I am 60 years old, PSA 6.03 and diagnosed with PC after a TRUS biopsy January 22. The biopsy showed 5 of 12 samples with cancer. Of the 5 samples, 4 were on the right side and were 3 +3=6. The 5th sample was on the left and was 3+4=7.
My Urologist sent me for a PSMA PET scan on February 22. The results showed :
“FINDINGS: There is a hypermetabolic focus in the posterior right 4th rib with SUV max 3.04 (image 186), which corresponds to a subtle focus of sclerosis. There are subtle foci of hypermetabolic activity in the anterior left 4th rib, anterior left 5th rib, anterolateral left 7th rib with associated subtle sclerotic foci. There is hypermetabolic activity in the lateral right 7th rib with associated
sclerotic focus. No other suspicious radiotracer activity is identified in the neck, chest, abdomen, or pelvis or visualized skeleton.
IMPRESSION: Foci of hypermetabolic activity within multiple bilateral ribs as above, which may represent osseous metastases.”
I see the Urologist next week, but sounds like the Radiologist isn’t sure that it is cancer since he said “may represent “. I guess my next step will be to see an Oncologist. Has anyone else had a similar PSMA result?
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Those may be false positives. You have favorable intermediate risk PCa. Favorable risk men should not have a PSMA PET/CT - as you see it only causes anxiety and delays things while they are checked out.
I'm a layman but wanted to respond to you because your #'s are similar to what mine were in 2018. My PSA was 5.6 and TRUS showed three cores of 3+4 and one of 3+3. I had a 4KScore test and an mp MRI which showed a PRAIDS 4 lesion. All three of my 3+4's showed mostly 3 and a much smaller amount of 4, like 10%. I had a significantly enlarged prostate, hence chose RP. It has worked out great, all undetectable PSA's for 5.5 years and I'm strong and healthy.
Certainly, any biopsy can miss things but you only have one core of 3+4. I believe the chance that cancer has spread to your ribs is very, very small and you are definitely favorable intermediate. I'm glad PSMA PETS weren't around in my day. Please keep in mind that Urologists like to do surgery. That's what they do. My Labrador retrieves, that's what she does, with about the same enthusiasm as some Urologists like to do surgery.
I actually had two Urologists and one RO who tried to pressure me into doing something quickly. Learn everything you can about your cancer (maybe an mpMRI, also find out how much G4 is in that one core). You have time, don't let anybody hurry you. If I was a betting man, I'd give you 10 to 1 odds that you don't have any PCa in your ribs.
Did you ever have rib injuries? Bruised ribs? Did you ever have a plain CT of the chest/ribs? Solitary rib lesions will frequently light up in a PSMA-PET scan, but that doesn't indicate cancer.
PCa usually spreads outside of the prostate to nearby lymph nodes, and later to ribs and vertebra. Your PSMA-PET scan didn't mention any hot spots on the lymph nodes, so it's unlikely there it has spread to your bones. Plus, the low SUV=3 in your ribs is too low to worry about (I have a paper that says this, if I could find it...).
I recently had a PSMA-PET scan and an old football injury showed up as a moderate hot spot (SUV=5) that correlated exactly to the place where I have a solitary rib lesion (a hole in my rib) that was detected on chest CT scan 14 years ago. Three doctors concluded that the hot spot on the rib lesion was not prostate cancer. There are many papers out there that support this finding.
Are you thinking of getting an MRI next? That would be a good choice before jumping to treatment. You have lots of time. Relax and take a deep breath.
I haven’t had any rib injuries that I can remember, but I did get hospitalized with Sepsis after my biopsy last month. Still completing a month long antibiotic course. Maybe that has something to do with this? I see the Urologist next week. My wife immediately said that she believed that the scan showed false positives, and after the uplifting responses I have received, I feel much better about it. My first thoughts after the biopsy results was to do AS, was just hoping that the scan would make that choice easier. Thanks again for your response and advice!
I don't think the abdominal sepsis would cause PSMA uptake in selected ribs. Did you say the rib uptake was bilateral? That's important information, but I don't know what it means. Are you a smoker?
I was aware of the possibility of infection when I got the same type of transrectal biopsy, so I asked the Urologist to give me a shot of Rocephin, in addition to the Cipro that he normally prescribes. I had researched the susceptibility of these two antibiotics to e-Coli, and it turns out that e-Coli is resistant to Cipro, but is sensitive to Rocephin. You may want to consider asking for Rocephin (or equiv.) prophylaxis if you get another Transrectal biopsy.
Of course, getting a transperineal biopsy essentially eliminates the risk of infection. That's becoming the gold standard now, in many countries.
You may want to consider getting a repeat PSMA-PET scan in 1-2 years, to check that the rib uptake is not increasing over time. Of course, your PSA history will guide such a decision.
A MRI would be a good next step. Your Urologist should order one based on your Gleason 3+4 result.
Yes, the rib uptake is bilateral. I am not a smoker. Before the biopsy, the Urologist said I had less than 5 percent chance of getting an infection. Three days later I’m hospitalized with an infection lol. I had taken Cipro the day before and 2 days after the biopsy before getting sick. After 4 days in the hospital, went home with a midline in my bicep for 2 weeks IV of Rocephin, then two weeks of pills (Bactrim). Still on the Bactrim. In ref to the biopsy results, the Urologist recommended an MRI and told me I had less than 5% chance that the cancer had spread. I requested the PSMA instead since I beat the odds with the Sepsis lol. Thanks for your insight!
Wow...tough go with the antibiotics. Sorry to hear that. It sucks when you are one of the 5%.
I agree with your Urologist.
I googled Rib Sclerosis and found this description from a radiology website:
"A sclerotic area in the bone is a part where there is increased deposition of calcium and therefore the bone mineralization in higher in this area.
The exact nature of the lesion varies with age and other existing conditions.
It is usually a harmless benign finding like the bone island (benign bone tumor), healing fracture, osteoblastoma and enchondroma (cartilage tumor) in most cases and rarely even a malignancy (osteosarcoma or metastasis) can cause it.
Discuss the finding of a sclerotic rib lesion in details with your doctor. Since it is more often from benign causes, please do not worry much.
You may want to get a consult on why some of your ribs have sclerosis. I don't know what would cause that, but it might be important for reasons other than prostate cancer. You could also also ask the radiologist who wrote the PSMA-PET report for his opinion on what would cause sclerosis. He surely knows about that.
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