New PET scan results confused and a little scared

Al, the liver plays a key role in PSA production and clearance.
According to Courtney Lawhn Heath, MD, Radiologist, UCSF, San Francisco, CA common false positives and the limitations of treating PSMA PET as a straightforward diagnostic tool for prostate cancer.
It would be unusual for metastatic prostate cancer to appear first in the liver.
I'm responding without experience. The knowing gentlemen will follow.

I'm not one of the "knowing gentlemen", but I have been told that PSMA-PET can produce a lot of false positives.

In other words, a CT contrast scan can sometimes miss micrometastases that are there; PSMA-PET can hallucinate micrometastases that aren't. 🤷

Prostate cancer in the liver is unusual, but it happens. If it can be caught early, they can operate. If not, they use chemo from what I have heard.

Have they discussed getting an MRI to try to narrow down what it is? You sure don’t want to find out you may have cancer in a certain area, But it’s not certain.. This is a discussion you need to have with your doctors. Ask what further tasks can be done to eliminate it as an issue.

One of the problems with PSMA pet scans is that they can’t see mets Smaller than 2.5 mm and even 5 mm is hard according to a UCSF radiologist. So if they shrink down smaller ADT and/or an ARSI can keep them from growing in the future.

relax. PET scans are pretty accurate but not infallible..let the radiologist and oncologist confer...maybe schedule a new PET scan in 6-8 weeks...sounds like you are doing pretty well...but iif you do have a spot on liver, it should be early enough to eradicate before it causes trouble...PC is a worrisome disease..but worry and stress are counterproductive.. try to relax and stay positive !

Some day we'll have a radiology scan that can actually find cancer itself, but in 2025, we're still stuck with imaging that says "there's stuff going on here that might mean cancer's in the neighbourhood". It's gotten very good, but lots of things that aren't cancer can still cause a CT or PSMA-PET scan to light up. Their interpretation by a skilled radiologist is as much as art as a science.

So true ... It can be really nerve-wrecking scenario when "something" is seen but it is "inconclusive" or "probably nothing" 😵‍💫. One lingers above a deep void between hope and worry and feels stuck in no man's land. Somehow my husband and me are constantly in that gray area from the beginning. The best example is that one low-glow lymph node on a PSMA scan. Two world class experts said it is "nothing", but as the time passes my confidence in their "art of reading" is less and less 🥺 unfortunately ... Same with the last pathology report - it can really be with good margins, but one tiny spot is inconclusive, BUT "probably negative". As people in my old country would say: "Earth, please open under me " 😋

Sounds like a good report actually. The liver tracer is probably nothing. I’ve had both MRI and PSMA show uptake in liver; diagnosed as hemangioma. Best,
Phil

What's in the scan could be "nothing", but there might also be "something" that's too small for the scan to detect yet.

After a cancer diagnosis, we lose that (false?) sense of security we felt before. Far more than the side-effects of ADT and ARSI for 4 years and two rounds of radiation therapy, I've found the big challenge with a stage-4 cancer diagnosis has been adjusting to a life where I have to admit to myself that the future is uncertain. To an extent, that's true for everyone, but I can't fool myself any more. For example, my PSA is undetectable (< 0.01), my CT contrast and bone scans came up clear, and all my blood work is good and healthy, but that doesn't mean my "routine" MRI on Tuesday won't find something all the other tests missed, and then suddenly my life will lurch sideways again.

We just have to accept that this is our new normal and get on with it. :-/

Thanks Gently,

Yes it seems like it’s unlikely that the cancer has gone from the lymph nodes to the liver and doctor agreed.

Hi Phil,

Yes besides that it did look and sound good, met with the dr this morning and have 8 weeks of radiation coming up now plus ADT and we will circle back on the liver when it’s all done and get a separate MRI for that and go from there.