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What do you do when one lymph node on PSMA is inconclusive ?
Prostate Cancer | Last Active: Sep 28, 2025 | Replies (45)Comment receiving replies
@melvinw I too had prostatectomy in 2015 and my last psa was .5, but holding steady. Two negative PSMA's. Just curious where the node is? Are they radiating the node and the prostate bed? Also, what was your post-surgical Gleason and did you have extracapsular extraction? All the best.
Replies to "@melvinw I too had prostatectomy in 2015 and my last psa was .5, but holding steady...."
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@squash05
The node is in the prostate anastomosis, just a little left of center. Yes, that is the main target. My highest post-RT Gleason score was 3+4. No extracapsular extraction but I had a positive margin. My Prolaris score was 1.7, putting me on the highest end of intermediate risk. Prolaris estimated a 53% chance of BCR at ten years, so I always knew that was a strong possibility and kept up with regular PSA tests and DREs. As strange as this might sound, I am glad that I have an identifiable local lesion versus just a BCR—makes for a more targeted RT approach, hopefully with minimal side effects. Also, my PSA of 0.11 happened in June (had been undetectable for 10 years), and 3 months later, it hasn’t changed. So, like you, holding steady—good news in a bad news situation!
Given my low PSA, it was surprising that the PSMA PET detected anything, but the local node really lit up with an SUV of 13.4. I asked my RO about that (conventional wisdom says that if PSA is < 0.5, nothing is likely to show up). She didn’t have any answer other than it’s a matter of probability rather than some precise correlation. She also mentioned that she had a post-RT patient with PSA of 5 and nothing lit up on the PET scan. It’ an amazing technology (wasn't around in 2015) but it has its limits.
Hope you keep holding steady!