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Good News on PET-Scan, time to consider next steps

Posted by stjosephstmary @stjosephstmary, Sep 27 5:25pm

I discussed my PET-Scan results with my Urologist (PA) yesterday. She said no measurable prostate cancer recurrence was found!

The Report: No findings to suggest local disease recurrence, although this technique has limited sensitivity in assessing the prostatectomy bed because of early urinary excretion of radiopharmaceutical. No regional or distant lymphatic metastases. No skeletal or other hematogenous metastases. No suspicious lytic/blastic osseous lesions on CT images.

The recommendation from my Urologist (PA) is to visit with the Radiation Oncology MD, to discuss Salvage Radiation Therapy (SRT). They can apply radiation to the prostate bed to kill the prostate cancer cells that has been discovered in my ultrasensitive PSA test. SRT has a very good cure rate when PSA is X< 0.1. This will be Step 2 to the cure, however, there are risks in proceeding with SRT.

My Case History:
In January 2022, my PSA was 7. Primary Care MD referred me to Urology, typical for men my age (60) with PSA > 5. After an In-Office Biopsy, no cancer was found in 12 samples taken.

In January 2023, my PSA was 14. MRI Guided Biopsy found T2 hypointense nodule measuring 1.6 x 1.6 cm. This is a triple match. This bulges the capsule. PI-RADS 5-highly suspicious for malignancy.
Biopsy recommended. Biopsy found Prostate Cancer with Gleason Score 4 + 4 = 8. Gleason Score 8 -10 = Aggressive Cancer.

June 2023 Prostatectomy (Prostate Removal Surgery) was performed by an excellent MD. Radiation Treatment was the other option to surgery, but Prostatectomy was recommended for my age & health.

For 2 years after Prostate Removal Surgery, Ultra-Sensitive PSA testing has been undetectable X < 0.02. In August 2025, my PSA was X < 0.05. The Urologist (PA) indicated PET-Scan & SRT would be recommended when Ultra-Sensitive PSA reaches X< 0.1
Based on Case History, my Urologist (MD) did not want to wait 3 months for another Ultra-Sensitive PSA-Test; he ordered PET-Scan & Salvage Radiation Therapy (SRT) ASAP. Now that I have the good news on my PET-Scan, how soon should I proceed with SRT? The side effects have me worried.

For this entire time, I have not visited with an oncologist. I have scheduled an appointment with one to expand my team of experts in the Phoenix Area. I also have a referral on naturopath doctor who could offer assistance during SRT. Looking forward to the discussion. Thank you!

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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Sicetnon3 | @sicernon3 | 6 days ago

My suggestion (not scientific) is to proceed with radiation. My sense is that there is still a remnant unobserved by current technology. It puts one in the “ better safe than sorry” group. Best to you on your journey…

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heavyphil | @heavyphil | 6 days ago
In reply to @brianjarvis "@jeffmarc Yes, those “metasti-seeds” (as Kwon sometimes refers to them) can be anywhere in the body...." + (show)
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@jeffmarc Yes, those “metasti-seeds” (as Kwon sometimes refers to them) can be anywhere in the body.

But, Kwon cautions in that presentation that “…only 1/3 of men who have recurrence following prostatectomy have recurrence only in the prostate bed, and that they should not get salvage radiation there unless they’re absolutely certain of the location of recurrence.” He says to “first confirm where the recurrence is.”

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@brianjarvis Totally, that’s why it is recommended to radiate the pelvic nodes as well ((SPORTT trial); that’s another place that has cancer cells 30% of the time.
The remaining 30% could be anywhere but in cases where PSA < .2 it’s usually (and hopefully) somewhere between the umbilicus and the groin area.
SRT usually blankets this area, though some may consider it overkill…Best,
Phil

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samadhi | @samadhi | 6 days ago

Pathology report shows IDC, Cribriform gland and Seminal vessicle involvement which makes it higher grade.

You may look at doubling time calculators eg.
https://www.mdcalc.com/calc/10198/psa-doubling-time-psadt-calculator
Doubling time greater than 12 months has better prognosis.

Best wishes..

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stjosephstmary | @stjosephstmary | 5 days ago
In reply to @jeffmarc "@stjosephstmary You have multiple very aggressive things going on with your prostate cancer. All three of..." + (show)
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@stjosephstmary
You have multiple very aggressive things going on with your prostate cancer. All three of the following things mean that your cancer is much more aggressive than your Gleason score shows.

Intraductal Carcinoma (IDC): Present. IDC Incorporated into Grade: Yes.
Cribriform Glands: Present.
Seminal Vesicle Invasion: Present, right.

If you just had one of these three things, it would not be good but you have all three and getting salvage radiation as soon as possible makes a lot of sense.

You should do some searching about these three items, you will find that they are very aggressive. They actually have said a UCF seminar that if you have cribriform and intraductal That really puts a five in your Gleason score.

You should ask if the cribriform Is small or large. Large cribriform Is much more aggressive.

I’m not surprised they want to do salvage radiation as soon as possible, Your chance of reoccurrence is very high. With all three of these things, a decipher scores is probably not even worth doing, It would tell you your chance of reoccurrence, but you have so many aggressive things going on that the chance of reoccurrence is very high.

Be proactive about your treatment, Your progression free survival is dependent on getting the right treatment as soon as possible and staying on good treatment.

According to most medical advisors with all these negative things you have you should be on ADT plus an ARSI (Zytiga or a lutamide). Speak to an oncologist about this, Preferably not a medical oncologist you need to speak to a Genito urinary oncologist, They are the ones that specialize in prostate cancer. If you could mention where you live in the country, we could give you information on oncologist to speak to.

Be aware that if you have reoccurrence before three years, you are much more likely to have future reoccurrences. I’ve had four but I’m still alive after 15 years because I’ve stayed on the correct drug treatments for my situation.

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@jeffmarc Thank you for the response. I am in Phoenix, AZ. I meet in 1 week with Genito urinary oncologist in Chandler, AZ.

Clarification: The items listed in the 2023 Pathology were from the prostate that was removed. The pathology also mentions the Right Seminal Vesicle was absent and may have been transected at the base of the prostate.

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jeff Marchi | @jeffmarc | 5 days ago
In reply to @stjosephstmary "@jeffmarc Thank you for the response. I am in Phoenix, AZ. I meet in 1 week..." + (show)
Profile picture for stjosephstmary @stjosephstmary

@jeffmarc Thank you for the response. I am in Phoenix, AZ. I meet in 1 week with Genito urinary oncologist in Chandler, AZ.

Clarification: The items listed in the 2023 Pathology were from the prostate that was removed. The pathology also mentions the Right Seminal Vesicle was absent and may have been transected at the base of the prostate.

Jump to this post

@stjosephstmary
While removal of the prostate may eliminate those aggressive features the fact is that the reoccurrence rate is very high if you had those issues. One reason is that they can result in the cancer getting outside the prostate before the surgery.

If you want to know the real facts about Recurrence possibility get a decipher test.

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