Followup on Lack of CT Correlate: Is this a Liver Met?

[lokibear0803]

About 3 weeks ago I posted this, basically about PSMA uptake (DCFPyL scan) in a small area of liver without a CT correlate:

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A followup MRI showed no hepatic metastasis. However, my oncologist and her radiologist are assuming that, regardless, there is moderate to high probability that this is liver PCa metastasis....even though (1) this would be an uncommon finding for someone with my history (locoregional lymph mets in pelvic area only for about 7 years now), (2) they characterize the appearance as a bit “weird” and “very tiny” (although no size has been determined), and (3) there is no correlation in either CT or MRI. The SUV uptake in that liver spot is 16, while the uptake in other spots range from 7-34.

MO admits this may instead be some kind of “metabolic response” that is not cancer, and as such should remain the same size when I scan again after 6 months of lupron/abiraterone. I would also speculate that it might just disappear entirely (see below for my reasoning), while PCa lesions will simply get smaller.

One thing I didn’t mention is that I’ve been taking about 800mg of EGCG since April 2020 (and the stopped altogether just before the PyL scan). From my own research, I have found it’s feasible that EGCG can induce hepatotoxicity, and other non-malignant conditions can in fact cause PSMA uptake; liver enzymes are often elevated from the EGCG, although for me this has not the case.

Can hepatotoxicity occur without elevated liver enzymes, and if so can this cause PSMA uptake?

Regardless, is my speculation reasonable, that the EGCG could have caused some metabolic response resulting in false positive PSMA uptake? If so, do you have a sense of the probability?

Is it reasonable to think that, unless this is permanent liver damage/other condition, that this “metabolic response” would disappear within 6 months (now that I’ve stopped the EGCG)?

Finally is it reasonable to assume that if the spot has either remained the same size, or has disappeared completely, after 6 months lupron/abi, that we can rule out prostate metastasis?

I also welcome your own speculations and insights, and any suggestions for what questions to ask my MO. Thanks very much in advance for anyone’s thoughts.

[Shooter1]

Cysts in my lung and liver have all just set there with no change....Hope you have same results..

[lokibear0803 in reply to Shooter1]

No change, while you’re on ADT? so they didn’t shrink? Do you interpret that to mean that they are not cancer? Sorry if I’m misunderstanding; there’s a lot I don’t understand about PCa... and I thank you for your good wishes.

[Hidden]

Supplements can be really touchy. I took some sublingual DHEA and my PSA soared the next month, along with scan uptake. A bit different situation from you but its likely an area that no one knows much of anything about and makes one think twice before adding an unusual supplement. I wonder if you should have your scan read by another expert, perhaps at UCLA

[lokibear0803 in reply to Hidden]

Thanks Anomalous, yes getting more experts to read/interpret is part of my plan. So, you’re suggesting UCLA...my scan was done as part of a trial at Stanford, but I don’t live in California...how would I go about requesting such a thing from a UCLA radiologist, and do you have someone specific in mind? Are you suggesting UCLA because they have a reputation to excel in this kind of thing?

It was the DCFPyL scan, which as you know is relatively new...so I already had some misgivings about interpretations since there’s not that much experience with this one.

Just curious, after you stopped the DHEA, did PSA and uptake go back down?

[Hidden in reply to lokibear0803]

Sorry, i have no idea where to get your pylarify re-read. only reason i suggested UCLA is because they have a lot of experience with PSMA scans, which I guess is not the same thing, but presumably similar. the 16 reading is concerning, but the liver produces a good bit of PSMA I think. My PSA went down because i went straight to lupron a month later and then radiation six weeks after that. DHEA is a testosterone precursor though so its different than what you were taking. Still, supplements are chemicals and they all have individual characteristics. My RO was sympathetic to the idea that the DHEA jazzed uptake and that it could just go away after stopping. So yeah, that indicated to me that there is a possibility that it is a temporary thing.

I think most doctors take the position that anomalous uptakes are likely metastatic because that is the safest and most conservative position to take. May not be what we want to hear though.

[j-o-h-n]

I don't mean to sound cruel but by all means please get yourself a GOOD Medical Oncologist. Ask here (in a separate post) if anyone can recommend one in your area. Keep fighting the good fight... God Bless...

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/10/2021 10:30 PM DST