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Latest PSMA Scan results - Meeting with Oncologist Friday
I'm not an expert yet - but not as bad as I thought. Surely time for some sort of ADT.
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EXAM: NM PET/CT PSMA SKULL BASE TO MID THIGH
INDICATION: Prostate cancer staging
COMPARISON: PET-CT 07/25/2025. MR pelvis 02/15/2026.
TECHNIQUE: Images were obtained from the skull vertex through the proximal thighs. Low-dose CT was obtained for attenuation correction and anatomic correlation.
RADIOPHARMACEUTICAL: 5.29 millicurie (mCi) Gallium-68 Gozetotide.
PSA: 1.0 ng/mL dated 02/04/2026.
FINDINGS:
Physiologic uptake is noted within the lacrimal and salivary glands, liver, spleen, kidneys, excreted urine (including possibly within the ureters), bladder and small bowel.
SUV OF BLOOD POOL: 3
SUV OF NORMAL LIVER PARENCHYMA: 9
SUV OF PAROTID GLAND: 29
HEAD/NECK: No suspicious radiotracer activity. Mucous retention cyst left maxillary sinus.
CHEST: No suspicious radiotracer activity. Lungs are grossly clear. Calcified right hilar lymph nodes and right lung calcified granuloma. No pleural effusion.
ABDOMEN/PELVIS: Prostatectomy without suspicious tracer activity at the vesicourethral anastomosis. Tiny new tracer avid left periaortic retroperitoneal node (image 124), aortocaval lymph node SUV max 6.7 (image 136), and right obturator lymph node SUV max 7.4 (image 152). Additional minimally avid foci anterior to the right S1 segment on the prior study is less conspicuous on the current study. Left hepatic cyst. Cholelithiasis. Stable unenhanced appearance of the remaining solid abdominal organs.
MUSCULOSKELETAL: No suspicious radiotracer activity. Previous faint tracer uptake within the left posterior 6th rib in the right iliac bone are less conspicuous.
IMPRESSION
1. Few tiny retroperitoneal and pelvic lymph nodes with demonstrate mild tracer uptake suspicious for nodal metastases. Key images saved.
2. No findings for metastatic disease elsewhere.
miPSMA EXPRESSION SCORE: 1
0 (none)- below blood pool
1 (low)- equal to or above blood pool and lower than liver
2 (intermediate)- equal or above liver and lower than parotid glands
3 (high)- equal to or above parotid glands
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sounds like you have some (3-5) pelvic lymph node with tracer uptake...prob will recommend short round of radiation and perhaps a ( short ?) 6 mos to 1 yr round of ADT. PET scan is catching it very early, it appears !
lots of missing info such as time of original diagnosis, PSA then, Gleason score...and time since prosectomy ?
but prob a somewhat optimistic outlook since tracer uptake is very light.
I had 2 pelvic lymph nodes light did 45 IMRT sessions and on ADT for 2 yr ( Gleason 8-PSA 61 but now < .01 at 5 1/2 mnths into treatment- next PSA in 30 days)
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1 Reaction@xahnegrey40 - Sorry didn't do entire story on this post. But I have posted previous.
PSA went from 2 to 14 in 3 years, biopsy in 2014 (55 y/o) 7 carcinomas, Gleason score 3+4 (7) with bladder lesion noted.
Prostatectomy in 2014, biochemical recurrence in 2015 with 39 salvage radiation treatments and 1 year Lupron. < 0.01 for 10 years.
2024 PSA rising again - PSMA PET Scan showed foci on left iliac node, 1 dose SBRT (early 2025). PSA still rising PSMA showed foci on right iliac, spine and rib. MRI showed only the iliac, 1 dose SBRT (late 2025). PSA still rising - this is from the latest PSMA yesterday.
So not so early - it is stage 4 and I will die with prostate cancer (just still fighting and hoping to see my grandchildren grow up).
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?
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4 Reactions@brianjarvis
Thanks for the detailed explanation, Brian, much appreciated.
Meeting Oncologist to discuss on Friday.
I am assuming another dose of SBRT? I am sure we will discuss ADT as well (about time I guess)
@briang1958 It depends. There are many options for just a couple of recurrent lesions.
Dr. Johnson (of Mayo Clinic) talks about treating recurrence in this presentation, starting with discussing scans we’ve all heard about (MRI, bone, & CT scans), and then going into detail about PSMA PET scans and treatments: https://youtu.be/JoJomACA5UM
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3 ReactionsThanks so much-great video!
@brianjarvis Hey Brian. Thanks for this. I couldn't turn this guy off until the end. Great speaker!
as disappointing as recurrence must be- you have had a long stretch of PC frre time..thanks to the PET scan, this very early recurrence should be dispatched without much trouble...so if you go ADT, remember 1 st 30 days or so of ORGOVYX can be challenging but after that, not a big deal..just have to remember to take the pills daily...stay hydrated...it is NOT the horror story some present...and a light round of radiation is not too bad either...then I predict another long stretch of PC free life.
let us know what oncologist recommends !
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3 Reactions@xahnegrey40
I appreciate the feedback
I was on Lupron for a year in 2015 - 2016 and it was the nightmare I said it was. Hell, I even got fired from my job and I deserved it my performance sucked. 41 radiation treatments and counting.
The metastasis keeps moving around - we zap it and more appears for 2 years now.
More to come after CO tomorrow
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1 Reaction@briang1958 Yes I have heard LUPRON is not easy..I would ask for ORGOVYX...it suppresses cancer growth quickly and no PSA flare..plus, if you just need a break, you can stop a day or two ( I stopped for over a week and still PSA went down to < .02 in 3 months)
..with the LUPRON injection, you are committed...maybe ORGOVYX will be a better choice with less side effects..good luck and report what oncologist recommends..
( Nubeqa might also be a good choice as well)
Good luck !
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