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What do you do when one lymph node on PSMA is inconclusive ?
We got PSMA results with clear uptake in right lobe of prostate which was expected but one lymph node on the left side in iliac region has very low uptake (around 2 SUV). Radiologist wrote that it is probably just reactive node but that micro met. can not be excluded.
I am wondering if anybody had similar result and what was the next step ? Is there possibility to do biopsy of that node ? I mean there is like drastic difference in staging if node was or was not involved *sigh .
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Btw, when I read the radiologist’s report on my PSMA PET scan, I found this guide to very helpful for understanding terminology and the highly technical language. When my RO walked me through the scan on his computer, I was prepared with thoughts and questions. Made for a very productive interaction.
https://www.pockethealth.com/patient-resources/how-read-a-pet-scan-report/
@squash05
The node is in the prostate anastomosis, just a little left of center. Yes, that is the main target. My highest post-RT Gleason score was 3+4. No extracapsular extraction but I had a positive margin. My Prolaris score was 1.7, putting me on the highest end of intermediate risk. Prolaris estimated a 53% chance of BCR at ten years, so I always knew that was a strong possibility and kept up with regular PSA tests and DREs. As strange as this might sound, I am glad that I have an identifiable local lesion versus just a BCR—makes for a more targeted RT approach, hopefully with minimal side effects. Also, my PSA of 0.11 happened in June (had been undetectable for 10 years), and 3 months later, it hasn’t changed. So, like you, holding steady—good news in a bad news situation!
Given my low PSA, it was surprising that the PSMA PET detected anything, but the local node really lit up with an SUV of 13.4. I asked my RO about that (conventional wisdom says that if PSA is < 0.5, nothing is likely to show up). She didn’t have any answer other than it’s a matter of probability rather than some precise correlation. She also mentioned that she had a post-RT patient with PSA of 5 and nothing lit up on the PET scan. It’ an amazing technology (wasn't around in 2015) but it has its limits.
Hope you keep holding steady!
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4 Reactions@melvinw Yet another illustration that with PCa, what you see isn’t always what you got…and vice versa!
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4 ReactionsMan, you have the right!
@heavyphil
Absolutely true !!! Everything is up to "interpretation" either of a scan or of the pathology. Often findings can be "all that " or "nothing" at the same time O-o
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