PSMA Scan positive

[Peppertree602]

Bio up to date with all details.

Had PSMA scan today after finishing radiation in June. Still on Orgovyx and Erleada and last PSA undetectable June 1. Next test Oct October 15th next week. It seems it came back with some uptake that has ROs scratching heads. Would truly welcome folks who understand these reports opinion. Appointments with Docs next week.

1. Small focus of abnormal increased activity in the left pelvis immediately adjacent to the left ureter with no corresponding CT abnormality. The appearance is concerning for possible small lymph node metastasis. This was present on March 19, 2024 but is more conspicuous on today's study.

2. Small focus of abnormal increased uptake in the right neck which is new compared to March 19, 2024. This is of uncertain etiology. Based on its location, this is unlikely to represent lymph node metastasis related to the patient's prostate cancer. Further evaluation with dedicated CT scan of the neck with intravenous contrast may be of benefit.

COMPARISON: Outside PET/CT exam dated March 19, 2024

FINDINGS:

Head and Neck: Uptake is seen in the inferior right neck at the level of the thyroid cartilage with an SUV of 4.6. No corresponding CT abnormality is seen. No other areas of abnormal uptake are identified in the head and neck.

Chest: No abnormal uptake

Abdomen: No abnormal uptake

Pelvis: There is abnormal uptake identified in the left pelvis immediately adjacent to the left ureter. See axial image 252. This has a peak SUV of 10.5. No corresponding CT abnormality is identified. However this likely represents a left iliac chain lymph node a similar finding does appear to be present on the prior exam from March 19, 2024. However was less conspicuous at that time likely related to differences in technique.

No other areas of abnormal uptake are identified in the pelvis.

Skeletal: No abnormal osseous uptake is seen to suggest osseous metastatic disease.

Additional CT findings: Metallic densities are seen in the region of the prostate bed.

[Tall_Allen]

Assuming the neck is a false positive, whole pelvic salvage radiation may be curative. That should be accompanied with 3 years of ADT and 2 years of Zytiga (there is a clinical trial of 2 years of both ADT+Erleada). Suggest pausing your supplement use during radiation, since it is counterproductive if you are taking antioxidants).

[Peppertree602 in reply to Tall_Allen]

Thanks for re-lying so quickly. I just finished whole pelvic radiation with boost to lymph nodes so that is why worrisome

[Tall_Allen in reply to Peppertree602]

Thanks for explaining. Why did you have a PET scan so soon after radiation? It is certain to be useless. I guess your ROs don't understand how radiation kills cancer. Partly, the tumors are killed instantly, but partly they incorporate hydroxyl radicals and other reactive oxygen species (ROS) into the cancer DNA (which is why antioxidants can interfere). Such cancer cells don't die off instantly, but go into a state of dormancy. When they emerge, sometimes years later, and they try to replicate, they die (mitotic catastrophe), In the meantime, the PSMA on the cell surface is still there where it can attach to PSMA-PET-radiochemicals and show up on PET scans.

It is also thought that some errant cells are killed off by the immune system (bystander or abscopal effect). Killer T-cells also use ROS to kill cancer cells - another reason to avoid antioxidant supplements.

[Peppertree602 in reply to Tall_Allen]

Thank you so much makes a lot of sense I will ask my RO who did radiation next week when his office opens after hurricane Milton which destroyed so much in Sarasota

The radiologist who wanted the scan so soon is nuclear radiologist who is a close personal friend

[Peppertree602 in reply to Peppertree602]

TA again thank you for replying! Typically what is time frame after salvage radiation should one wait for a scan?

[swwags in reply to Peppertree602]

My RO says 4 months

[Tall_Allen in reply to Peppertree602]

You shouldn't get a scan at all unless PSA suggests recurrence.

[Sushupthi in reply to Tall_Allen]

Tall_Allen: This is very useful; I am in a somewhat similar situation - 6 months into ADT + Zytega after Cyberknife + Whole pelvic IMRT. The ADT/Zytega will continue for 2 years. I take vitamin and calcium supplements, Curcumin (Turmeric) and drink plenty of Pomegranate juice (an antioxidant, I believe). I could not find what antioxidant supplements Peppertree602 was taking. Should I stop the Pomegranate juice and Turmeric supplement? Thx

[Tall_Allen in reply to Sushupthi]

None of that is useful for prostate cancer.

Pomegranate has been proven useless in two randomized placebo-controlled trials.

nature.com/articles/pcan201532

jcancer.org/v04p0597.htm

Curcumin:

prostatecancer.news/2019/04...

Vitamin D and Calcium:

prostatecancer.news/2018/07...

Get your nutrients from food, not supplements.

[Sushupthi in reply to Tall_Allen]

Thanks for the links; plus the links in your profile page-very useful.

I appreciate the viewpoints re., the supplements.

My question was the other way round - does taking Pomegranate juice, touted as an antioxidant, interfere with the killing of the prostate cancer cells via radiation? That part of your reply to Peppertree piqued my interest.

Rgds

[Tall_Allen in reply to Sushupthi]

Probably, you can't drink enough pomegranate juice to make a difference. But since it has been proven to make no difference in prostate cancer progression, why risk it?

[NanoMRI]

As you are asking for opinions, based on my experiences with my radiology report over the past ten years, despite all the efforts, prostate cancer remains. I do find second radiology opinions very useful. All the best!

[Peppertree602 in reply to NanoMRI]

Next week for sure

[Ashikpong in reply to NanoMRI]

Uplift someone with a word of encouragement, and deny negative vibes.

[NanoMRI in reply to Ashikpong]

Interesting that you (negatively) flagged my comments. I shared my opinion based on my experiences that include multiple imaging successes with very early detection.

I can appreciate that an opinion of a written radiology finding being a 'false positive' seems uplifting and encouraging, but in my experiences ignoring the possibility/reality of remaining cancer does not favor more positive outcomes. I favor additional investigations including 2nd radiology opinions - as noted. I recently had a Pylarify PSMA done at 0.033 (many say NO at this PSA). It identified a 2cm lesion that after additional investigations is metastatic melanoma.

In his bio Peppertree602 shares he feels his medical team is of highest caliber - and yet it has been suggested his doctors do not understand what they are practicing? This is uplifting and encouraging?

All the best to all of us fighting this beast and all cancers!

[GP24]

I would assume the spot in the neck is a false positive. No action required before the next PSMA PET.