PSMA negative, Biopsy positive

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.

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.

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.

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

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.

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.

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

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

Research "PSMA-negative" and "PSMA-invisible" prostate cancer. 10-15% PCa can be invisible to PSMA-PET scans.

My experience, may be helpful.
I had a fully negative PSMA-PET (F18 Plarify) scan even after biopsy and MRI showed a PIRADS-2 lesion. Biopsy scored me at Favorable Intermediate Risk (3 + 4=7).
It blew my mind that the PET scan couldn't even visualize the presence of known, biopsied cancer tissue.
My RO and Urologist's responses set my mind more at ease:
1) RO said- There are Micro and Macro cancers. The Micro is at a cellular level and too small to be visualized. When there are enough of the cells congregated together then they can be visualized. So, for example, there might be enough micro cells to show up in a PSA test but not on enough to be visualized on PSMA-PET scan.
2) UROLOGIST said- He agreed with the RO plus he added that because the bladder is so close to the prostate and my bladder was not fully emptied during imaging, the urine (which uptakes the radioactive tracers) lights up and effectively blocks the cancer cells from being visible. At the time, I had BPH and, even after peeing just before the scan, there was a lot of urine left in my bladder. He showed me the images and convinced me that it wasn't just a botched PSMA-PET scan.

So I guess I just had unrealistic expectations of the PSMA-PET scan capability.

Best wishes on you and your husband's journey.