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BCR finding in PSMA test

Posted by zj69 @zj69, May 25, 2023

Hi Everyone,

I went for PSMA test and got my result. Could you please help me to understand?

CLINICAL HISTORY: 53-year-old male post radical prostatectomy in May 2022 with rising PSA last measures 0.28 ng/ml.

COMPARISON: Comparison is made with prior PET CT from September 3, 2021

For reference purposes:
Mediastinal blood pool SUVmax/mean: 1.6/1.0
Liver SUVmax/mean: 9.2/7.1
Parotid glands SUVmax/mean: 26.8/17.6

FINDINGS:

PROSTATE:
Status post radical prostatectomy. Focal PSMA-avid lesion inferior to the bladder and right of the midline, measures approximately 1.3 cm with SUVmax 37.7 (PET image 422; PSMA score 3).

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.

Otherwise, no suspicious PSMA-avid lymph nodes are seen in the pelvis, retroperitoneum, mesentery or above the diaphragm.

DISTANT:
Interval resolution of the right lower lobe patchy ground-glass opacities.
No PSMA-avid pulmonary nodules.
Diffuse hepatic steatosis. No focal abnormal PSMA-avid lesions in the liver, spleen, pancreas and adrenal glands.
No concerning focal skeletal PSMA uptake or morphologically aggressive osseous lesion is identified.

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.

Verified By: Veit-Haibach, Patrick
Reviewed With: Veit-Haibach, Patrick

Thanks

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zj69 | @zj69 | Jun 9, 2023
In reply to @tonytiger "It appears from your pathology you would be classified as "high risk". (For recurrence of cancer)..." + (show)
@tonytiger

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.

Jump to this post

Thanks. Very informative.

REPLY
edmond1971 | @edmond1971 | Jun 10, 2023

I would encourage asking your health team for their consideration/approval to get a PSA test every four weeks as you embark on the next steps for your treatment options. Your current results are in the very/low range so time is on your side for almost all options, but getting a sense of how it increases will be helpful to learn how it is growing. For me, I had a PSA of 9.8 in August 2022 and then did 4 sequential tests (Bone scan, MRI scan, CT Scan, PSMA Pet Scan) over the next two months and during that timeframe my PSA increased from 9.8 to 14.0 to 19.4. So, it made it pretty easy in October 2022 to make a decision for treatment. --- Continue to educate yourself, ask questions, don't accept anything that doesn't sit well with you. Keep The Faith!

REPLY
michaelcharles | @michaelcharles | Jun 11, 2023

My non-medical understanding:

PSA rising above .2 indicates recurrence.
Sweet spot for treatment. 2 - .4/.5

My 90 day postop PSA was a failure: .19
Post op path G 9 w/EPE

Surgical margins, lymph nodes and seminal vesicules clear.

PSMA PET scans pre and post op suspicious, but inconclusive.

Just completed:
37 IMRT radiation txs to the whole pelvic floor (WPRT) and 25 of those txs included the pelvic lymph nodes.

Together with a course of ADT hormone therapy; Orgovyx 4 months.

Cases are individual, and also similar. Hormone therapy choices vary between Rad Oncs and Med Oncs, and the specifics of your PCa. Possibly a medical trial might be an option.

Basically, I believe that you are heading for radiation and ADT.

And in my world, the sooner the better.

Bless you and all the brothers struggling with this unrelenting disease.

REPLY
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