Nuclear medicine (NM) PSMA PET-CT prostate scan results

Curious if your scan results mention any SUV uptake or was this not a PSMA scan (GA-68 or similar tracer)?
Good luck with your surgery.

Your PSA is a little low to do a PSMA Pet test as the doctor has recommended, But, if there is prostate cancer found that is the best way to do it. If something is found then the radiation your doctor talking about would make sense. You definitely should get that test.

Yes, your PSA is low, but some people don’t produce all that much and the scan can find things that nothing else is capable of finding.

Personally, I'm not familiar with any "NM (Nuclear Magnetic) PET-CT" scan? The two are dissimilar technologies. While both are forms of tomography, a PET scan, uses a fluorescing radiotracer, and detects the light emitted from the decay of "positrons" bound to a protein (PSMA), on the surface of cancerous prostate cells, while a CT scan uses simple, computer-enhanced 3D/x-ray technology. However, based solely upon the magnitude or value of the units cited here (i.e., 2.61 and 1.77), I'm guessing it was either a CT scan (?), or some form of NMR (Nuclear Magnetic Resonance)? Not sure.

As for the low (0.2) PSA result? That is indeed quite low, and could be caused by a variety of other things besides cancer, but given the overall circumstances (testing, history, age, etc.), if I was to recommend anything at all, it would be to skip any further appointments with the urologist, and speak to a qualified "oncologist" instead. I say this, because I (myself) had several borderline 'terrible' (i.e., amateurish, inexperienced, ill-advised) projections and recommendations from 'urologists'. In other words, get to a specialist, who does just "cancer".

@mjp0512
It was a SUV that measured out at 2.61 on one side and 1.6 on the other. Neither were high enough for immediate attention.

I think the details of your PSA history are critical to making any decision about treatment for a relapse (if it is that). When did your PSA first become detectable (>0.1)? Can you calculate a PSA doubling time?

I agree about consulting an oncologist, and maybe two or three. You may get a variety of opinions ranging from active surveillance to hitting you hard with radiation and short term hormone therapy.

From what you had said, you appear to be in a bit of a gray zone in terms of having a relapse or not, and if you are, how to treat it. I have been going through something similar since June 2025. Here's my relapse story, which might be useful for you.

I am currently 73. Had a RARP in 2015. Pathology showed Gleason 7 (3+4), Grade pT2c, one positive margin. Prolaris score with 10-year risk of biochemical recurrence was 53%.

My PSA was undetectable (<0.1) for ten years. In June 2025, it rose to 0.11. Two years prior, my urologist detected a small nodule in my prostate fossa, but since my PSA was still undeteactble at that time, no further action was taken. When it became detectable in 2025, a PSMA PET scan was ordered. The nodule lit up intensely (maximum SUV of 13.3) on the scan, strongly suggesting that it was a cancersous lesion. No evidence of distant mets, but again my PSA was only 0.11, which is low for getting any results on a PSMA PET scan. A pelvic MRI provided further eivdence of a local recurrence. I agreed with the docs that we had caught a relapse at a very early stage.

After consulting with three oncologists (two ROs, one MO), I agreed to radiation therapy (IMRT), hitting the both the pelvic region and pelvic lymph nodes (prophylactic treatment). Thirty eight sessions over 8 weeks from mid September to mid November. No ADT/hormone therapy (although two oncos recommended it). Just before starting radiation, I switched over to Labcorp ultra sensitive PSA testing. Going into therapy, my usPSA was 0.094, and standard PSA (from Quest) was still 0.11. So, like you, I was below the magical 0.2 value, but given the "glowing" nodule, initiating treatment seemed warranted.

Radiation therapy went fairly smoothly and so far I have not experienced any lasting side effects.

However, strangely, my PSA has not changed after radition therapy. It is bouncing between 0.086 and 0.114, with no upward, nor downward trend. This is a bit puzzling to me, but my oncologist and urologist seem okay with my "low and stable" PSA" for now.

Given that my PSA after radiation has not changed in any significant way from just before, I really would like to understand what is going on. My docs just seem to have a clinical mindset about it--'you're low and stable, see you after the next test'.

Anyway, given my PSA results, I can't 100% rule out that the nodule wasn't cancerous ( again, no biopsy). I think this is the least likely scenario. I could also have micromets that were outside the radiation field that are producing PSA. Or, my preferred hypothesis is that the lesion was cancerous but the cancer is indolent. If the cells are dividing at a very slow rate, then they are not really dying from the radiation at a fast rate. Perhaps given moe time, my PSA will drop slowly. I'm not interested in a biopsy to find out the nodule is all about, and another PSMA PET scan is unlikely to show anything new, given my low PSA.

Anyway, the moral of the story, I think, is that when you have a suspected relapse after many years, with a low PSA (<0.2), the whole situation is a bit murky in terms of how best to proceed. Nothing is cut and dry. Multiple medical opinions, and all the data you can gather, are the best tools for moving forward. In the end, you may need to make a decision that comes with a certain degree of uncertainty. And like I said, PSA doubling time, is probably one of the best pieces of information to ascertain how aggressive the suspected relapse is, short of doing a biopsy.

Best wishes moving forward. Keep us posted.

Mel

Thank you, Mel.

Tico

It can take a long time for the radiation to kill all the cells. I know of people that had to wait three years before they hit the bottom of their PSA.

I can understand whether the doctors aren’t concerned yet. Give it time you might find your PSA starts to drop even more over time.

@jeffmarc Thanks for that info, Jeff. That is my default position--just give it more time. Actually, it will be one year post-RT in mid November. If my PSA is still hovering around 0.1, then I'll be satisfied with that (no doubling over the course of a year) and just keep moving forward. It's my science mind that wants to understand what is going one, more than anxiety about the cancer itself. But without more data, I (and the docs) can only speculate about things. I heard someone say the other day that the thing we often want most is clarity. So true, but most the time, life is an "onward through the fog" proposition.

I've have medical good care, and am taking care of myself with diet, exercise, sleep and minimal stress. What happens beyond that is outside of my control. As you have said many times, this is a manageable disease for most men. I have lots more options on the table if things take a wrong turn. The main thing is to stay on top of the PSA testing and to attend to my health in general.