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What do you do when one lymph node on PSMA is inconclusive ?

Posted by surftohealth88 @surftohealth88, 6 days ago

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 .

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dlachn | @dlachn | 2 days ago
In reply to @johnw22 "My goodness that’s sounds like a lot. I’m told they can’t biopsy my node(s). Starting IMRT..." + (show)
@johnw22

My goodness that’s sounds like a lot. I’m told they can’t biopsy my node(s). Starting IMRT soon. I’ve gotten two second opinions. One said they would go head and treat the nods while the other opinion was to radiate the prostate and follow the para-aortic nodes. Guess I should have gone to medical school.

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If we're talking about same nodes this doctor I had is a specialist in this procedure. If you want his information let me know. The procedure was painless and easy. They enter thru the esophagus travel down and push out of the esophagus and biopsy the node. Didn't even have a sore throat

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johnw22 | @johnw22 | 2 days ago
In reply to @dlachn "If we're talking about same nodes this doctor I had is a specialist in this procedure...." + (show)
@dlachn

If we're talking about same nodes this doctor I had is a specialist in this procedure. If you want his information let me know. The procedure was painless and easy. They enter thru the esophagus travel down and push out of the esophagus and biopsy the node. Didn't even have a sore throat

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Thank you but I don’t think we are talking about the same nodes.

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surftohealth88 | @surftohealth88 | 2 days ago
In reply to @johnw22 "Thank you for your insight. Much appreciated. I’m 76. Diagnosed at age 70 with Gleason 6...." + (show)
@johnw22

Thank you for your insight. Much appreciated. I’m 76. Diagnosed at age 70 with Gleason 6. Was on active follow up until September 2024 when path came back Gleason 9. WTF! All my care is at an NCCN/NCI designated cancer center in Ohio. Doing well on Orgovyx and starting 28 IMRT sessions soon. I’m not concerned at all about radiation to prostate but freaking out about para-aortic treatment. I wonder how many other men are out there diagnosed with Gleason 6 but harboring something much more aggressive.

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Same here - 2019 gleason 6 in only 2 cores of 12, genetic test (one of the first available at that time ) showed "low " risk , like in 30 years low "prediction". Six years later - IDC-P with cribriform : (. That is why biopsy should be done every 2-3 years once gleason of any kind is discovered.

I think that it is unconscionable to tell patients that 3+3 means "nothing" and that it is not even cancer ! IT IS CANCER and should be alarming in a sense that "ultra active surveillance" should be initiated at that point no matter what MRI shows or what PSA level is .

What is the point of "active surveillance" if it does not find out cancer in 3+4 stage and localized ???? Now that PSMA /CT is available it should be part of active surveillance every 2 years .

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johnw22 | @johnw22 | 2 days ago
In reply to @surftohealth88 "Same here - 2019 gleason 6 in only 2 cores of 12, genetic test (one of..." + (show)
@surftohealth88

Same here - 2019 gleason 6 in only 2 cores of 12, genetic test (one of the first available at that time ) showed "low " risk , like in 30 years low "prediction". Six years later - IDC-P with cribriform : (. That is why biopsy should be done every 2-3 years once gleason of any kind is discovered.

I think that it is unconscionable to tell patients that 3+3 means "nothing" and that it is not even cancer ! IT IS CANCER and should be alarming in a sense that "ultra active surveillance" should be initiated at that point no matter what MRI shows or what PSA level is .

What is the point of "active surveillance" if it does not find out cancer in 3+4 stage and localized ???? Now that PSMA /CT is available it should be part of active surveillance every 2 years .

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Totally agree.

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