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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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OK - some more information to make the following make more sense.
You may have seen my posts about multiple perianal abscesses over the last 14 months, and I am having bowel issues "This was most likely caused by damage from the 39 Salvage Radiation Treatments in 2015 " I am working with a colorectal surgeon and had an MRI last Sunday where they found a large fistula. I have not met with him since the MRI but believe he wants to get in there and am not sure what he wants to do.
My new Oncologist says:
There is not a huge rush to do something with the 1.0 PSA and these low-grade foci, He wants to wait and see what the Colorectal Team wants to do and wait until after that treatment is complete.
He thinks that the new node foci are either too far north or too close to where this surgery will be for any sort of radiation, but we will consult the RO.
He believes that some sort of ADT will be the course of treatment. He did mention 6-month belly shots, but I did not press him about what the alternatives or his recommendations are at this time.
Like I said this is a new Oncologist for me and I concur with what he is saying and we have a plan to revisit next month.
@briang1958 Yes, you definitely want to have whatever surgery your CR surgeon is proposing first. Even if direct radiation to that area is not planned, why not eliminate it entirely as a possible complication?
The ADT is another matter; if I am reading your posts correctly, you’ve been on Lupron since 2014? And now your PSA is still rising. Doesn’t seem that Orgovyx by itself will make a difference since you may now be castrate resistant.
As others have mentioned, a drug such as Darolutamide might be a good choice since its SE’s are lower than Enzalutamide.
But you should be able to stop those mets in their tracks while you address the fistula. Best,
Phil
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Hey Phil - I now have all my records and as a guy with memory starting to go away, I may have mis-spoke. I had my BCR 2 years after RP circa 2017 - this was treated with 39 Salvage RTs and (2) 3-month LUPRON. I was then in remission until 2024 (no ADT). Now we are working on the "mets" 2 SRBTs so far 1 on each iliac. Now this.
Yes, we will be brainstorming the ADT and I definitely appreciate all of you and your experiences and advice to arm me for these discussions with the CO.
edited - maybe remission is not the right word, but PSA not at a place anyone was worried.
PSA (PSA-2.pdf)
@briang1958 OK, then I change my suggestion - ORGOVYX it is!
Just do your exercises, take naps to rejuvenate and you’ll be great.
Phil
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