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PSMA negative, Biopsy positive

Posted by undetectable @undetectable, Jul 19, 2023

My husband (71) has a Gleason 8, PSA 8 (4+4). His recent MRI-guided biopsy revealed 9/18 positive cores, four of those 4+4. PSMA showed no spread but the area of diagnosed malignancy didn't light up either. His urologist (at large well-regarded medical center) said he's clear, but the radiologist (at cancer center) who interpreted results said the scan could have 'reduced sensitivity.'

Husband's plan is to choose a surgeon who will decide whether to retest. (He has ruled out radiation because of the ADT.) Is anyone else familiar with this kind of PSMA PET result?

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edmond1971 | @edmond1971 | Jul 19, 2023

My understanding from my oncologist and various webinars is that psma pet has utility for 85-90% of prostate cancers. So your scenario might be supported by this characteristic... might being the operative word.

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undetectable | @undetectable | Jul 20, 2023

Thanks - this was our theory as well, but the radiation oncologist said the urologist probably was trusting the CT to determine spread. We are meeting with three surgeons and will find out what they think.

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mrauks | @mrauks | Jul 21, 2023

I would trust the biopsy results. My PSMA turned out to be incorrect. With surgery you will know from the pathology what exactly is going on. Best of luck.

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undetectable | @undetectable | Jul 21, 2023
In reply to @mrauks "I would trust the biopsy results. My PSMA turned out to be incorrect. With surgery you..." + (show)
@mrauks

I would trust the biopsy results. My PSMA turned out to be incorrect. With surgery you will know from the pathology what exactly is going on. Best of luck.

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Thanks. Hope you're on the road to recovery. Did you find out that the PSMA was incorrect during surgery?

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donaldguy | @donaldguy | Jul 21, 2023

My experience is that four Gleason 4+4 cores will probably grade as high risk. I had two 5+4 and two 4+4. I was strongly encouraged to have RLP, which I did as well as having adjacent lymph nodes removed. All nodes and all margins were cancer free. Before surgery, I had full body PET, CT chest, and full body nuclear bone scan. All clear. I’m happy with my decision to remove prostate but everyone’s different. I’m 74.

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undetectable | @undetectable | Sep 17, 2023

Update: We got a second opinion from a nuclear med specialist at a major cancer center. There was uptake in the prostate where the MRI and biopsy found tumors. Thanks for everyone's help.

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kenhorse | @kenhorse | Sep 17, 2023

I was diagnosed with Gleason 8 in August of last year (biopsy showed 6 of 12, all on right side). PSMA 2 weeks afterwards that showed it was all contained in prostate. Underwent RARP Jan 31st of this year, lymph nodes clear, Gleason downgraded to 7.
2 PSA tests since < 0.04

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1 reply
undetectable | @undetectable | Sep 17, 2023
In reply to @kenhorse "I was diagnosed with Gleason 8 in August of last year (biopsy showed 6 of 12,..." + (show)
@kenhorse

I was diagnosed with Gleason 8 in August of last year (biopsy showed 6 of 12, all on right side). PSMA 2 weeks afterwards that showed it was all contained in prostate. Underwent RARP Jan 31st of this year, lymph nodes clear, Gleason downgraded to 7.
2 PSA tests since < 0.04

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Congrats. Husband had RP last week, easy recovery. Hoping for similar results.

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