What do you do when one lymph node on PSMA is inconclusive ?

@johnw22

I am being treated at UCLA. My understanding is that IMRT is delivered at a lower radiation dose at each session, requiring a longer interval to complete. The SBRT offers the advantage of a high-dose accelerated regimen (5 treatments over a 2 week interval) with equivalent outcomes and similar side effects.

The hydrogel spacer marketed as Barrigel or SpaceOAR is inserted transperineally (during the same procedure where gold fiduciaries are placed, if needed). The spacer creates a barrier between the prostate and the rectum to reduce the incidence of permanent radiation colitis following RT. Perhaps in your circumstance, the radiation oncologist did not feel it offered a particular advantage with your IMRT regimen.

Too, the need to irradiate your para-aortic nodes, I suspect, may have impacted the choice of IMRT over SBRT.

I am sure the medical center at Ohio State is top notch and you are receiving state of the art care.

@rbtsch1951

Thanks for clarification . My husband had RP but will need possibly salvage or adjuvant RT and RO told him that he will have gold markers and IMRT. Does that mean that IMRT machine has no guidance ? And how are gold markers inserted ? Through perineal region ?

@surftohealth88 I was very anxious about the procedure but it was quick with very little discomfort.

@johnw22

Thanks John : ))) ! Do they do it the same way a biopsy is done ?

@surftohealth88 that’s a good question for the RO as I am speaking to what I learned about radiation as primary treatment and not as salvage or adjuvant treatment after RP.

Sorry I cannot be more helpful to your question.

@surftohealth88 Most of us are on our side for biopsy but for markers I was are on my back with my feet and legs up in the air.

@rbtsch1951 thank you. I agree.

This past week I started IMRT for a local recurrence after prostatectomy in 2015. The local recurrence is a palpable lesion (discovered during a DRE) that was confirmed by PET PSMA and MRI imaging. My PSA is 0.11. One of my pelvic lymph nodes showed nonspecific activity on the PET with SUV = 1. The radiologist favored this to be inflammatory rather than a met. My RO also spoke with the radiologist to confirm that opinion. Nonetheless, my pelvic lymph nodes are being treated prophylactically, at the recommendation of my RO. All my readings of the medical literature convinced me that the lymph node treatment is a good call (better chances of favorable treatment outcome). No biopsies involved.

Did the doctors review the results with you, or are you going over the results in your chart online prior to your followup meeting with the doctor?

I reviewed my results when they were available and waited for the doctor to review the results with me, meaning I did not contact him after seeing my results. I had uptake in several areas, lung, 2 areas in the chest, hip, liver, and I believe a few areas level of uptake were in the 3's. There was a note in the record that stated metastasis could not be excluded. When I did go over everything with my doctor, he seemed confident that it was in the prostate only.
I had surgery. My PSA after surgery was < .04 but has since risen to .06, 17 months after surgery. My pretreatment PSA was about 7.5, and my Gleason was 9 with extra-prostatic extension found on pathology.
What are your options? Wait for your follow-up appointment to discuss the results. Send an email to your doctor if you can't wait. Discuss a course of action that meets your specific case needs. What is good for 1 person may not be for another. There are many different variations of the disease and other factors to consider when determining what the best treatment approach may be for you.
Despite a rising PSA, I am not panic stricken. I am still optimistic about the possibility of a second chance at a cure. If that does not happen, there are many additional treatments that slow disease progression.
I wish you all the best and hope that whatever you chose works well for you and you never have to worry about it again. In the meantime, I hope you are comforted knowing that there are many people here who have been living full, happy lives (like me) while fighting advanced prostate cancer and other illnesses.

@melvinw I too had prostatectomy in 2015 and my last psa was .5, but holding steady. Two negative PSMA's. Just curious where the node is? Are they radiating the node and the prostate bed? Also, what was your post-surgical Gleason and did you have extracapsular extraction? All the best.