MRI results

[Simonapo]

Hi everyone, my Dad’s PSA at the end of 2023 was 0.008. This year (2024), PSA had some fluctuations: 0.024, 0.029, 0.026, 0.025. PSMA Pet showed one small spot on the rib which was radiated by Dr. Kishan at UCLA. After SBRT, PSA was 0.015, and then in August was 0.022. He started having pain recently in his back, I took him to physical therapy and injured his back even more during the therapy. His PCP ordered an MRI that showed: “There is a T1 hypointense, mildly STIR hyperintense enhancing lesion at L2 vertebral body again measuring 3.1 cm in maximum transverse dimension. No definite extraosseous extension. There is an additional T1 hypointense enhancing lesion at the left posterior L3 vertebral body measuring 1.0 cm. Findings are suspicious for metastatic lesions”.

Is it possible to have such a large 3cm met that didn’t show in the PSMA Pet that was done few months back? Also shouldn’t PSA be higher having these Mets? Shouldn’t Alkaline Phosphate be higher (his is at 44 and stable). Could these not be Mets and be signals of the trauma from physical therapy? Has anyone else had large Mets with very small changes in PSA, stable low Alkaline phosphate and not showing on very recent PSMA scan? Sorry for all these questions, I appreciate all your input. Thank you so much. We have an appointment with his oncologist Dr. Dorff at City of Hope mid this month, but I am very worried.