PSMA PET results 6/6/25

Hi @mjp0512 ,

So sorry to hear about your situation. I am a layman, so this info is only my opinion based on what I have learned through my own case and research.

From your PSMA PET scan results it looks like you have more metastases than would put you in the oligometastatic category, which is typically 1 - 5 metastases. You would not be a candidate for surgery. Your metastases are both regional (pelvic) and distant (chest). You are probably a candidate for radiation plus triplet drug therapy, to start with. I believe you should seek an appointment, if possible, with a top notch genitourinary medical oncologist at a center of excellence to review your PET scan findings and medical history and guide your course of treatment.

Triplet drug therapy, to start with, might be Orgovyx + Abiraterone with Prednisone + Docetaxel.

The folks who moderate the Ancan.org weekly Zoom meeting for high risk / recurrent/ advanced prostate cancer patients may be a good source of information for you if you are willing to share your case. This gives you the opportunity to discuss your situation in real time. The next meeting is Tuesday, 6/10, at 5 pm Central time. Please join 10 minutes before the meeting to let them know you you would like to share your case. Here is the link to join the meeting:
https://www.gotomeet.me/AnswerCancer
Their website is ancan.org.

Best of luck to you!

As you probably have already guessed your cancer has spread outside the prostate. The finding of “ PSMA avid metastatic lymphadenopathy in the pelvis, retroperitoneum, and mediastinum.” indicates the spread of prostate cancer to these regions. This finding, often detected through PSMA PET/CT scans, suggests advanced stage IV prostate cancer.

2.1 cm LEFT superior mediastinal node with max SUV 8.0 is suspicious of a malignancy in the lung.

This report shows a lot of issues, You need to speak to your doctor to get clarity on what else is going on.

In this situation, there is usually a recommendation for triplet therapy To stop the cancer from growing and to use chemo to try to eliminate in other areas of the body.

Thanks for your reply and thanks for the link. Unfortunately, I won't be back from the Drs in time to join that discussion.

Thanks, jeff. Yea, I thought I saw "You're Screwed" in big red letters at the top of the report.

Kidding aside, I'm not looking for anything close to a cure. I just want to slow it down enough for my heart failure to kill me before the cancer does while still maintaining an acceptable quality of life. Dr and I have already discussed this. We'll see what's up tomorrow now that he'll have the scan in front of him.

Your doctor is going to have to decide what medication you are going on. For ADT taking the pill Orgovyx Once a day gives you a lot more options and flexibility than the other choices. If cardio health is the most important thing, however you might consider using the Estradiol patch Which works just as well as the ADT drugs, but doesn’t cause as many side effects. The Patch trial just completed in Europe and you should ask your doctor about using that instead.

You definitely do not want to use abiraterone If you have heart issues, It gave me afib and high blood pressure And I’ve heard from many other people with cardiac problems with it,. Darolutamide Is the drug with the least side effects, You could ask your Doctor about having that instead of one of the other lutamides.

They are probably gonna recommend chemotherapy, Since this is an apparently spread to More than one location.

They frequently will do radiation instead of surgery in these cases.

Here is Mine NOT SURE WHAT TO MAKE OF IT__DOC APPT 7/9/25

MR PELVIS WITH AND WITHOUT CONTRAST
(PETMR PSMA)

Lesion 1:
Mid/apical anterior fibromuscular stroma; 2.7 x 2.2 x 1.2
cm; (Se/Im 6/108)
On T2-weighted MR imaging, the lesion is seen as a focus
of low signal intensity (T2 score = 5/5).
The lesion demonstrates marked restricted diffusion (DWI
score = 5/5). ADC value: 0.663 x 10^-3 mm^2/s
The lesion is associated with suspicious enhancement (DCE
positive).

No definite corresponding PSMA avidity.
Overall PI-RADS v2 score = 5
Capsular margin and neurovascular bundle: Lesion #1 is
associated with approximately 2 mm anterior extracapsular
extension (Se/Im 6/108).
Seminal vesicles: No evidence of seminal vesicle invasion.
Lymph nodes: No evidence of lymphadenopathy in the field
of view
Bones: No suspicious lesions
Whole Body MR: Additional, non-diagnostic MR images were
obtained for anatomic localization.
Brain: No large masses, hydrocephalus or extra-axial
fluid collections
Chest: No large pulmonary masses or pulmonary nodules.
Note, MRI is limited for assessment of pulmonary nodules.
If pulmonary nodules assessment is clinically warranted, a
CT chest is recommended.
Abdomen: Tiny bilateral renal cysts. Bilateral hydroceles,
left larger than right. Evaluation of the small and large
bowel is limited in the setting of PET/MRI due to
peristalsis and artifact from bowel gas.
IMPRESSION:
- PI-RADS v2 score 5: clinically significant cancer is
highly likely to be present.
- Lesion #1 is associated with macroscopic extracapsular
extension. No evidence of seminal vesicle invasion.
- MR T-stage = T3A
- No lymphadenopathy. No suspicious bone lesions.

Hi Jeff, did you ever have chemo for PCa? If so, what was your experience?

I have posted my PSMA/MRI test results in previous posting which did not show anything, my Decipher was .017

I have not. I’ve heard from a lot of people that have had it.

Chemo does not change your life, Yes, while you are on it, it can be not too bad or a real pain, Again, no two people are the same. I was in an Ancan.org Advanced prostate cancer meeting and one guy came in and said he was doing chemo but after doing chemo, for 10 days, he couldn’t eat food, didn’t taste good. He lost a lot of weight then he’d have a few days where he’d recovered completely, ate a lot of food, then back to the next chemo session. Other people have said that said they were just uncomfortable for a few days after, had to rest to recover. There’s almost always fatigue involved.

“Lesion #1 is associated with macroscopic extracapsular extension”.

Is the real significant thing here? It means that the lesion has gotten out of the capsule into the surrounding tissue but has not spread to nearby body structures, Something that could occur who know when, nobody. That’s the T3A.

It looks like nothing else was really found, a good thing. It’s probably just the prostate and some surrounding tissues that needs to be removed.

Radiation would be perfectly appropriate for this condition. I know you have heart problems so that would probably make the most sense. I’m sure this is what your doctor told you as well. ADT alone is probably not going to be enough. You should be talking to a radiation oncologist about your treatment.