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Question on PSMA Results re: lymph node
I FINALLY got a call from my urologist about the PSMA results. One of the many descriptions on the report says “Small right pelvic sidewall lymph node with radiotracer activity suspicious for metastatic lymphadenopathy.” Urologist said the tracer there didn’t light up very much and said I will still have the choice of surgery or radiation. I don’t have the detailed conversation with him on what to do next until December 12. Still concerned about length of time everything takes I started the process of appointment at Mayo already even though I haven’t seen an initial treatment plan yet. Question: I understood by all of my reading on this board and Dr. Walsh’s book that if PSMA lights up, cancer cell(s) are at that spot. Im not sure how a lower intensity of the lightness of the tracer makes that questionable. Has anyone heard of that?
My stats: Gleason 9, 7 of 12 samples positive, PSA at time of scan 18.9
Thanks for your input and support. Jay
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I had a lightup on two pelvic lymph nodes but light intensity was not discussed. Got them radiated as well as prostate 28x. On ADT drugs for 23 months now- PSA < .01. AGE 76.
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3 ReactionsForgot to mention - Brain fog- duh.
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1 Reaction@jcbagley,
The node could have low SUV unrelated to the cancer. It may not matter because the intention to radiate or remove the node may remain even with low SUV. I was told that if three months on ADT removed the evident PSA in the node, it was cancer. If the node remained evident and low it would be considered non cancerous.
I suspect ADT is next for you. With surgery or radiation they like to shrink the tumor. I wish your physician was more interactive. I do think you should be getting discs of the MRI and the radiology reports for yourself and to send for second and third opinions. If you decide on ADT, you'll have a couple of months.
Maybe call your urologist and ask about Orgovyx, if you should start it and if he will prescribe it so that the insurance approval process can start.
You shouldn't get a treatment plan from the urologist. That will be offered when you see a Radiation or Surgical Oncologist. i'm glad you are already in progress at Mayo.
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2 ReactionsLower lightness just means less uptake, but it’s still uptake. Of course some conditions ALSO have uptake - non malignant bone lesions, hemangiomas, etc. But with your PSA and Gleason score - did you have a Decipher test? - I would lean more toward treatment than not…JMHO
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1 ReactionWell, your medical team can discuss with you and by medical team I mean urologist, radiologist and oncologist.
When I had my C11 Choline scan at Mayo in Jan 17 my urologist and radiologist disagreed about one of the four "hot" sites being cancerous.
So, I made the decision based on my clinical data of high risk PCa, GS8, GG4, time to BCR and PSADT and PSAV to include it in the radiation treatment plan.
They agreed...
Given the clinical history you present, you have high risk PCa which may warrant aggressive therapy.
A urologist could do surgery to take out the lymph nodes, question to ask may be just that one or others too. When my urologist discussed this option with me, he was not a big fan, nor was I, in part because finding them in his experience was not as simple as one would think. That and with likelihood of micro-metastatic PCa elsewhere the likelihood that eradicating the PCa was dubious and either WPLN or SBRT may be a better treatment choice. That's why we say medical team, a radiologist should lead in that question of WPLN or SBRT, certainly the urologist and oncologist can chime in.
As to doublet therapy, an ADT agent such as Orgovyx has advantages over say Lupron:
Faster to castration
No flare
Lower CV side effect profile
Faster recovery of T
The side effects of no T are still in play either way.
Your medical team may add a 2nd agent such as an ARI.
How long would you be on those, your medical team can discuss, could be anywhere from 6-24 months.
If so, you and your medical team need to decide on decision criteria to come off treatment.
You could discuss doublet or triplet therapy. I am not sure chemotherapy is necessary at this point but discuss with your medical team.
Given you have advanced PCa and your clinical data, discuss with your medical team whether or not to do doublet therapy.
Whatever you decide it requires an integrated approach by your team, likely you will be the quarterback though!
Kevin
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4 ReactionsThanks Kevin, this is valuable information. Just waiting now for appointments to arrive. Soon, thank goodness.
@jcbagley, thinking of you as you prepare for your appointment tomorrow. I hope the information from other members helped to prepare your questions for the doc. I look forward to your update.