Hi Brian. I did have a PSMA pet scan before treatment that showed no spred. My gleason score was 3 + 4 but my Decipher was .95. That's when we did the PSMA scan and a decision was made against ADT. It's a bit early for a bounce but I'm hoping for the best.
.95 Decipher and it was decided NOT to use ADT?
It seems to me that the Decipher score is much more informative in terms of PCa aggressiveness than a negative PSMA. @jeffmarc recently informed the forum that PSMA doesn’t show anything unless it is 2.7mms. In diameter; other studies have shown it to be as high as 5mms.
Cannot say that your PSA increase is meaningful until you see a trend. Do you know if your IMRT included pelvic lymph nodes? They are often not treated when PSMA is negative, so please ask your RO if they were treated. If not, that may be where the PSA is coming from.
Phil
My biopsy report stated approx 10% 4 so I guess it would be 90% 3. It also stated 70% of the tumor is cancer. I'm not sure what that means. 14 cores were taken and only one showed the cancer. I had 28 imrt sessions and I did have Barrigel and 3 gold markers installed.
Although your Decipher score is admittedly high, I find your other facts - only 1 positive core out of 14 and the single positive being limited to a small amount of pattern 4 - to be quite encouraging. Lean heavily on the feedback of your RO at this early post-radiation moment.
Just like with most every other test/scan for prostate cancer - PSA, MRI (PIRADS), biopsy (Gleason), Decipher (decipher score), etc. - a PSMA PET scan always results in a “SUVmax” score, which indicates the aggressiveness of every instance of tracer binding activity they see.
You mentioned that they noted “tracer binding activity in both central lobes of prostate.” They should have then indicated SUVmax scores for both of those. (If not, you should ask what those SUVmax scores of tracer binding activity were.)
Here’s a (very lengthy) explanation of how they use the SUVmax scores to determine cancer location and aggressiveness:
As it turns out, PSMA (prostate specific membrane antigen) is not really “prostate specific.” There are other organs, tissues, and fluids that naturally express PSMA (without being cancerous) and will show as tracer uptake on a PSMA PET scan - particularly in the lacrimal (tear) and parotid (salivary) glands, blood, liver, spleen, pancreas, ganglia, and more, as well as the kidneys, ureters and the bladder (as the body tries to quickly excrete the radioligand that was injected).
“SUV” stands for “standard uptake value” and is a measure of radiotracer uptake that indicates how high grade the cancer is. The higher the SUVmax, the more advanced the cancer.
They use the PSMA SUVmax values of your blood (the lowest level), liver (the medium level), and parotid or the lacrimal glands (the highest level) of SUVmax tracer binding expression for comparison.
If a suspicious area (lesion) is expressing PSMA, and it has:
> a PSMA SUV score less than blood, then it’s not likely cancer, but instead just normal, background PSMA cellular expression;
> a PSMA SUV score greater than blood, but lower than liver, then it’s likely low-grade prostate cancer;
> a PSMA SUV score greater than liver, but lower than lacrimal/parotid glands, then it’s likely moderate-grade prostate cancer;
> a PSMA SUV score greater than parotid glands, then it’s likely high-grade prostate cancer;
That PSMA PET information - in addition to PSA, MRI, biopsy, decipher, etc. information - helps guide them in developing the appropriate treatment for your specific disease.
As always, discuss all this with your doctor when you get your SUVmax scores from them for your PSMA PET scan report.
I just received a call from my doctors nurse who wasn't much help. She thinks there was no SUV MAX because the PSMA pet was performed before treatment. I'm beginning to think I picked the wrong place for my care.
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.95 Decipher and it was decided NOT to use ADT?
It seems to me that the Decipher score is much more informative in terms of PCa aggressiveness than a negative PSMA.
@jeffmarc recently informed the forum that PSMA doesn’t show anything unless it is 2.7mms. In diameter; other studies have shown it to be as high as 5mms.
Cannot say that your PSA increase is meaningful until you see a trend. Do you know if your IMRT included pelvic lymph nodes? They are often not treated when PSMA is negative, so please ask your RO if they were treated. If not, that may be where the PSA is coming from.
Phil
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2 ReactionsAlthough your Decipher score is admittedly high, I find your other facts - only 1 positive core out of 14 and the single positive being limited to a small amount of pattern 4 - to be quite encouraging. Lean heavily on the feedback of your RO at this early post-radiation moment.
Best wishes brother.
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2 ReactionsHi Brian. I'm still trying to touch base with my doctor but I did find the note SUV LO: 0.00 SUV HI : 5.00 below one of my PET images.
I just received a call from my doctors nurse who wasn't much help. She thinks there was no SUV MAX because the PSMA pet was performed before treatment. I'm beginning to think I picked the wrong place for my care.