Petscan results and RO proposed treatments.

[BeHealthi]

Hi everyone,

Here are my husband’s PETScan results and the proposed treatments by his RO. I would like to ask for inputs/advices/suggestions from TallAllen and everyone who have more knowledge about PC treatments to helping us. Thanks so much for your help.

FINDINGS:

Prostate bed: Status post prostatectomy. Focus of radiotracer activity inferior to the bladder in the resection bed SUV max 24 (4985/45).

mi-T-stage: TO.

Regional lymph nodes: No evidence of pelvic lymphadenopathy.

mi-N-stage: NO

Distant s i t e s o f d i s e a s e :

Extrapelvic nodes: No evidence of extra-pelvic lymphadenopathy.

Bones: N o definite evidence of osseous metastases. Faint radiotracer uptake along the anterior aspect of the L2 vertebral body (4985/110)

Soft tissue metastases: No evidence of soft tissue metastases.

mi-M-stage: MO

CT findings:

Head and neck: Physiologic radiotracer uptake is noted in the salivary glands.

Chest: Lungs are clear. Mild coronary artery calcifications.

Abdomen/Pelvis: Normal uptake is noted in the kidneys as with expected prominent urinary excretion of radiotracer.

Musculoskeletal: Faint radiotracer uptake along the skin surface of the right lateral abdominal wall, favored inflammatory.

IMPRESSION:

1. Status post prostatectomy. Focus of radiotracer activity inferior to the bladder in the resection bed which may reflect radiotracer in the urethra versus focal recurrent disease.

2. Faint radiotracer uptake along the anterior aspect of the L2 vertebral body which is nonspecific and of uncertain clinical significance. Attention on follow-up imaging suggested to excluding emerging metastasis assist versus MR

According to my husband’s R.O, the scan results are not conclusive enough for evidence of cancer and he is not concerned about the faint radiotracer on the L-2. He said it’s hard to tell if it was the urine or recurrences in the illuminated areas where the prostate used to be. The RO is sending my husband to the urologist for further investigate with an ultrasound. If there’s any suspect spot(s), biopsy will be followed. If there’s nothings then they will proceed with the markers (3) later on. For treatments, my husband will have 6 mos. of ADT: Cassodex to start and Lupron (2) ; total radiation doses 65 GY for either 36 or 37 fractions, and 74 Gy if the pelvic nodes adjacent to the prostate bed are included.

[Tall_Allen]

With his low and slow PSA, I don't think he even needs the ADT and he doesn't need the pelvic nodes irradiated - he can do that later if indicated.

[BeHealthi in reply to Tall_Allen]

Thanks, Tall_Allen. Before the PetScan he was advised by other RO about having ADT too. I have read about its side effects and hope that my husband doesn’t have to have it but don't know if it’s possible. Do you know what the free biochemical recurrence percentage is with and without ADT for treatments? He emailed his doctor today to see if he can have Orgovyx instead of Lupron and we are waiting for his reply. If his doctor says no, should he ask for the one-month shots instead, as perhaps the side effects will wear off quicker? The RO said he wants to see what they would find out from the micro ultrasound/biopsy, and then he will decide if lymph nodes should be included in the treatments. He said that the micro ultrasound is as good as MRI. Question: Is it safe to have a biopsy done at this point? I have read that biopsies may cause the spreading of the cancer cells. His doctor advised him to take vitamin D and calcium supplements during the treatments, but I have read somewhere that they may have caused the radiations to become less effective. I will do some research on this subject later. Thanks for your help as always.

[Tall_Allen in reply to BeHealthi]

As I said, he doesn't need ADT - it doesn't add to the success of his treatment at his PSA level.

prostatecancer.news/2022/05...

I don't know how to be more clear.

[BeHealthi in reply to Tall_Allen]

Thanks, Allen. I have read the links and i am confused by this summary . Am I missing something?

”SPPORT is telling us that if we are willing to put up with 4 months of ADT and some extra short-term toxicity from the wider field of radiation, a cure is likely. RTOG 9601 tells us that if your PSA<0.7, you aren't likely to die if you don't get the extra short-term hormone therapy, but you may have to have lifelong ADT eventually. It will always be a managed disease. Patients should acknowledge these trade-offs and discuss with their doctors”

[Tall_Allen in reply to BeHealthi]

My apologies. I gave the wrong link, and was wrong in what I wrote - thanks for correcting me.

I meant this link which says,

"Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. " (with 9 years median follow-up)

thelancet.com/journals/lanc...

But, you are right that SPPORT did indeed find that 4-6 months of adjuvant ADT reduced biochemical progression among men getting salvage radiation. (with 8 years median follow-up)

The difference is the endpoint used in the trials. Biochemical progression precedes by several years the detection of distant metastases, especially by conventional imaging. So IMO (revised!), 4 months of ADT is wise because it prevents problems later.

[BeHealthi in reply to Tall_Allen]

Thanks so much TA. Your inputs have helped so much to all of us in the forum.

[BeHealthi]

Interesting, this is new to me and I just googled it. This would be a wonderful vaccine if it is truly effective and not so expensive here in the US.

[CRPCMan]

Totally listen to TallAllen.