PSMA results

[hwrjr]

Here is the summary impression:

IMPRESSION:

* Prostate: PSMA (+) disease in the anterior mid- zone and apex of the prostate, consistent with primary malignancy.

* Nodes: No tracer- avid pelvic, retroperitoneal, or mesenteric adenopathy

* Distant metastases: No visceral or osseous metastatic disease

What do you guys think? Looks like recurrent cancer in the prostate only. The report lacks RAD or SUV scores so cant tell how likely the cancer is or how aggressive. Seems like mpMRI and biopsy are next.

[Tall_Allen]

Hard to interpret without SUVmax. Posluma gives fewer false positives than other PSMA PET scans. But you are right- mpMRI and biopsy are definitive.

[hwrjr in reply to Tall_Allen]

Prostate & Seminal Vesicles: PSMA activity greater than liver within

the anterior mid zone to apex. No activity within the seminal vesicles.

What does the reference to the liver mean?

Thanks for your reply. I feel like I can always count on you. You've followed my journey for 9 years.

[Tall_Allen in reply to hwrjr]

The liver is the benign reference. PSMA uptake has to be greater than liver uptake to be significant.

[janebob99]

Good results.

Yes, MRI should be next, then biopsy last, so that you can do a MRI/US fusion biopsy.

How did you get to do a PSMA-PET scan before an MRI or biopsy?

[hwrjr in reply to janebob99]

I got PSMA because I was BCF.

[climb4blue]

your PSA is greater than nadir +2 so your next step is treatment rather than an MRI and/or biopsy.

[hwrjr in reply to climb4blue]

I have meeting with MO on March 5. I'll discuss next steps with him. I don't see how treatment can commence without a definitive finding of recurrent cancer and the Gleason score, which only a biopsy can determine.

[janebob99 in reply to hwrjr]

I missed that you already had proton therapy, and are now experiencing a PSA rise after nadir. Let us know what your MO recommends.

Bob

[climb4blue]

I realized that recurrence diagnostics were already taking place since that is the purpose of PSMA testing for distant metastases and will definitely help your MO in treatment planning. My point was more that recurrence SOC would be some form of treatment based on your PSA readings rather than a confirmatory biopsy of the prostate that what was done when being initially diagnosed with prostate cancer. I surmise that an MRI and/or biopsy could be used but for treatment decision modalities rather than whether treatment should be administered at all. I am hopeful that early recurrence treatment will have a better outcome, so I was concerned that you might not be getting recurrence treatment. A Gleason score is not useful for patients with recurrence.

[hwrjr in reply to climb4blue]

Primary RT can cause changes to the prostate tissue that result in a small percentage of false positives in PSMA. Unfortunately mpMRI has it's problems too following radiorecurrence. Prostate biopsy after irradiation presents difficulties as well, reporting false positives and false negatives, as well as difficulty determining accurate Gleason. These limitations would seem to make getting a definitive result difficult but current guidelines requires positive biopsy before salvage treatment.