions**:

- **Transurethral Resection of the Prostate (TURP)**:

- **Description**: Surgical removal of part of the prostate to relieve obstruction.

- **Pros**: Highly effective for relieving obstruction, can provide long-term relief.

- **Cons**: Invasive with associated risks such as bleeding and infection.

- **Prostatic Urethral Lift (UroLift)**:

- **Description**: Lifts and holds the prostate tissue to open the urethra.

- **Pros**: Minimally invasive, preserves sexual function, quick recovery.

- **Cons**: May not be suitable for very large prostates or severe cases.

- **Bladder Neck Incision (BNI)**:

- **Description**: Incisions made in the bladder neck to widen it.

- **Pros**: Effective for relieving obstruction, less invasive than TURP.

- **Cons**: Risk of incontinence, may need repeat procedures.

3. **Chronic Indwelling Catheter**:

- **Description**: A permanent catheter is placed through the urethra or via a suprapubic route.

- **Pros**: Provides continuous bladder drainage, effective for severe cases.

- **Cons**: High risk of infections, discomfort, and lifestyle limitations.

4. **Urinary Diversion**:

- **Description**: Creating a new way for urine to exit the body (e.g., urostomy).

- **Pros**: Bypasses the obstructed urethra completely.

- **Cons**: Major surgery, significant lifestyle changes, risk of complications.

5. **Medications**:

- **Alpha-Blockers and 5-Alpha Reductase Inhibitors**:

- **Description**: Medications to relax the bladder neck and shrink the prostate.

- **Pros**: Non-invasive, can be used long-term.

- **Cons**: May not be sufficient for severe retention, side effects.

The choice of treatment should be individualized, taking into account the patient's overall health, the specific cause of the retention, the severity of symptoms, and patient preferences. A thorough evaluation by a urologist is essential to determine the most appropriate course of action.

[Seasid in reply to Seasid]

Q. Could they remove the radiated prostate and move his urinary bladder further down and reconnect it so he is free from urinary retention if the Nano knife procedure is performed after the failed SBRT radiation therapy of the prostate?

A. While radical prostatectomy (the surgical removal of the prostate) is an option for prostate cancer treatment, it becomes more complex after radiation therapy, such as SBRT (stereotactic body radiation therapy). The procedure you are describing involves removing the prostate and moving the urinary bladder down to reconnect it to the urethra, which could potentially address issues of urinary retention.

However, there are several important considerations:

1. **Post-Radiation Surgery**: Surgery after radiation therapy can be more challenging due to the changes in tissue caused by radiation, such as increased fibrosis and reduced tissue healing capacity. This can make the surgery more complex and increase the risk of complications.

2. **NanoKnife Procedure**: The NanoKnife (irreversible electroporation) is a non-thermal ablative technique used to treat localized prostate cancer. It involves using electrical pulses to create permanent pores in cell membranes, leading to cell death. While it can be an option for localized treatment, it might not address issues of urinary retention directly.

3. **Urinary Retention**: If urinary retention is a significant issue, it could be caused by factors such as obstruction from the prostate or changes in bladder function due to radiation. A multidisciplinary approach involving urologists, oncologists, and possibly reconstructive surgeons is necessary to determine the best course of action.

4. **Alternatives**: Other interventions might include less invasive procedures like transurethral resection of the prostate (TURP) or the placement of a suprapubic catheter for bladder drainage.

Given these factors, it's crucial to have a detailed discussion with your healthcare team, including a urologist and an oncologist, to explore all options and decide on the most appropriate treatment plan based on the specific circumstances. They can provide a comprehensive assessment and tailor the approach to your individual needs.