BCR finding in PSMA test

It appears from the report that they found suspicious “positive” PSMA activity at the bladder neck and back of the bladder also some “low grade” PSMA activity in two pelvic lymph nodes. Everything else seems clear ( organs and bones)

The next step would be a pelvic MRI to confirm the lesions and perhaps a biopsy if it appears to be cancer.

The good news is that PSMA pet scans can detect very small amounts of cancer in an early stage. You Urologist will guide you in your treatment options.

I had a rising PSA many years after surgery and had a PSMA petscan last summer that was inconclusive but showed suspicious activity in the bladder. An MRI confirmed the presence of a 2mm lesion and biopsy confirmed that it was Gleason 9 (4+5) cancer.

My treatment plan was Eligard injections with abiraterone ADT for one year and 37 fractions of IMRT radiation to the pelvis and expanded to include pelvic lymph nodes. I am 3 months past radiation treatment and recovering slowly from the symptoms. I am currently still on ADT for another 4 months. It appears that the cancer is in remission at this time.

I hope this helps. I wanted you to know that we have something in common.

My favorite sources of information:

Prostate Cancer Research Institute (PCRI.gov)

National Cancer Institute (Cancer.gov)

American Cancer Society (Cancer.org)

Thanks, tonytiger.

Is it local recurrences? bilateral inguinal and axillary lymph nodes.

Hello,

Recurrence of cancer in the pelvis would be considered a local recurrence, even if it involves two lymph nodes. The good news is that the nodes are in the pelvic region and not close to the bone.

The chance for remission or even a cure is much higher if it is a locally recurring cancer.

IMRT Radiation to the pelvis and lymph nodes will eradicate the cancer if caught early.

P.S. I am not a doctor I am just giving you my opinion based on my own recent experience. Your Urologist and Radiation Oncologist can give better advice.

I understand what you are saying. In my report, it is mentioned below. Is it local nodes for distant nodes?

LYMPH NODES:
Status post pelvic nodal dissection.
There are again seen prominent bilateral inguinal and axillary lymph nodes with low-grade PSMA uptake, favoured reactive.

But in the last section below.

IMPRESSION:

PSMA-avid focus inferior of the vesico-ureteric junction, concerning for local recurrence, PROMISE positive, MRI evaluation is recommended.
No convincing PSMA-avid nodal, solid organ or osseous metastases on PET.

i am going for MRI for evaluation before any treatment.

Thanks

As I understand your report: there are visible enlarged lymph nodes in the groin and armpit regions, but they show low PSMA activity. This may not be cancerous. there is a PSMA uptake in the area located below the junction of the bladder and ureter. This raises a concern for local recurrence and further evaluation with an MRI is recommended. There is no clear evidence of cancerous spread to lymph nodes, other organs, or bones found on the PET scan.

You Urologist can explain the report far better than I can with my limited knowledge, but I hope this helps you understand the report is suggesting local recurrence. I’m glad you are going to follow up with the MRI. This will give you a more detailed diagnosis.

I hope this helps.

Thanks for your response.

Hello,

I had a urologist appointment to discuss my PSMA-PET result. He told me it was a local recurrence of prostate fossa and that I needed to go with an MRI first and Radiation. I am going to see the doctor on 12 Jun. for an update. Do you think later, after Radiation, it can recur? I got the impression that my PSA is .28, and they found that only place in scanning.

Thanks

I think some more information would be helpful. What was your gleason grade and staging from the pathology report after your prostatectomy? What was your PSA post-surgery? Was the cancer confined to the prostate or was there anything outside the margins?

When was your last PSA test? what was the result?

No one can predict if cancer will recur. If caught early there is a higher likelihood that it can be cured or place in remission for a very long time. But everyone is different. The treatment plan depends on you in your discussion with your doctor; weighing the benefits and the risks of side effects that will impact your quality of life.

Listen to your doctor's recommendations, ask questions. Take the time to get informed about your type of cancer and possible treatment options. Schedule an appointment with a Radiation Oncologist and get a second opinion. You still have time on your side to decide what is best for you. Don't rush into treatment yet. And try not to worry too much.

Thanks for your reply. Please see the below detail.

53M RALP Feb 15 2022 Path: Gleason 3+5, Negative margins, pT3aN1.
Pre-op PET negative for nodal or metastatic disease.

PSA
- Apr 2022: 0.017
-Oct 2022: 0.075
- Jan 2023: 0.10
- Apr 2023: 0.28

I went for PSMA PET CT scan 3 weeks ago, and here is the finding.

PSMA-avid focus inferior of the vesicoureteric junction, concerning local recurrence, PROMISE positive, MRI evaluation is recommended.
No convincing PSMA-avid nodal, solid organ, or osseous metastases on PET.

Thanks

It appears from your pathology you would be classified as "high risk". (For recurrence of cancer) The good news is your PSA post-surgery has been "undetectable" and stable. There does seem to be an upward trend in your PSA, but you had a PSMA pet scan early enough to find a small lesion. Does your Dr. plan to do a biopsy? It would be helpful to know if the Gleason grade has changed or not. It would also be useful to have the biopsy sample sent for genomic testing. This type of test can determine what type of cancer you have and guide treatment decisions with targeted therapies that might be more effective in treating the cancer.

Either way, with radiation therapy and a short course of hormone therapy (ADT for 6-12 months) there is about an 80% chance that this can result in a cure and at the very least a long remission before cancer could come back.

here is a video that I think might help.