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Rut Roh Rorge - PSA wrong direction
Prostate Cancer | Last Active: Jun 3 9:25am | Replies (64)Comment receiving replies
Wow, that was fast PSMA PET results 4/30/26:
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Impression:
Increased focal PSMA activity in the RIGHT apical prostate adjacent to fiducial marker since 6/6/2025. Decreased PSMA activity in the LEFT apical prostate.
Increased PSMA activity and sclerosis associated with L5 vertebral body osseous metastasis.
Interval resolution of PSMA avid metastatic lymphadenopathy in the pelvis, retroperitoneum, and mediastinum.
Narrative
PET/CT PSMA ILLUCCIX FOR PROSTATE TUMOR IMAGING
HISTORY: Oligometastatic prostate cancer, diagnosed in May 2025. Radiation therapy September-October 2025. On systemic therapy. Rising PSA level.
COMPARISON: 6/6/2025.
Findings:
Neck: No suspicious tracer avid disease.
Chest: No suspicious tracer avid disease.
Abdomen/Pelvis: Fiducial markers in the prostate gland. Increased focal tracer activity in the RIGHT apical prostate adjacent to a fiducial marker, max SUV 19.3, previously 11.1. Decreased tracer activity in the LEFT apical prostate, max SUV 7.8, previously 10.0.
Interval resolution of tracer avid metastatic lymphadenopathy in the pelvis, retroperitoneum, and mediastinum.
Bones: Increased tracer activity associated with sclerotic lesion in the L5 vertebral body, current max SUV 17.5, previously 11.9. Increased sclerosis since prior study. No new tracer avid osseous lesions identified.
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Not as bad as I thought it was going to be. Can probably zap the L5 lesion but I have no idea what's available for the prostate since it's already been radiated. Apparently, my RO wasn't a very good shot. It's pretty cool that everything else is gone, though.
Replies to "Wow, that was fast PSMA PET results 4/30/26: _______________________________________ Impression: Increased focal PSMA activity in the..."
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@mjp0512
That is a real serious problem with your prostate. It does look like they did not completely zap what was there?
Yes, they can do the L5 for sure they did my L4. They wanted to do it in three sessions because it was wrapped around my L4 and they didn’t want to put it too much radiation on all at once.
Here are some answers about what to do for the prostate that is reoccurring. There are doctors that are trained in using surgery to treat prostates that have reoccurrence after radiation. I know the Mayo Clinic has many doctors that can do this. If you can’t get to them, there are other places that have doctors that specialize in doing that.
People who have radiation as their primary treatment have been told by doctors that surgery isn’t really an option if there’s a reoccurrence. Other options are not really mentioned..
This study shows that both salvage focal therapy (HIFU and cryotherapy) and salvage surgery were equally effective at extending the life of a patient that started off with radiation.
Those that had focal therapy had fewer perioperative complications.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2844900