PSMA PET Scan

[toyman79912]

I had RP in 2023 and had ADT and radiation that same year. My PSA start ticking up from .006 to the last PSA test which came back at .38. My doctor ordered a PSMA PET scan, and I had it done last week. I just get my result in the portal, but I do not know how to read it. My appointment is not until next month. Can someone help me read this report. Thank you very much in advance

PET/CT Prostate limited

Clinical information:Prostate cancer..

Site of cancer:Prostate .

Treatment history:Prostatectomy . PSA: 0.38 ng/mL

Code: . Subsequent staging.

Technique: 4.9 mCi ILLUCIX administered IV Arm.. Attenuation corrected positron

emission tomography PET images were obtained from the level of the base of the skull to

the level of the mid thigh . Multiplanar reconstructions are review in coronal, transaxial

and sagittal plane. Noncontrast CT images were performed for attenuation correction and

localization purposes, only these images do not constitute a diagnostic–quality CT

examination and were not used to diagnose disease independently of the PET images.

Time from injection to imaging 77 minutes .Glucose level NA .

RADIATION DOSE: CTDI: 4.7 .mGy DLP : 477 .mGy .

COMPARISON: 11/15/2022.

FINDINGS:

Background metabolic activity parotid gland: SUV max 14.03..

Background metabolic activity in liver measures SUV max.5.35.

Blood pool metabolic activity in the descending thoracic aorta measures SUV max 1.71.

Background metabolic activity prostate gland: SUV max 11.03 .

NECK

Relevant findings: :unremarkable.

THORAX:

Relevant findings: None

No evidence of nodal hypermetabolism.

No active metabolic pulmonary nodules, mediastinal/hilar or axillary lymphadenopathy.

ABDOMEN AND PELVIS:

Relevant findings: The prostate surgical bed shows no hypermetabolic foci

No evidence of nodal hypermetabolism. GI and genitourinary FDG activity is

physiological. No evidence of hydronephrosis or renal masses.

No evidence of ascites or mesenteric masses

MUSCULOSKELETAL:

Relevant findings: No evidence of bone metastases.

CT SOURCE DATA.:

IMPRESSION: .PSMA :RADS .mi T 0. mi N 0. .mi.M 0.

1.The prostate surgical bed shows no hypermetabolic foci.

2. No evidence of nodal hypermetabolism.

3. No evidence of metastatic bone disease.

[Tall_Allen]

Congratulations! It's clear.

There's an error: "GI and genitourinary FDG activity is physiological." (it should read PSMA, not FDG, of course).

[toyman79912 in reply to Tall_Allen]

Thank you Tall_Allen for your quick reply. Since my PSA is going up, does that mean the cancer cells are too minute to be picked up on the scan?

[Tall_Allen in reply to toyman79912]

Yes.

[NanoMRI]

As I have learned, imaging can be challenging with this beast. As I share, at a PSA of 0.13 a PSMA PET CT was clear but different imaging (I had done in Europe) successfully identified multiple cancerous pelvic lymph nodes. After my RP and unsuccessful salvage RT I learned to not give this beast time and obscurity.

[toyman79912 in reply to NanoMRI]

NanoMRI, thank you for your reply. Did you have another PSMA PET CT done immediately or did you wait until your PSA went up more? If you waited, what was your PSA when you got the second one which successfully identified the cancerous lymph nodes?

[NanoMRI in reply to toyman79912]

I don't wait. Clarifying - in January 2018, at uPSA 0.13, this after my unsuccessful salvage RT to prostate bed, I traveled to Europe for multiple imaging methods for comparison, including Ga68 PSMA PET CT and Ferrotran nanoparticle MRI, all done in the same week at 0.13 (latter two were not available in US). Again, the PSMA was clear while the Ferrotran successfully identified cancerous nodes. I then chose salvage extensive pelvic lymph node surgery using the frozen section pathology method and six cancerous nodes were confirmed including the common iliac and para-aortic nodes.

Note, post my RP done nearly ten years ago, I chose to rely on ultrasenstive PSA testing and <0.010 as best indicator. Values above 0.010 concern me and I learned to begin next round of investigative methods at 0.03X. I have had three PSMA PETs and mpMRIs since December 2021, uPSA range 0.03X. All were clear. I also have liquid blood biopsy testing.

My plan prior to my PSMA done this past July, anticipating it being clear, was to have Choline and fluciclovine PET CTs for comparison, just in case my PC is not PSMA avid. But the PSMA PET was not clear - it identified a likely 2cm metastatic liver tumor. Further investigations including biopsy confirmed it as metastatic melanoma which is now my focus with doublet immunotherapy. Just yesterday, my uPSA was 0.031 (keeping close watch on PC despite new focus on metastatic melanoma). Early next year, when this doublet immunotherapy is finished, I will pick up further imaging for prostate cancer unless my uPSA drops.

I share this background because you are younger than me, and from all my experiences and lessons, I would be on very high alert with a PSA of 0.38 post RP and post RT, despite a "clear" PSMA PET CT. I cannot imagine giving you a congratulations on the clear PSMA. I hope this helps. All the best!

[toyman79912 in reply to NanoMRI]

NanoMRI, thank you for giving me insight on your journey. I was a little disappointed in my “clear” scan since I know the cancer is still in me but the scan was unable to pick it up. I was hoping to identify the location of the beast and able to treated now. I will have my next appointment with the doctor and plan out the next course of action

[NanoMRI in reply to toyman79912]

In my experiences it takes effort to find doc's willing to get out ahead of this beast - most seem to follow the path of treating PC as a chronic illness with ADT. Clearly, I am an advocate for multiple imaging methods and liquid blood biopsy testing, and going after remaining tumor burdens. Best!

[j-o-h-n]

Good News...... now back to playing with your toys...

Good Luck, Good Health and Good Humor.

j-o-h-n