Connect
What do you do when one lymph node on PSMA is inconclusive ?
We got PSMA results with clear uptake in right lobe of prostate which was expected but one lymph node on the left side in iliac region has very low uptake (around 2 SUV). Radiologist wrote that it is probably just reactive node but that micro met. can not be excluded.
I am wondering if anybody had similar result and what was the next step ? Is there possibility to do biopsy of that node ? I mean there is like drastic difference in staging if node was or was not involved *sigh .
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
You’re caught in a “Schrödinger’s Node” situation: until it’s biopsied or followed up, it’s both metastatic and not. Most centers handle this by weighing risk factors, imaging features, and whether the node is accessible for biopsy (often it’s not). They may opt to treat with slightly broader fields or closer monitoring — but yes, the uncertainty is frustrating, and it’s not uncommon.
-
Like -
Helpful -
Hug
4 ReactionsFabulous : )))) !!! Could not ask for better scenario *thumbs up lol. Waited for PSMA/CT for ages, than waited 9 days for results and now we don't know what is actually there. Just fantastic all around XP.
We can't ask our super-capable urologist for opinion because it will be useless, so we will have to wait for zoom app. with onco urologist at UCSF next week and every day now feels like a year *sigh. Oh well...
-
Like -
Helpful -
Hug
1 ReactionThey'll just radiate the node. And you'll get a 1 after the N.
I'm familiar with this equivocal node. In the case I know best the node was at 3 SUV on the PSMA. They said that if after 2 months of ADT (Orgovyx) the node disappeared, it would be confirmed cancer. If the node was still there after the 2 months it would not be cancer and would not be treated. The node remained and so was not included in the radiation field.
-
Like -
Helpful -
Hug
4 ReactionsThanks so much for the info < 3
Do you by any chance know if this finding of one inconclusive node now excludes my husband from having RP ?
If you do RP, they will likely take that node out and pathology will give you a definite answer.
-
Like -
Helpful -
Hug
3 Reactionstopf is correct.
-
Like -
Helpful -
Hug
1 ReactionWhen you mention “clear uptake” and “very low uptake,” how do those SUVmax scores compare to the SUVmax scores of your blood, liver, and parotid glands? What were all of those (and any other) SUVmax scores? That information will help determine what to do next.
-
Like -
Helpful -
Hug
1 ReactionI'm in the same boat..watch and see 2 scans later 7 month go by same size size .5 ...two different oncologist sad the same thing ..now on orgovyx and taking a blood test after 6 weeks make sure it's working psa drops ...6,8 weeks after scan..if it's shrinking they'll had it if not and it stays the same we watch cause as stated by the docs it could be benign....fingers crossed
-
Like -
Helpful -
Hug
1 ReactionError....if it shrinks they'll sap it
-
Like -
Helpful -
Hug
1 ReactionThanks everybody for helpful and informative comments. It is very much appreciated and comforting to know that it does not exclude RP.
Brian asked about uptakes. Cancer in right lobe of prostate has SUV 6.2 which is little bit less than average for intermediate risk for F-18 tracer (average is 7.8 vs. 16.85 for high risk in research papers) .
This one lymph node was described as "mild tracer max uptake approximately SUV 2" . Size of a node is 0.9 x 0.7 . Maybe reactive but early metastatic involvement can not be excluded.