Uncommon metastic finding?Anyone have a similar biopsy & PET scan?

Some or all of those suspected Mets may be treatable with focal radiotherapy. Your radiation oncologist would make that call.

First of all, I’m sorry that you are facing such news so soon after receiving a biopsy report indicating 3+4=7 Gleason in only one core, and only 10% pattern 4.

It has to be difficult to digest your PSMA PET Scan results, after thinking you were in the Favorable Intermediate Risk (FaIR) category, based on such a recent biopsy.

If you don’t mind me asking, was there something in your initial mpMRI that led you and your doctor to order the bone scan and then an immediate PSMA PET Scan? It sounds like you had all these tests going on simultaneously prior to receiving your biopsy results.

I certainly hope you don’t have to proceed to Oligametastasis prostate cancer treatments, but I found that the University of Maryland is recruiting for such individuals.

“This study is targeting patients who are initially diagnosed with an advanced cancer that has begun to spread…using a targeted form of highly-focused radiation therapy”.

“The UMSOM researchers aim to recruit 122 study participants who were initially diagnosed with prostate cancer and had oligometastases detected in their bones or soft tissue on an imaging scan.”
https://www.medschool.umaryland.edu/news/2023/patients-with-advanced-prostate-cancer-may-benefit-from-focused-radiation-therapy-that-targets-metastases.html
Of course, there may be other places already providing similar treatments to the UMSOM study…I haven’t checked.

Wishing you all the best as you continue down the road towards restorative health.

Thanks Handera!
1. How I got here: it is a kind of "The Old Lady Who Swallowed the Fly" story. My increasing PSA (Prostate Specific Antigen) level in my annual blood test lead my primary care physician to refer me to a urologist (4 month wait to get in!), who ordered an MRI, which, on October 20, 2023, indicated a probability of prostate cancer (PIRAD 4), and a vague impression on my posterior right iliac wing that looked at it could possibly be metastasized prostate cancer; a bone scan was recommended to confirm. On November 13, 2023, a bone scan didn’t find anything on the right posterior iliac wing, but did show signs of something on my 6th, 7th and 9th left ribs that could be metastasized cancer (or could be arthritis, past trauma, or past infection – bone scans, as you may know, do not differentiate). So the next step to confirm whether my prostate cancer has metastasized was this PSMA PET scan (1/22/24). Biopsy was on 11/29/23.
2. Thanks, I did come across the UM study (TERPS trial) the other day and planned to speak with my newly appointed oncologist about it. My late sister's oncologist (who was a colleague of hers too) is an oncologist at UM so I am picking his mind about it. I'm hoping to hear about Theranostics from my oncologist (or I'll be bringing it up). Lutetium-177 vipivotide tetraxetan PSMA therapy (Pluvicto) is a new theranostic medicine for advanced metastatic prostate cancer, approved by the FDA in March 2022. UChicago Medicine is participating in a Phase III clinical trial that is looking to add this same therapy as a first line treatment for patients with newly metastatic prostate cancer. I'm also interest in proton radiation options but we'll see.
Thanks again and the best to you too on your journey!

Wow! It sounds like you were pushed into the deep end as soon as you arrived at the pool :/

Your children’s story’s fundamental question “… but why did the old lady swallow the fly?” reminds me of my doc’s comment about researching PCa treatments…”it’s a bottomless pit”. During my latest appointment, I kidded him that I think I found a ledge where I can still see daylight overhead 🙂

It sounds like you either had a lot of medical knowledge/expertise pre-dx or have an amazing aptitude to find, absorb and act upon the latest PCa research.

We are all muddling about in this “bottomless pit of mystery” and it’s good to read and make contact with folks who are using their God-given abilities to dutifully continue on their conscripted journeys.

May yours lead to satisfaction and good health!

My PET scan indicated my Prostate Cancer (Gleason Score of 4+3=7) had spread to my hip bones in 4 different areas. When I saw the results on my medical portal I was totally depressed. . called my Urologist on what to do. He said we needed to treat my cancer and ignore the PET Scan. Imagine!
It took 2 weeks before I got his opinion that it wasn’t bone cancer. He determined it was Paget’s Disease of the Bone. I had never before heard of that condition. That two weeks of thinking I had bone cancer was a very difficult time for me.
I hope you just have a false positive like I did. I just completed 45 days of Proton Therapy with little side effects and I feel fine. My PSA score is 3.59 in the normal range. It is expected to drop even lower after 30 days.
Best wishes
Jack
East Lansing, Michigan

Thanks for sharing Jack. I am glad your refined dx & treatment is working out well for you. I want to incorporate PT in my treatment (Where did you do your PT? is that also where your urologist who made the Pagets dx is?). I don't want to pin false hope on fault with the PSMA Pet Scan (an earlier MRI suspected the pelvic spot and a previous bone scan suspected spots on three ribs); I have to trust that the radiologists at MSK will do a good read on ALL my imaging, but I am also sending them to Johns Hopkin for a second opinion.
Best,
Rich
Upstate NY

BTW: If you haven’t seen this already, tomorrow nights ANCAN webinar is all about the topic you mentioned.

“Radionuclide Diagnostics & Theranostics Theory and Clinical Practice Meet!”
https://register.gotowebinar.com/register/2413223950152319836?mc_cid=4d34b604b3&mc_eid=4bcb2e226d

Cool! I haven't seen this. Am registering now! Thanks!!

Yes, I am hoping if they bear out on MSK's review of the PSMA PET Scan (and a second op from Johns Hopkin), that they can be treated with proton MDT. Want to avoid ADT/hormone therapy, if possible.