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PET CT PSMA Ga RESULTS - Further treatment to be decided

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Posted 4/20/2017 6:07 PM (GMT 0)
Hi all need you opinion regarding PSMA report

Hi I had my PSMA scan few days ago and have received my report today and I am going to see RO & MO next week.

I can understand most of the report however I am not sure about lymph node statement in the report which says

Multiple sub centimeter sized lymph nodes noted with non PSMA with calcification in most of them.

and conclusion only says

Conclusion – PSMA avid focal lesion in right side of prostrate.

The other bits are pretty clear and there are no mention of uptake or mets or hot spots. There is no mention of lymph nodes in conclusion section.bone neck head section are pretty straight forward.

Just wondering anyone can explain does this means there are no mets and and cancer is focal to bed for the time being??






history-
first ever psa-7.9 JUL-16
2ND PSA 14 AUG-16
BIOPSY GLEASON 5+4=9
pet ct fdg clear
bone scan clear
RRALP nov-16 PATH- PT3BN1
Gleason 10 with +margin and +LN
POST SURGERY PSA
Dec16 psa <.008
Feb 17 psa .01
Mar17 psa .100
APR17 PSMA
Posted 4/20/2017 6:32 PM (GMT 0)
I'm not 100% sure about this but I think that calcification refers to an area that is no longer active. It may have been prostate cancer that your body fought off or it may be something else.
Posted 4/20/2017 6:36 PM (GMT 0)
Jack,

your signature equals these statements in the PSMA report:

+margin = PSMA avid focal lesion in right side of prostrate
+LN = Multiple sub centimeter sized lymph nodes

I would start with ADT now and discuss radiation options with several ROs. I think it makes sense to radiate the focal lesion and the mets while on ADT. This is probably beneficial but there are no randomized studies to prove that.

George
Posted 4/20/2017 6:44 PM (GMT 0)
Hi I do understand Ive positive LN in pathology however these lymph odes mentioned did not show any psma uptake in pet ct also not been highlighted in conclusion?


Thanks
Posted 4/20/2017 6:51 PM (GMT 0)
Ok, I also do not understand what they mean with that. A PSMA scan will only show mets and liasions that have PSMA uptake. It will not show mets that have no PSMA uptake.

George
Posted 4/20/2017 6:59 PM (GMT 0)
Yes but CT scan will pick all the non uptake parts as well just like an normal xray eventhough they dont lightup in scan with psma agent. Scan alsopicked degenrative spine and other bits which are not cancerous, age related or related to prostrate cancer.

Cheers
Posted 4/20/2017 7:17 PM (GMT 0)
Jack -

Your PSA, even though increasing, seems pretty low for the 68Ga PSMA to find a lot of uptake. Possibly only the lesion found is all there is?

When I had mine at UCSF my PSA was >2.

Bobby Mac
Posted 4/20/2017 7:18 PM (GMT 0)
Calcification and enlarged lymph nodes could be caused by cancer, but there are other causes also like infections. Did they use X-ray to see them?
Posted 4/20/2017 7:22 PM (GMT 0)
No its gallium 68 psma pet scan
Posted 4/20/2017 7:23 PM (GMT 0)
Bobby Mac,

you are right, the PSA is way too low for a PSMA PET/CT - provided you are not on ADT.

However, since they determined Gleason 10 with +LN I would be very surprised if there were no lymph node mets.

George
Posted 4/20/2017 7:34 PM (GMT 0)

Somebody said...
Multiple sub centimeter sized lymph nodes noted with non PSMA with calcification in most of them.


I don't know but doesn't it mean that gallium 68 psma pet scan didn't found anything but the nodes are enlarged and they are calcified. Reason for calcification could be cancer mets or an infection?
Posted 4/20/2017 7:34 PM (GMT 0)
Yes no adt yet, but how likely is it none of the lynphnode shows uptake.
Couple of question incase these arr mets

Are there any other tests which can confirm these are mets or not.

If say these are mets can these be radiated or removed

Thanks
Posted 4/20/2017 7:51 PM (GMT 0)
Jack -

They can radiate regional Nodes if positive, along with prostate bed.

Bobby Mac
Posted 4/20/2017 8:01 PM (GMT 0)
All the nodes listed in ct are around chest/neck area.
Posted 4/20/2017 8:24 PM (GMT 0)
Jack -

The Nodes with calcification had no PSMA uptake - probably not PCa - but again your PSA is very low -

You and your RO need to discuss if regional pelvic Nodes should be radiated along with the prostate bed.

Bobby Mac
Posted 4/20/2017 9:19 PM (GMT 0)
Hey Jack,

If my husband had these results (his pathology is similar to yours) I'd be somewhat relieved. I looked up LN calcification and found this:

The lymph nodes are shaped like a bean and are in clusters all over the body. They are usually found in the groin, neck, and armpit areas. While they can become enlarged during an infection, calcified lymph nodes may also occur. This happens when there is a granulomatous response to an infection.

It says here in this recent article about Ga-68 scans that the sensitivity of scans for PSA between 0.2 and 0.5 is 57%. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161015/

I've read somewhere that the sensitivity of these scans is improved for higher PSA doubling times as well as the PSA itself.

I'm surprised that you were not planning adjuvant radiation. How many LN did they remove and how many were malignant?
Posted 4/20/2017 9:23 PM (GMT 0)
jack-

You had a CT with your PET scan. On a CT, LNs less than 1 cm are normally not suspicious, but they showed up on the CT because they contained calcifications or other peculiarities (e.g., misshapen), but nothing suspicious for cancer on the PET scan.

So what does this tell you? Not really a whole lot. All it says is that based on what is detectable with a PSA of 0.1 (which isn't much), your only obviously detectable mets are in the prostate bed (which you knew already). It doesn't rule out other cancerous pelvic LNs - you only know that the ones that are there are probably under 8 mm. In fact, with your stats, you have a high probability of other LN mets, so whole pelvic SRT is likely to be beneficial.

It doesn't rule out distant mets completely, but tells you that if any are there, they're probably not very big.
Posted 4/21/2017 10:01 AM (GMT 0)
Hi anie88

21 ln removed and 1 positive from left.

Thanks
Posted 4/21/2017 10:04 AM (GMT 0)
Thanks tallallen and bollymac and all others who replied that does make sense I will wait for MO and ROs opinion.

Cheers
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