The physiologic uptake within your lacrimal and salivary glands, liver, spleen, kidneys, excreted urine (including possibly within the ureters), and bladder is normal. (I don’t know about the small bowel.)

As it turns out, PSMA (prostate specific membrane antigen) is not really “prostate specific.” There are other organs, tissues, and fluids that naturally express PSMA (without being cancerous) and will show up as physiologic tracer uptake on a PSMA PET scan - particularly in the lacrimal (tear) and parotid (salivary) glands, blood, liver, spleen, pancreas, ganglia, and more, as well as the kidneys, ureters and the bladder (as the body tries to quickly excrete the radioligand that was injected).

So, they use for comparison the PSMA SUVmax values of your blood (as the lowest level), liver (as the medium level), and parotid or lacrimal glands (as the highest level) of SUVmax expression.

If a suspicious area (lesion) has physiologic uptake, and it has:
> a PSMA SUV score less than blood, then it’s not likely cancer, but instead just normal, background PSMA cellular expression;

> a PSMA SUV score greater than blood, but lower than liver, then it’s likely low-grade prostate cancer;

> a PSMA SUV score greater than liver, but lower than the lacrimal/parotid glands, then it’s likely moderate-grade prostate cancer;

> a PSMA SUV score greater than the parotid/lacrimal glands, then it’s likely high-grade prostate cancer;

Since your left periaortic retroperitoneal node and aortocaval lymph node have SUVmax 6.7, and your right obturator lymph node has SUVmax 7.4 — both are in-between the SUVnax of your blood (3.0) and SUVmax of your liver (9.0), meaning that your numbers represent low-grade prostate cancer.

What are the plans to treat those few lesions?