PSMA scan conflicting results

Thanks, I did. I used Chat Gpt which is remarkable. It agreed with the aggressive treatment pattern which I wanted. It says the isolated rib lesion could very well be benign and mentioned studies about false positives of ribs in general and especially when there are no other sites being seen. I have a feeling your rib uptake was less than mine, unfortunately mine is in the middle region. Not above 10 but not below 2.5. Good luck with your treatment as well.

I'm the same way also. I suggested to start the ADT to my Urologist because of the rapid PSA bump I had and also because of the indeterminate rib lesion. I am getting my pelvic area mapped next week and will start treatment to bed and pelvic lymph nodes approximately 4 weeks later. 28 treatments I think. After this 8 treatments of SBRT to the rib. The risk of not doing the rib outweighs the risk of radiating it even though no one has confirmed it is cancer or not. I pray it's not. I haven't noticed Firmagon side effects other than my stomach being sore and red at injection sites. I went to gym today and played golf yesterday with no ill effects. Mentally I am in a little better place now that I started treatment for this unexpected surprise of BCR.

I hope you get some good direction from your Oncologist on a treatment plan. Sending prayers...

I had a PSMA PET scan in October 2024. My PSA was 1. It showed a lesion in my sternum and lit up with SUV I believe of 21. I I had two different biopsies first one shows inconclusive. My oncologist recommended. I get 4 or 5 radiation treatments to see If the PSA goes down we got it. The radiologist said don’t do it because your heart is right behind the sternum and it would affect your heart. I had a second biopsy done and showed negative.. apparently there are many false positives in a bone. Do the biopsy.

Thanks for the reply, but according to the Orthopedic Oncologist the left first rib in my case at least was too risky to biopsy. My Radiologist also said 50 50 if they would get a viable sample. The MRI follow on to the PSMA pet scan was inconclusive due to motion from breathing. My Radiologist is sticking to cancer diagnosis even though my Uptake is moderate at 6.3. A second opinion agreed with the Radiologist. They seem to be basing their assessment only on SUV (brightness on scan), it's sclerotic, and the fact I have BCR. I've read benign lesions can have higher SUV's than mine and also be sclerotic. Lesion is described as well defined. I'm leaning towards SBRT even though that carries some side effect risks. Very frustrating.

Thanks for your reply. I was told the same thing on the biopsy on the sternum it was 50-50. I did a second time and they got a good biopsy and showed negative. However, I did a second psma pet scan my PSA went to 2.8. Results show I have two lymph nodes. They don’t give me an SUV number. They just say they’re mild and one in the T7 region of my back again I think it’ll be a false positive in my back. My oncologist is recommending short term ADT therapy, but I’m not sure yet. I’m looking into proton therapy (IMPT)which appeals to me more. If I can get it done it’s radiation if you haven’t checked it out.but it’s much more precise and only hits the target. Very little side effects and effective. If you’re considering radiation, check it out it’s very effective. Good luck

Have you had Salvage Radiation to your Prostate Bed and Pelvic lymph nodes prior? I'm assuming you've had a Prostatectomy in the past and you're experiencing a Biochemical Recurrence. Good luck with your treatment also.

Still have my prostate, and looking at several treatment possibilities. Will make decision soon. Current situation is 2 lymph nodes . Results from a PSMA PET SCAN.

2018 had brachytherapy, IMRT.

5 years? There are many, many people that have had extensive metastatic cancer all over their body that have responded well to therapy. It is not uncommon to get much more time. A lot of the statistics in mortality rates are old. Therapies improve all the time. Do what you can with diet and exercise and live a clean life.

Phil, I am so confused. I went and got a second opinion at a cancer center in Michigan, Karmanos. They believe my first rib is cancer also. I asked why they are saying that and they basing it on the brightness of the lesion which measured 6.3 on the SUV . Karmanos said to treat only the rib and not do SRT to the prostate bed and pelvic lymph nodes as nothing showed up there. They also said no ADT. Both of these things were suggested as to prevent side effects. Well, I started ADT a month ago because PSA jumped from.24 to .42 in 6 weeks. I have been marked up for SRT by first opinion Oncologist and am waiting for SRT to begin. After SRT complete I will start SBRT to rib. I had my prostatectomy in August of 2022 and was clear until this July. I had a Decipher score of .37 which was supposed to be low risk for metastatic disease. Everything I have read is that a solitary first rib lesion being cancer is rare, especially without spread to the spine or pelvis first. My SUV is moderate, squarely in the grey zone of being benign or cancer. The SUV ratio is 3.7 which is also in the middle between cancer or benign. I have clavicular joint arthritis as well as arthritis in knees and back which is supposed to increase chances of being benign but none of that seems to matter to the Oncologists, both Radiologist and Medical oncologists. Karmanos suggested getting rib treatment first. The plan I'm on is getting SBRT to rib after SRT. I have been inputting all my data into AI platforms and I'm receiving odds that rib is probably benign. Right now I'm lost and am losing confidence that anyone knows what is going on. I'm taking the most aggressive path for treatment at this time, side effects be damned. Can anyone on this board offer any advice or first hand experience in this?