What do you do when one lymph node on PSMA is inconclusive ?

My goodness that’s sounds like a lot. I’m told they can’t biopsy my node(s). Starting IMRT soon. I’ve gotten two second opinions. One said they would go head and treat the nods while the other opinion was to radiate the prostate and follow the para-aortic nodes. Guess I should have gone to medical school.

If we're talking about same nodes this doctor I had is a specialist in this procedure. If you want his information let me know. The procedure was painless and easy. They enter thru the esophagus travel down and push out of the esophagus and biopsy the node. Didn't even have a sore throat

Thank you for your insight. Much appreciated. I’m 76. Diagnosed at age 70 with Gleason 6. Was on active follow up until September 2024 when path came back Gleason 9. WTF! All my care is at an NCCN/NCI designated cancer center in Ohio. Doing well on Orgovyx and starting 28 IMRT sessions soon. I’m not concerned at all about radiation to prostate but freaking out about para-aortic treatment. I wonder how many other men are out there diagnosed with Gleason 6 but harboring something much more aggressive.

Same here - 2019 gleason 6 in only 2 cores of 12, genetic test (one of the first available at that time ) showed "low " risk , like in 30 years low "prediction". Six years later - IDC-P with cribriform : (. That is why biopsy should be done every 2-3 years once gleason of any kind is discovered.

I think that it is unconscionable to tell patients that 3+3 means "nothing" and that it is not even cancer ! IT IS CANCER and should be alarming in a sense that "ultra active surveillance" should be initiated at that point no matter what MRI shows or what PSA level is .

What is the point of "active surveillance" if it does not find out cancer in 3+4 stage and localized ???? Now that PSMA /CT is available it should be part of active surveillance every 2 years .

Thank you for your insight. Much appreciated. I’m 76. Diagnosed at age 70 with Gleason 6. Was on active follow up until September 2024 when path came back Gleason 9. WTF! All my care is at an NCCN/NCI designated cancer center in Ohio. Doing well on Orgovyx and starting 28 IMRT sessions soon. I’m not concerned at all about radiation to prostate but freaking out about para-aortic treatment. I wonder how many other men are out there diagnosed with Gleason 6 but harboring something much more aggressive.

Just came across this old message trail and wanted to share, too, that I was Gleason 3+3, 3+4 when I was diagnosed in 10/2021 (at age 69 - turned 70 12/2021) with low Oncotype score and recommended AS. This year on routine follow up my PSA jumped from 8.7 to 15 and although MRI was unchanged from previous, a repeat biopsy confirmed Gleason 4+5, 4+4 and PSMA PET CT confirmed bilateral disease in the prostate and an equivocal external iliac lymph node (not enlarged on imaging) with low-grade tracer uptake. Just started SBRT and ADT (will be 74 in 3 months).

Hope your treatments have been going well …

@rbtsch1951 Thank you for connecting. I’m 77 now with original diagnosis at age 70. I had IMRT to my prostate, pelvis and abdomen (para aortic nodes) due to PSMA findings. Aggressive treatment given inconclusive PSMA report. Finished treatment on July 31. I have been taking Orgovyx for 9 months. Side effects from hormone therapy are fatigue, brain fog but no hot flashes. Side effects from radiation are fatigue and diarrhea. After two months the diarrhea is finally improving. The spontaneous diarrhea has made exercise impossible. The exposure to these treatments has left me completely void of any sex life. First follow up PSA came back as undetectable. My urologic oncologist is not part of my treatment team. All of my many MRI’s indicated no spread of the cancer outside of the prostate. How are you doing? PS all of my treatment was at the Ohio State University Comprehensive Cancer Center in Columbus, Ohio.

@johnw22

Glad to hear you are weathering the storm and, though the side effects are present, it sounds as if you are doing well for the most part.

While on Active Surveillance it was easy to deny that PCa would ever be a threat. Now, the reality is rapidly sinking in and weighing me down.

I have received 3 of planned 5 SBRT treatments and am 2 weeks out from my first Lupron injection. I am easily fatigued, experiencing moderate bladder irritability (now have tamsulosin added to my regimen) and have intermittent mild transient nausea. I had diarrhea for the first time this AM. It remains to be seen if that continues. (I did receive a hydrogel rectal spacer before the start of SBRT to reduce the risks of radiation colitis.)

I worry mostly about the loss of libido and ED, especially since my spouse is quite a bit younger than myself.

Still, I try to remind myself how lucky we are that good treatments for PCa exist, but I admit it takes a concerted effort not to think more negatively.

I know we proceed and process one day at a time.

Hopefully things will continue to go well for you.

@rbtsch1951 Thank you for sharing. I feel the same way and it is difficult not to be negative. Were you given the option of Orgovyx vs Lupron? I have gold markers but no rectal spacer.
Why SBRT?

@johnw22

Sorry to interrupt - how were gold markers placed in ? I am asking since my husband might have them inserted in near future.

Thanks in advance : )