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PSMA scan conflicting results
My RALP was 3 years ago. I had been undetectable until July 2025. My PSA was .24. Got a PSMA pet scan with following results. Mild uptake SUV 4.1 is seen in prostate, inferiorly, for which malignant disease is not excluded. There is a well defined PSMA avid sclerotic lesion of the first left rib suspicious for bony metastatic disease. Everything else appears ok. I went over results with my Urologist who also was my surgeon. He is suspicious of the rib finding as this could be a false positive in his opinion. He said he will confer with my Oncologist and Radiologist who wrote the report. As it turns out I had a meeting setup with the Oncologist the following day. She is more convinced the rib finding is real but will order a bone biopsy if possible. If not, she'll order an MRI but basically she thinks it's 50 50 we will get a definite answer if cancer or not. She showed me the scans in person of the rib and prostate bed. She said the actual pictures of the prostate bed show no uptake. There is a tumor board meeting in two weeks where she will present my scans to get more opinions. She doesn't want to radiate bed and pelvic lymph nodes needlessly at this point which I agree with since the issue may only be in the rib (as rare as that may be). In the meantime I will get another PSA test. I know my Urologist/surgeon did not look at actual scans but only read the report up to now, but the Oncologist will get with him to review all scans further. I know a bone met is bad but she's confident it can be resolved with SBRT external beam radiation. Very confusing. If it wasn't for the rib I'm sure we'd be radiating the bed and pelvic lymph nodes after another confirmed PSA reading. I really don't want to radiate these more sensitive areas unless necessary and feel I should wait the couple of weeks for a bone biopsy or MRI. If inconclusive I'd opt for rib radiation first to see if PSA drops. This is only one weeks worth of radiation. Also, I'd like to know the tumor board's opinion.
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Perry, sorry for the shitty news; sounds like salvage radiation to bed/nodes with ADT is necessary.
They may want to do SBRT to the rib lesion as well or wait to see the results of salvage treatment. Good Luck,
Phil
Thanks. I'm thinking the same. I just want to get started as my PSA is rising fast. I'm really beginning to feel my mortality. Phil, how was your experience with SRT?
Not that bad…even Orgovyx was pretty tolerable.
I will say, however, that it was 6 weeks of living a VERY regimented lifestyle.
Exercise daily, fiber supplements 3X/day, dietary restrictions which eliminated 99% of the foods I regularly eat, and of course, the trip to the clinic and the bladder/water equation….
It was do-able, like most things are when a gun is pointed at your head, but I wouldn’t want to do it again…
Just approach it as something that has to be done - like a weeks long training seminar for work, or classes you have to take to get your car insurance down - and it will be over before you know it.
Phil
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3 ReactionsHad first dose of Firmagon today. 2 shots in the stomach. I've had more painful flu shots surprisingly. At least I feel like I'm doing something now......
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1 ReactionI guess your onco really wanted to knock down the PSA in a hurry with the Firmagon.
But yes, doing something is much, much better than waiting and wondering. Best to you,
Phil
Wow. Oncologist called me today. MRI was inconclusive on rib. Too much motion from breathing supposedly. I was so still in that machine so I think it's ridiculous. The tumor board agrees with PSMA PET scan that rib is suspicious for cancer. Actually, she said the board Believes it is cancer but not 100 percent sure. The prostate uptake is now in their opinion from the rectum and not cancer. However, because of the PSA rise they suggest treating aggressively which means SRT to bed and pelvic lymph nodes. After this they will SBRT the rib in case it is cancer there. I started ADT yesterday so even though everything is not conclusive other than my PSA rise I'm not sure what else I can do other than getting a second opinion which I'm doing at the Karmanos Cancer center.... I was thinking about sending my scans in to an AI portal that reviews scans, (if that exists).
Sorry, a bit confused at: they now believe that the prostate uptake is from the rectum and not cancer…don’t know what that means.
Rectum can have some uptake normally. Had clear colonoscopy 18 months ago, so they're going to treat bed and pelvic lymph nodes. They do that normally if no uptake but PSA rises.
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1 ReactionI've had a PSMA lit rib for 7 years which was immediately ided by my radio oncologist as benign. H'es kind of Big Wheel in the SBRT field and radiology in general (Sean P. Collins). He treated other nodes but not it. I'm in clinical trials now getting PSMA PETs every 6 months. It's still there and still seen as benign.
Suggest you Google AI the issue
Good luck!!
Hi Perry, I just had my first dose of Firmagon on Aug 6. 2 shots in the abdomen, same as you. I still don’t have any side effects yet that I am aware of. I have had Covid for the last 6 days and I do feel the effects of that. It made me feel better to start the Firmagon. I’m normally a very anxious person (treated with Lexipro) but PCa has put me over the edge. Starting radiation later in September.