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New PET scan results confused and a little scared

Posted by albcan @albcan, Sep 3 1:32pm

Hi everyone,

So I just got results from a new PET scan that was done last Friday the 29th of Aug.

Background had RARP last Dec 24 2024 and follow up PSA tests in March and June 25 were undetectable but then in Aug jumped to .12.

We had been waiting for the PSA rise to start radiation and hormones so the scan was the step prior to see where it was and plan the radiation etc.

The results of the scan were

1. Postsurgical changes of prostatectomy. No abnormal tracer uptake in the resection bed. 2. Previously seen PSMA positive left pelvic sidewall lymph node is no longer tracer avid. No new PSMA receptor positive adenopathy. 3. Focus of right hepatic lobe parafalcine increased tracer uptake without definite underlying lesion on CT. This is nonspecific and could be physiologic, though underlying lesion is not completely excluded.

If I’m reading this correctly it says that there is no evidence of the cancer now in the prostate bed which is what we were expecting but it seems to hint that there could now be cancer forming in the liver?

This seems strange since normally it would go to the bones or other lymph nodes first?

We know it was in the lymph nodes previously also there were margins and I have all the other data like crib form decipher score etc if it’s important but I’m wondering if anyone else has any experience like this or feedback on the report.

Thanks very much for your feedback.

Al

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albcan | @albcan | Sep 4 11:54am
In reply to @jeffmarc "Prostate cancer in the liver is unusual, but it happens. If it can be caught early,..." + (show)
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Prostate cancer in the liver is unusual, but it happens. If it can be caught early, they can operate. If not, they use chemo from what I have heard.

Have they discussed getting an MRI to try to narrow down what it is? You sure don’t want to find out you may have cancer in a certain area, But it’s not certain.. This is a discussion you need to have with your doctors. Ask what further tasks can be done to eliminate it as an issue.

One of the problems with PSMA pet scans is that they can’t see mets Smaller than 2.5 mm and even 5 mm is hard according to a UCSF radiologist. So if they shrink down smaller ADT and/or an ARSI can keep them from growing in the future.

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Thanks Jeff,

Yes the dr said we can do an MRI on that but wasn’t overly concerned right now and at the same time has prescribed ADT as well as 38 sessions of radiation to the prostate bed so we’re going to move forward with that and look at the liver after that’s all complete.

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albcan | @albcan | Sep 4 12:01pm
In reply to @northoftheborder "What's in the scan could be "nothing", but there might also be "something" that's too small..." + (show)
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What's in the scan could be "nothing", but there might also be "something" that's too small for the scan to detect yet.

After a cancer diagnosis, we lose that (false?) sense of security we felt before. Far more than the side-effects of ADT and ARSI for 4 years and two rounds of radiation therapy, I've found the big challenge with a stage-4 cancer diagnosis has been adjusting to a life where I have to admit to myself that the future is uncertain. To an extent, that's true for everyone, but I can't fool myself any more. For example, my PSA is undetectable (< 0.01), my CT contrast and bone scans came up clear, and all my blood work is good and healthy, but that doesn't mean my "routine" MRI on Tuesday won't find something all the other tests missed, and then suddenly my life will lurch sideways again.

We just have to accept that this is our new normal and get on with it. :-/

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Thanks north of the border,

I really appreciate all the responses and perspectives.

Must be the Canadian in you 😁

Anyways met with the dr and we are moving forward with radiation my first time as well as hormones, both were expected as soon as the PSA rose which it did and then look at the liver once we’re done with all of that.

I’m looking forward to or hoping that there will be a nice long gap after this before we need treatments again but it’ll be what it’ll be :).

Thanks Again for all the encouragement!

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gently | @gently | Sep 4 12:41pm
In reply to @albcan "Thanks Gently, Yes it seems like it’s unlikely that the cancer has gone from the lymph..." + (show)
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Thanks Gently,

Yes it seems like it’s unlikely that the cancer has gone from the lymph nodes to the liver and doctor agreed.

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oh, good!

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perrychristopher | @perrychristopher | Sep 5 7:53am

From what I read the liver has uptake of the tracer normally. That is why they said it could be physiological or normal liver function. It seems like you had a very good scan imo.

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trchar | @trchar | Sep 5 10:35am

The typical visualization of psma uptake is between 1-2 on the Gleason scale, that is the sweet spot. .12 is awfully low to rely on the results from a PSMA/PET. Congrats though on your treatments.

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icorps | @icorps | Sep 6 10:09am

You might consider feeding the info you provided into a Google AI search and ask for a prognosis. But be sure to read the caveats that attend it and to click on paper clip icons that are the basis for the information.
Good luck!!

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rlpostrp | @rlpostrp | Sep 6 11:56am

A quick online search said that metastasis to the liver is the third most common area at 25%. Bone is the usual area at 90%, followed by bladder/rectum at 46%. So, it "is" possible that you have spread to the liver. The only way to know for sure is a liver biopsy. I'm surprised that your PSA is only .12 ng/ml, but that the PET Scan showed radioactive tracer uptake. Sounds like you caught it early enough though. The biopsy will tell your physician if it is adenocarcinoma from your prostate, or if it might be an unfortunate coincidence of liver sarcoma. But...if the PET scan used Gallium 68 which is specific for prostate, I imagine it is in fact from your prostate. Talk with your physician...get that biopsy. Good luck with everything.

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koji480 | @koji480 | Sep 6 4:28pm

Actually, spreading prostate cancer does not always go to the bones first, that is just more common. PCa can spread to any organ first. Your scan does not appear to be something to be overly worried about but I am sure your MO will have answers.

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albcan | @albcan | Sep 10 8:42am
In reply to @icorps "You might consider feeding the info you provided into a Google AI search and ask for..." + (show)
Profile picture for icorps @icorps

You might consider feeding the info you provided into a Google AI search and ask for a prognosis. But be sure to read the caveats that attend it and to click on paper clip icons that are the basis for the information.
Good luck!!

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Thanks Icorps,
We did that and got lots of useful information back and like you said the paper clips were very useful to get more information. We’re good with our treatment plan now of 8 weeks radiation as well as ADT and will circle back to recheck the liver once it’s all done.

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