PSMA Pet scan interputation

My RO use the capital PSMA PET in conjunction with my MRI in my simulation CT to localize the lesion to the degree that he was able to avoid overexposing the urethra to radiation it's called urethral steering.

I would be cautious about a change in treatment based on a biopsy 2nd opinion. Remember that a Gleason score is just one specialist’s experienced, educated opinion of what is seen in the tissues. Much of the interpretation of images, scans, and slides is often as much an art as it is a science and dependent on the skill and experience of whoever is doing the reading. So, if a 1st and 2nd opinion are different, there’s no way to know which one is “right.”
When I was diagnosed with 7(3+4), I got a 2nd opinion on the biopsy tissues.
But, I made a commitment:
> if the 2nd opinion came back a lower 6(3+3), I would still get treated to the higher 7(3+4).
> if the 2nd opinion came back the same 7(3+4), I would get treated to the 7(3+4).
> if the 2nd opinion came back a higher 7(4+3), I would get treated to the higher 7(4+3).
As it turned out, the 2nd opinion came back a higher 7(4+3) so, that’s what I got treated to.
You’ll have to establish your own criteria for which biopsy interpretation you’ll use for making your treatment decision and the outcome you want.
Wishing you the best in your decision.

It’s because with your other results - MRI & biopsy - you already know what’s in your prostate and if localized, you can make a treatment decision from only that.
What you want to know is whether the cancer has spread, and the PSMA PET scan tells you that along with how aggressive it might be.
The PSMA PET scan can also tell you how aggressive (& how much) is the cancer in your prostate - by the SUVMax score they assign to prostate cancers; that score should align with the severity of your Gleason score.

Hey edtrucks, it’s a bewildering situation to be in for sure. I agree that a Decipher test is an excellent adjunctive measure.
Also, please remember that there are focal therapies such as ultrasound, heat, laser and cryotherapy (FLA, TulsaPro to name two) which focus only on the PiRad lesions - not the entire gland. Side effects and life changes are MUCH less than with surgery or radiation.
Perhaps if you are proactive and act NOW, you can get rid of these lesions before they get worse. Best
Phil

My second MRI, 4 years after the first, showed no signs of cancer, but my biopsy after the MRI showed two cores of cancer, one at 3+4. I opted for surgery. The post op pathology report showed that my cancer was actually 4+5. And they also did a Decipher test which showed I was high risk. My point is: my tests were very inconsistent. My pathology report showed a higher grade of cancer. I was glad I got the RP. BTW, 15 months since my surgery, my 4 PSA tests have been < 0.01. Hoping and praying for more of the same in my upcoming appt. Ask lots of questions. Best of luck in whatever path you choose! 🙏🤞

Hi heavyphil, it's an interesting concept to focus only on the lesions, but my lesions didn't show cancer after a guided biopsy. Although one PI Rad 4 was very small and could have been missed with the needle, the other was large enough to hit. I've read that PI Rad 4 ratings are only cancerous 35% on average, so its not that unusual to have a negative result on a PI Rad 4 biopsy. Have you had different experiences?

I did Tulsa Pro for Gleason 7(4+3). My PSA was 8.6. It was an easy process as I had only 30% of my 45cc prostate ablated. I didn’t feel like I was risking much of anything as the side effects are usually minimal, and all other treatment options are still on the table if the cancer returns. Literally no pain and I was back walking my normal 4 miles per day the next morning. At 6 months there is no sign of cancer. Medicare and my supplement paid it all.

Ed, you previously stated that you were a 3+4 in one lesion, downgraded from 4+3. Gleason 3+4 IS cancer, which I personally would want to eradicate before it got larger or worse in grade.
Waiting is fine - until you can’t and then what? Focal therapy might be off the table. TulsoPro is advertised pretty much specifically for what you have: smaller, lower grade tumors. Worth a look at least.
Phil

Sounds like a great option. Did they determine only 30% needed to be ablated prior to the procedure? The closest location for Tulsa Pro to me is Atlanta. I think I'll check further into this as our PSA and cancer grade are very similar. Thanks.

Yes on 30%. I only had one clearly defined lesion. My biopsy had 6 cores in the lesion (all cancerous) and 12 random that showed no cancer. I only had the catheter for 2 days as I had a relatively small ablation. Catheter did not stop me from being out and about for those two days. If you click on my profile you can see my Tulsa Pro discussion and comments I have made on this forum.