BCR finding in PSMA test

Posted by zj69 @zj69, May 25 3:54pm

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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tonytiger | @tonytiger | May 25 5:39pm

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)

zj69 | @zj69 | May 25 6:14pm

In reply to @tonytiger "It appears from the report that they found suspicious “positive” PSMA activity at the bladder neck..." + (show)

Thanks, tonytiger.

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

tonytiger | @tonytiger | May 25 6:23pm

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.

zj69 | @zj69 | May 25 7:43pm

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:

i am going for MRI for evaluation before any treatment.

Thanks

tonytiger | @tonytiger | 6 days ago

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.