I'm working with the premise I'm experiencing a BCR. After 2 years of undetectable psa, my recent psa test were the following:
My last 3 mo eligard shot was July 2021. I stopped the AA at this time also
Oct 2021 psa <.1 T < 3 ng/dl ALP 97
Jan 2022 psa < .04 T 230 ALP 103
April 20, 2022 psa .31 T 255 ALP 88
May 4, 2022 psa .51 T NA ALP NA
Pylarify PET/CT scan May 17, 2022
There are tracer avid left hilar and AP window nodes. Although this raises the possibility of prostate cancer metastases, the lack of coexisting abdominopelvic metastatic adenopathy would be somewhat atypical, and raises the possibility of these nodes representing a separate metastatic process besides prostate cancer.
No evidence of prostatectomy bed recurrence nor solid organ metastases.
EXAM TYPE: NM PET TUMOR SCAN W/ CT SKULL BASE TO MID THIGH
EXAM DATE AND TIME: 5/17/2022 3:12 PM EDT
INDICATION: Elevated prostate specific antigen (PSA); Subsequent treatment strategy
Approximately 60minutes following the intravenous administration of 7.88i of F-18 DCFPyl (Pylarify), PET/CT fusion imaging from the skull vertex to the mid thighs was obtained.
The CT portion of this study is a low dose, non-contrast CT, used for attenuation correction and localization only, and is not a diagnostic CT.
There is no abnormal activity in the prostatectomy bed to suggest prostate bed recurrence
There are no abdominopelvic nodal metastases
However, there is a tracer avid left hilar node, SUV max of 12.76, difficult to measure but about 1.4 cm in axial dimension.
In addition, there is a tracer avid AP window node, SUV max of 10.09, about 1.0 cm in axial dimension.
Distant metastases: There are no lung, liver, or skeletal metastases.
Nondiagnostic CT findings: Multiple liver cysts. Azygous lobe
I'm now exploring what options are available to me. I'm not in a rush to do something as the psa is still low. I'm in the process of seeking out prostate oncologist for second and third opinions.
My MO wants me to make appt with my urologist. While there is little to nothing he can do for me, he seems like he would be open to working with me if I chose to implement a BAT protocol. The MO not so much.
I'm in the gray area of prostate cancer treatment. No known metastases but rising psa.
So I'm seeking opinions from other men who may have encountered this same situation to understand what my choices would or could be.