SUVmax of 80!

[Rodeoz15]

Hi everyone

Hope you all are in good health.

I wanted to check if anyone has had such a high SUVmax on a PSMA-PET? My father's recent scan shows a new lesion in the perirectal region with an SUVmax of 80.1. Everywhere I have searched, I can't find anyone with such high SUVmax. ChatGPT tells me this is highly unusual. His PSA has risen from 0.6 to 3.6 in about 4 months. No pain or any other symptoms. He has mets all over his bones since 2021. This lesion in the rectum is new.

Could the PET scan have an error? Wanted to check if we should repeat it at a better hospital. Or is this a very highly aggresive lesion?

Thanks in advance

Rodeoz

[EnjoyLife1]

My husband had very high suv max values into the 70s before pluvicto. He finished 6 rounds of pluvicto with mixed results with a lot of the mets getting smaller or resolving. One bone met which only had an suv max of 4.2 grew like crazy while he was on Pluvicto and now he will get radiation. If your dad can handle the treatment, pluvicto should help the super avid ones.

[Brightman]

Not sure if the PSMA could have any error - wouldn’t think so ? I had a PSMA Pet scan on Monday. It showed up a lesion on 8 th rib with SUV max 15.9 , another on left hip bone with SUV max20.2 and a possible lesion on skull of SUV max 2.3 (at left parieto-occipital skull but could be flare of blood vessel activity at adjacent venous sinus) on which I had a CT scan yesterday & will find out about that on Tuesday. I will have SBRT radiation on these as I have done on two other lesions. The oncologist said these were almost in the lower range and greater than 20 could cause a problem. Best wishes.

[TeleGuy]

The scan that convinced me to do 177Lu therapy had many lymph nodes in the 60s and one as high as 114. GP24 posted here about a clinical trial of Pluvicto for the hormone sensitive state. I had an excellent response but my disease is lymph compared to your bone.

[Manilo]

I had a few mets in the spine with SuvMax 60's & 70's after PSA went from 1 to 5, then went down to 8 after SBRT.

One of the mets with pain, and broke a vertebrae.

I was going to do Lu177 but did SBRT which is more effective in oligometastatic Bone lesions.

PSA went down to 0.8

While the SBRT, I did one cycle of Keytruda, in hope of getting an abscopal effect.

When PSA went down to 0.8 four months after SBRT, I stopped Enza and 4 weeks later started BAT with Testosterone monthly during two shots.

I can't give advice, but in your case I think I would try SBRT to the aggressive lessons plus Lu177 one cycle and one shot of Keytruda at the same time. It is not the protocol, but I've done it once, and would do it again.

Keytruda side effects were quite annoying but transient (neutropenia, fever, meningitis simptoms, skin issues with peripheral neuropathy in face and ears, fungi infections). As well as esophagitis grade 2 due to SBRT

[Seasid in reply to Manilo]

Why didn't you try olaparib during SBRT radiation?

[Tinuriel]

Don't panic. I just found my husband's PSMA scan results where he had a lymph node show an SUV of 125 and another of 32. They may have disappeared entirely during chemo as they have not been mentioned in following scans.