PSMA finding of thyroid cancer

[Jojoteacher]

My husband’s PSMA showed thyroid cancer. I understand that MPC rarely metastasizes to the thyroid, so it’s probably a separate issue. It’s hard to stay positive with two cancers now. I would like to hear positive stories from people who have dealt with a second cancer. Thank you.

[NanoMRI]

Positive is that it has been found before symptoms. My recent (Pylarify PSMA) PET CT, done at uPSA 0.03, identified a liver lesion of unknown type - subsequent biopsy confirmed as metastatic melanoma. Of course I am not positive about this but I am most grateful it has been found now giving me a better chance to deal with it. All the best!

[Tall_Allen]

A primary thyroid cancer expresses PSMA? Or did they find it on the CT scan?

[Schwah in reply to Tall_Allen]

TA, doesn’t every PSMA scan include a PET scan that would be expected to show any other potential cancers ( non PSA Avid) ?

Schwah

[Tall_Allen in reply to Schwah]

No. a PSMA PET scan does not automatically include a PET scan for non-PSMA-avid cancers.

[Schwah in reply to Tall_Allen]

So i’m confused. I specifically asked Dr. Mark Czernin (head if nuclear medicine at UCLA) if my PSMA scan would also show any other non PC cancers. He was very clear that it would. In fact based upon one PSMA scan, I was referred to a dr to look at an unrelated (and non PSMA avid) spot elsewhere. Turned out to be nothing. But even the actual report says:

“PET CT BODY WITH DIAGNOSTIC CT OF THE NECK CHEST ABD PELVIS W/IV CONTRAST.”

So how can your statement and and Dr. Czernin both be true?

Schwah

[Tall_Allen in reply to Schwah]

He probably meant the CT scan and you misunderstood. I advocate FDG PET scans in all those contemplating Pluvicto, as described here:

prostatecancer.news/2019/12...

Czernin isn't really that up on all this. You'd have to ask Jeremie Calais, who is the expert on PSMA radiotherapy in the nuclear medicine department.

[maley2711]

If actually thyroid cancer, it is the LEAST deadly....about 5% I believe. Wife had hers removed quite a few years ago.....on levothyroxine for the rest of her life. Was it PSMA avid, or just something unusual observed in the scan?

[MomOfMaisy in reply to maley2711]

Yes, I was diagnosed with thyroid cancer in 2013 with significant sized tumors on both sides. Had a thyroidectomy and have been on levothyroxine. My endocrinologist first had me take the name brand Synthroid for the first 5 years since some of the generic ingredients aren’t always consistent. I chose NOT to do radioactive iodine after the surgery. After doing research and realizing that there are sometimes side effects like salivary gland issues, I decided against it. My endocrinologist and I monitored it for years and so far, so good! Also, unfortunately, the surgeon wasn’t as experienced with thyroid surgery as I wanted. I was on an HMO and I didn’t have the choice to go with someplace like UCSF. Subsequently she permanently damaged a vocal nerve that left me without the pitch I used to have. And my voice tires easily in loud environments. Other than that, it’s been fine.

[maley2711 in reply to MomOfMaisy]

I think we laways need to be careful in believing that a problem was caused by one's surgeon and no problem would have occurred witha different surgeon.

[Jojoteacher in reply to maley2711]

It lit up on the PSMA. I read that PSMA does pick up thyroid cancer.

[street-air]

”A recent retrospective cohort found (Ga-PSMA-11, 18F-PSMA, or 18F-DCFPyL) PSMA-avid thyroid gland lesions in 1.1% of patients undergoing PSMA PET evaluation for PCa; of these, a small but clinically significant proportion (3 of 61) were malignant, with one differentiated thyroid carcinoma, one Hürthle cell carcinoma and one renal cell carcinoma metastasis31”

nature.com/articles/s41698-...

has it been biopsied and found malignant? that would be a 4% chance from a 1.1% chance..

[AnOrangeADay in reply to street-air]

PSMA-avid thyroid lesions, which can be unexpected and are sometimes called thyroid incidentalomas (PTIs). While PSMA is expressed in various tissues, the clinical significance of a PTI is not entirely clear

[Jojoteacher in reply to street-air]

Yes, it was biopsies and found to be cancerous.

[Momtonani]

We found out the hard way it is more common than you think. Node showed up on scans years before an ultrasound was ordered that we had to ask for. Thankfully his doc obliged our request. Other doctors wrote it off as common with age. Biopsy showed it was prostate cancer. He then developed a tumor in the spine that did not show up on regular body scans. No clue it was there until he could not walk and had an MRI. Never confirmed the two were related. But we could not help but wonder if it had been addressed when discovered if certain things could have been prevented. Sorry you are both dealing with a new blow😔

[Runner4000]

Was your husband’s cancer biopsied and tested? I had a “hot spot” show up there, and it was tested and found—so far—to be benign.

[Jojoteacher in reply to Runner4000]

Yes, biopsied and found to be cancer. Now they are doing further testing before deciding on an action plan.

[rm9x]

Hi - I had the same thing happen on last year's PET scan. The endocrinologist stated that the PET scan was not an indicator of thyroid cancer; however the ran me through the process of biopsy and pictures. It ended up being nothing. I can only recommend that you wait until you have more specific thyroid related testing.

[Jojoteacher in reply to rm9x]

It was biopsied and found to be cancer. Now they are doing further testing before deciding on an action plan.

[Rocketman1960]

Like your husband, they also found a thyroid tumor during a PSMA scan. The separate cancer thyroid tumor was identified and removed 10 years ago. I do take meds to supplement the remaining 1/2 thyroid. I continue to fight the PC and am thankful for every day the Almighty gives me on Earth. I am 14 years out.

[Nittany]

I don't know, my thyroid cancer was detected by the CT scan during my initial screening battery at the National Cancer Institute. The PSMA-PET showed only prostate-cancer related hits and did not reflect the thyroid cancer.

Thyroid cancer is much more common than people realize and 95% of the time is curable with treatment, which is typically surgery and then drugs. In fact, as often as not, thyroid cancer doesn't present with symptoms and is only detected incidentally as in my CT work-up.

[GAdrummer]

My dad had salivary gland cancer and prostate cancer. I don't know which came first. The salivary gland was removed and some years later the prostate cancer was diagnosed at an advanced stage and he died two years later. My husband had a leiomyosarcoma removed from his leg and two years later was diagnosed with advanced nodes only prostate cancer. He got lucky with Keytruda and has been undetectable for 3 years. Neither were smokers but their fathers were, and their jobs exposed them to carcinogens and their mothers died of cancer (leukemia and breast cancer respectively).

I believe that the genetic changes (no matter what their origin), that support the development of one type of cancer, enable other other types as well. My husband had a rare type of prostate cancer first, that had a rare response to Keytruda. His other rare cancer, [who's heard of leiomyosarcoma?], would normally have killed him quickly, but it occurred in a rare, visible location that allowed a surgical cure. Standard of Care treatments for advanced prostate cancer tend to not work so well for rare types. If you have a rare type, you need to find a research doctor who is flexible and willing to think and act outside the box.