Help interpreting PET scan results - how serious is the prognosis?

[ConcernedSonNyc]

Here are my Dad’s PET scan results, he’s 64. I know the lymph node and bone progression are serious but I’m not sure how serious. Can anyone help interpret the results and offer some insight to how serious this may be? I know it’s going to be a tough battle, just trying to stay informed. Thanks

Test Results

IMPRESSION: PSMA PET/CT scan demonstrates nuclear medicine evidence of abnormal hypermetabolic activity along the prostate compatible with prostate cancer as above.

Prostate gland (Region 1): Positive

Pelvis, outside of prostate bed including pelvic LNs ( Region 2): Positive.

Extra-pelvic soft tissue lesions, retroperitoneal LNs, visceral metastases ( Region 3): Negative Skeleton ( Region 4) : Cannot adequately assess at this time for definite evidence of developing Osseus Metastases as detailed above.

Narrative

EXAM: ILLUCCIX PET/CT PSMA SKULL BASE TO MIDTHIGH

HISTORY: Gl 10 prostate cancer

TECHNIQUE: The patient was injected with 6.1 mCi Illuccix Ga68. Time from injection to initiation of image acquisition was 60 minutes. Following the intravenous administration of radiotracer, tomographic images were obtained from the skull base to mid thighs using a standard full tomograph. Non-diagnostic CT was performed for purposes of attenuation correction, PET CT fusion, and anatomical mapping. Very limited nondiagnostic low dose CT scan was performed, refer to dedicated CT for further characterization.

COMPARISON: None available at this time.

FINDINGS: Mediastinal pool measures: SUV max 2.5

No evidence of abnormal hypermetabolic activity within the limitations of this study given the physiological excretion in normal tissues such as lacrimal, salivary gland parotids, liver, bowels, bladder and kidneys obscuring any other underlying lesions.

Brain PET/CT PSMA Images:

No hypermetabolic activity within the included field of view and limits of the exam.

Head and Neck PET/CT Images:

No hypermetabolic activity Orbits, paranasal sinuses, and skull base: No radiotracer avid mass.

Nasopharynx: Physiologic uptake with No evidence of asymmetries.

Suprahyoid neck: No evidence of asymmetries or radiotracer-avid mass in the oropharynx, oral cavity, parapharyngeal space, and retropharyngeal space.

Infrahyoid neck: No evidence of abnormal uptake or asymmetries the larynx, hypopharynx, and supraglottis. Thyroid: Unremarkable .

Lymph nodes: No evidence of hypermetabolic radiotracer uptake enlarged lymph nodes.

Chest PET/CT PSMA Images:

Lung parenchyma: No radiotracer uptake along the lung structures.

Lymph nodes: No hypermetabolic enlarged axillary, mediastinal or hilar lymph nodes.

Heart: No pericardial effusion.

Esophagus: No radiotracer uptake.

Chest Wall: No radiotracer uptake.

Abdomen and Pelvis PET/CT PSMA Images:

Lymph nodes/Peritoneum: Bilateral few internal iliac lymph node uptake SUV 24 along the largest node measuring 7 x 6 mm axial image 186 series 4, and SUV measuring 15.2 along the largest node 6 x 6 mm.

Liver: No radiotracer uptake.

Gallbladder and biliary tree: No radiotracer uptake.

Adrenals: No radiotracer uptake.

Kidneys and ureters: Kidneys and ureters are unremarkable.

Bladder: Bladder is underdistended with appearing thickened wall, cystoscopy is suggested to for better characterization.

Reproductive organs: Prostate measuring 5 x 5 cm axial image 200 with multiple focal uptake SUV 88, right more than left. Lower uptake along the adjacent aspect of the seminal vesicles SUV 20, right more than left.

Bowel: No abnormal but physiologic radiotracer uptake.

Musculoskeletal PET/CT PSMA Images:

Bone: Multiple non-hypermetabolic 2 mm round sclerotic versus osteoblastic lesions are noted along L1 vertebral body axial image 129, left aspect of L5 vertebral body axial image 156, left iliac bone axial image 170, right iliac bone axial image 173 with some surrounding lytic appearance, left femoral head axial image 194; these may represent bony islands, however no prior imaging to document stability; therefore short-term follow-up CT lumbar spine/pelvis is highly recommended to document ability in the setting of bony islands or progression in the setting of metastatic disease. Degenerative changes are noted with nonspecific uptakes along the sacroiliac joints.

Soft Tissues: No radiotracer uptake.

[Tall_Allen]

"I know the lymph node and bone progression..." I see the evidence for pelvic lymph node progression ( which may be curable), but I don't see the evidence for "bone progression" in the report you linked. Why do you say that?

[ConcernedSonNyc in reply to Tall_Allen]

Oh, maybe I misinterpreted, I thought the below excerpt:

Musculoskeletal PET/CT PSMA Images:

Bone: Multiple non-hypermetabolic 2 mm round sclerotic versus osteoblastic lesions are noted along L1 vertebral body….

Indicated it had spread to the bone as wel

Another user explained I was reading the results wrong as well

Thanks so much for the help

[Tall_Allen in reply to ConcernedSonNyc]

Yes, you misinterpreted that. It says the opposite - it says that the lesions on the spine are not cancer.

[Xavier10]

Sounds potentially curable to me. Potentially. What was his PSA? Usually it's higher if it is already in the bones. Sounds like to me they just don't know what those lesions are; could be anything. So they want to do a follow up scan that I guess concentrates on it. But doesn't seem to have any PSMA uptake evidencing metastases or they would have said so. They didn't even call it "indeterminate." My guess is the metastases are limited to the lymph nodes described. the SUVmax 15 and SUVmax 24 are what they would consider "avid" so yes, that is advanced PCa. Potentially curable. Radiation to the prostate and the pelvic area as a whole and ADT for a significant period of time.

[ConcernedSonNyc in reply to Xavier10]

Ah ok - thanks for the explanation.

I’m not sure what his PSA was, I’ll double check and update the post if I can.

Really appreciate the help - thanks

[NanoMRI]

Kudos for helping your dad! I find second radiologist opinions helpful and crucial. And I find comparative imaging to be crucial as well. Findings such as "Cannot adequately assess at this time for definite evidence of developing Osseus Metastases as detailed above" also drive my interest in additional radiology opinions and comparative methods. All the best!

[j-o-h-n]

Greetings ConcernedSonNyc,

Where is your dear Dad being treated? In NYC?

Good Luck, Good Health and Good Humor.

j-o-h-n