PSMA Pet scan interpretation

Once cancer has been found inside the prostate, the chief treatment issues are

1) how best to eradicate it in the confines of the prostate itself; and
2) did any get out or is likely to have done so.

That 2nd one is what rightly most concerns your doc.
If the cancer is prostate confined they can snuff it there,
If it's out and about, they still have to nail it in the prostate but they also then have to hunt to kill it to wherever it's gone in your body.

Thanks for the input. It all makes sense, however my hope was to use the information from the PET Scan to make a better decision on treatment. If a biopsy needle is only 1.2 mm, and the entire area of a prostate around 250 mm, then it is difficult to determine the amount of cancer in the prostate from say 30 needle biopsies. Especially if you only have one needle biopsy that was a 3+4, and the 4 only represented < 5% of the sample. I would have liked to put a value on the amount cancer present through the illumination of cancer in the prostate from the PET Scan. I am unable to do that. I did see comments related to SUVMax score while I will ask about.

Hello,

Where did you get your Tusla pro treatment?

Thanks.

There is a membranous "capsule" that surrounds and contains your prostate. More aggressive, or long-undiagnosed tumors can cause the capsule to rupture, and see the tumor keep growing spreading to surrounding tissue and structures like the seminal vesicles, bladder neck (junction with urethra), or even the lymph nodes. When the tumor breaks through the capsule, that is called "Extraprostatic Extension" ("EPE"). At that point, "all bets are off." At the time of surgery, the radioactive Gallium 68 tracer used in the PET Scan weeks before has left your body long ago...within the same day you had the PET Scan. So...when you're on the table for the prostatectomy, your urologist/surgeon likely does not know that you have EPE as an anatomical feature to your prostate and tumor. (S)he removes as much of the prostate as (s)he can, but...like me and many others - the reason most of us are on this blog...is because due to the EPE, the urologist didn't get "all" of the cancerous prostate tissue out of you. This is revealed in the surgical pathology report when the pathologist documents "surgical margins", meaning that with all of the available prostate tissue provided, they microscopically observed cancer cells right up to the edge of the tissue, which means that the cancerous tissue extended beyond the amount surgically removed from your body. Believe me, you do not want to see "surgical margins" on your pathology report, because that means, that the doctor "didn't get it all", and that you still have cancer cells/tissue left in you. But...that tissue needs blood supply to survive, and your surgeon will have removed all vasculature that could possibly feed those cancer cells (so they will hopefully die), but...in order to hopefully see your sexual function fully restored within a year or two, your surgeon will have left the "neurovasuclar bundles" that were there for blood flow, sensation to your penis, and urinary flow function. Problem is that they kind of surround and are around the prostate area, so...it may be possible for the remaining cancer cells left in your body to migrate there to get that blood supply before they die. The good news is that prostate cancer is very slow growing, which with it, means that the cells must move very slowly. Because of that, hopefully most/all will die without the blood supply they seek, before they find it. Its a crap shoot...no one knows for sure...your surgeon can't guarantee you that (s)he got 99.9% of the cancer out of, and that if (s)he didn't, that the preserved neuromuscular bundles won't be a source of blood and survival for any cancer tissue that (s)he left in you. That is where you find God, and learn to pray if you haven't already. Each day I read new stories here on the blog about post-prostatectomy men who had stable, undetectable PSA tests for 5, 10, and 15 years, then...the PSA starts rising, to the point that the urologist says "your cancer is back." It took those 5, 10, or 15 years for it to ever-so-slowly grow to the point that the PSA those cells produce is now detectable, but now...well now you are talking with your urologist about Salvage Radiation therapy or hormonal treatment, etc.
I hope this explains a few things in more detail. I was the Director of Clinical and Anatomical Pathology Labs for half of my career, and saw this stuff directly and indirectly every day. I just never thought that I would be dealing with it later in my life now. But I should have: my grandfather lived to 96 "with" prostate cancer. He never had his prostate removed...he just had years of Lupron injections. My uncle - his son - also had prostate cancer. He had the surgery, and he died of an unrelated massive, cluster-bomb stroke about ten years later. And...my own father lived to 99 years 10 months "with" prostate cancer. He suffered greatly his last five years with monthly UTI's, often going systemic that required 5-10 days in the hospital, but even with a PSA over 200, and difficulty urinating at times, he lived "with" prostate cancer for what was likely 20 years. Good luck to you in your journey.