1. < Prostate Cancer

PSMA PET results 6/6/25

Posted by mjp0512 @mjp0512, Jun 9 8:13am

Surprisingly, the results from my PET scan were posted last night before my Dr. saw them. I debated whether or not to open it, but curiosity got the better of me.

Impression:

> Extensive PSMA activity within the prostate gland, consistent with newly diagnosed prostate carcinoma.
> PSMA avid metastatic lymphadenopathy in the pelvis, retroperitoneum, and mediastinum.
> PSMA avid osseous metastasis in the L5 vertebral body.
> Circumferential bladder wall thickening. 2.4 cm nonavid lymph node anterior to the bladder, nonspecific.. Recommend correlation with urinalysis.

Findings:

Neck:
• No tracer avid disease identified. Accessory RIGHT parotid tissue along the superficial aspect of the RIGHT masseter.
Chest:
• 2.1 cm LEFT superior mediastinal node with max SUV 8.0 (PET image 194)
• 1.8 cm retrocrural node with max SUV 6.9 (PET image 144)
Abdomen/Pelvis:
Numerous tracer avid lymph nodes in the pelvis and retroperitoneum. For example:
• 1.5 cm aortocaval node, max SUV 8.7 (PET image 121)
• 1.0 cm presacral node, max SUV 7.2 (PET image 79)
• 0.7 cm RIGHT internal iliac node, max SUV 5.2 (PET image 70)
• 0.8 cm LEFT external iliac node, max SUV 5.8 (PET image 75)
Prostate:
• Extensive tracer activity throughout the prostate gland including in the RIGHT central gland, bilateral posterior peripheral zones, and in the region of the RIGHT seminal vesicle. Max SUV of 14.9 in the LEFT posterior peripheral zone.
Bones:
• Tracer avid lesion in the RIGHT aspect of the L5 vertebral body, max SUV 11.9.
_______________________________

What do you think? Looks like we might be playing radiology Whack-a-Mole for a while. Not too crazy about the "for example" comment in the abdomen/pelvis section. Sounds like there's more there that's not specified.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

jeff Marchi | @jeffmarc | 5 days ago
In reply to @surftohealth88 "Jeff- John had RP already. He had no spread of the cancer, gleason 9 , but..." + (show)
@surftohealth88

Jeff- John had RP already.
He had no spread of the cancer, gleason 9 , but had positive margins discovered during surgery. Would you be so kind to tell him what are his possible options ? He is new to this, he just had surgery and it all is probably overwhelming.

Jump to this post

With Positive margins they usually want to do radiation. Nothing else is going to remove it unless you go back and did surgery again, And they don’t do that. So this is a case where they’re probably going to do salvage radiation, I would think, It’s possible they could narrow it to just the areas that have margin spread, I’ve not heard of that being done.

With a Gleason nine aren’t they putting him on ADT? I know it’s not spread, but if the margins aren’t clean, that means that something had spread outside the prostate. You should speak to the doctor and ask them whether ADT and an ARSI (Zytiga or a lutamide) are called for in this situation, considering he is a Gleason nine. You really want to try to suppress it as much as possible so you have a chance of remission. I ran into too cases where people had eights or nines, didn’t have ADT and had metastasis in a short time. I’m mentoring someone with that problem right now.

REPLY
1 reply
johndavis60 | @johndavis60 | 5 days ago
In reply to @jeffmarc "With Positive margins they usually want to do radiation. Nothing else is going to remove it..." + (show)
@jeffmarc

With Positive margins they usually want to do radiation. Nothing else is going to remove it unless you go back and did surgery again, And they don’t do that. So this is a case where they’re probably going to do salvage radiation, I would think, It’s possible they could narrow it to just the areas that have margin spread, I’ve not heard of that being done.

With a Gleason nine aren’t they putting him on ADT? I know it’s not spread, but if the margins aren’t clean, that means that something had spread outside the prostate. You should speak to the doctor and ask them whether ADT and an ARSI (Zytiga or a lutamide) are called for in this situation, considering he is a Gleason nine. You really want to try to suppress it as much as possible so you have a chance of remission. I ran into too cases where people had eights or nines, didn’t have ADT and had metastasis in a short time. I’m mentoring someone with that problem right now.

Jump to this post

Thanks @jeffmarc !
I’m 3 weeks out from surgery. 1st RO meeting is June 23, 1st MO meeting is July 16. They told me I have to wait at least 3 months for adjuvant radiation, but I will be asking these doctors about ADT and according to what you and others have written, and from what I have read, I should be on ADT for 2 years. Any other recommendations? By the way, not looking forward to ADT but am being aggressive to fight the PCa that I have. I don’t expect the doctors to push back, but who knows? Do you think they will prescribe Eligard, Lupron or Orgovyx?
Also, do ADT drugs work for Gleason 4+5=9 ? When you say those others got metastasis in a short time, how short? And did they have distant Mets to the bone or local lymph nodes?
Thanks!!

REPLY
1 reply
johndavis60 | @johndavis60 | 5 days ago
In reply to @surftohealth88 "Jeff- John had RP already. He had no spread of the cancer, gleason 9 , but..." + (show)
@surftohealth88

Jeff- John had RP already.
He had no spread of the cancer, gleason 9 , but had positive margins discovered during surgery. Would you be so kind to tell him what are his possible options ? He is new to this, he just had surgery and it all is probably overwhelming.

Jump to this post

Thank you for clarifying 🙂

REPLY
jeff Marchi | @jeffmarc | 5 days ago
In reply to @johndavis60 "Thanks @jeffmarc ! I’m 3 weeks out from surgery. 1st RO meeting is June 23, 1st..." + (show)
@johndavis60

Thanks @jeffmarc !
I’m 3 weeks out from surgery. 1st RO meeting is June 23, 1st MO meeting is July 16. They told me I have to wait at least 3 months for adjuvant radiation, but I will be asking these doctors about ADT and according to what you and others have written, and from what I have read, I should be on ADT for 2 years. Any other recommendations? By the way, not looking forward to ADT but am being aggressive to fight the PCa that I have. I don’t expect the doctors to push back, but who knows? Do you think they will prescribe Eligard, Lupron or Orgovyx?
Also, do ADT drugs work for Gleason 4+5=9 ? When you say those others got metastasis in a short time, how short? And did they have distant Mets to the bone or local lymph nodes?
Thanks!!

Jump to this post

Yes, the ADT drugs work for your 4+5, Though you would think they would want to put you on Zytiga or one of the lutamides. If they discussed putting you on a second drug, tell them you want Nubeqa (Darolutamide) which has the least side effects of that group of drugs. If they say you can go on Zytiga Then do that, It has some more side effects and if you have heart issues, you do not want to take it. These are all things to discuss with that doctor.

Yes, with Gleason 9 the recommended NCCN time for ADT is 24 months.

Now let’s talk about Eligard, Lupron or Orgovyx. You could not ask them, and tell them you want Orgovyx. It’s the most convenient and you can stop at any time since you take it once a day as a pill. If you cannot get it and they want to give you one of the other two, You tell them you want to have a Casodex Prescription for two weeks before you get that injection. Otherwise, you get a testosterone flare and it can mess up your system and your cancer. Your doctor should know about this. Make sure you ask.

The other choices they could give you Firmagon, Which is shot you get in the stomach. It’s like Lupron And the others it just doesn’t need Casodex first.

REPLY
1 reply
johndavis60 | @johndavis60 | 5 days ago
In reply to @jeffmarc "Yes, the ADT drugs work for your 4+5, Though you would think they would want to..." + (show)
@jeffmarc

Yes, the ADT drugs work for your 4+5, Though you would think they would want to put you on Zytiga or one of the lutamides. If they discussed putting you on a second drug, tell them you want Nubeqa (Darolutamide) which has the least side effects of that group of drugs. If they say you can go on Zytiga Then do that, It has some more side effects and if you have heart issues, you do not want to take it. These are all things to discuss with that doctor.

Yes, with Gleason 9 the recommended NCCN time for ADT is 24 months.

Now let’s talk about Eligard, Lupron or Orgovyx. You could not ask them, and tell them you want Orgovyx. It’s the most convenient and you can stop at any time since you take it once a day as a pill. If you cannot get it and they want to give you one of the other two, You tell them you want to have a Casodex Prescription for two weeks before you get that injection. Otherwise, you get a testosterone flare and it can mess up your system and your cancer. Your doctor should know about this. Make sure you ask.

The other choices they could give you Firmagon, Which is shot you get in the stomach. It’s like Lupron And the others it just doesn’t need Casodex first.

Jump to this post

Hi @jeffmarc , as always, I really appreciate your insights. I feel like I will be better prepared when I meet with the Dr. In fact, I decided to send my new doctor a message over MyChart just as a heads up that we will be discussing what to do with respect to ADT. Thanks again!!

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