18F-DCFPyL PET/CT Scan Results. Recommendation from my URO.

Aug. 9/18 in Vancouver, BC, had PSA specific 18F-FCFPyL PET/CT scan. Thanks TA. I'll remember you in my will. Images were acquired from top of head to proximal thighs. PSA on June 4/18 is 1.17.

FINDINGS:

1)Physiologic tracer uptake is seen within the lacrimal glands, major salivary glands, liver,
spleen, kidneys, and bowel.

2)No traser-avid lesion is identified in the head, neck region.

3) No traser-avid lesion is present in the thorax. No size- significant pulmonary nodule.

4) Uptake in the liver is physiologic.

5) There has been a previous prostatectomy. No suspicious uptake is seen in the prostate bed.

6) Intense tracer uptake (SUVmax 10.1) is seen within the two adjacent 8mm and 9mm lymph nodes in the distal right presacral region, just superior to the level of the sacrococcygeal junction. No other tracer-avid pelvic or para-aortic lymph nodes are present.

7) No tracer -avid bone lesions identified.

IMPRESSION:

Evidence of metastatic disease involving two adjacent lymph nodes in the distal right presacral region.

No tracer-avid disease identified elsewhere in this study.(end of report)

Saw my URO and we went over the images on the computer. Saw the two tiny bright spots in the two lymph nodes. He speculated that these could have been there since the prostate was removed and a lymph node with a 2mm lesion was removed April/2013. He said if it was him knowing that I am a very active/healthy "young" guy, he would remove these 2 lymph nodes. Said the procedure would be much less than prostate removal. When I asked him about RT he said that there could be SE due to the proxcimity to the bowel, etc.

Referred me to an experienced, highly regarded PC surgeon in Vancouver. Said my case was the first time for him that he can actually see where the cancer is because of this special, PSA specific PET/CT scan and there is a chance that the PC could be cured by surgery. Also said he would get me to see a MO .

My case because of high PSA after surgery 4/13, (2.8), going to a high of (9.25) Feb.12/15, and now back down to (1.17), 6/18, with out any treatments or drugs, is something my URO has never seen.

I am to see a RO on the 28th of Aug. for her opinion of the PET scan and what would be the next step. Obviously, RT might possibly be her choice of treatment but I will have to wait for the consult.

So, slice and dice or the death ray gun?

TA: I have to agree with you about the LN dissection. My thinking is there are a lot of PC cells floating around or already in other LN but like you have said, even this PET scan cannot detect lesions that are less than 4mm. Even if you take out these 2 LN's, how long will it be before more have to be removed before you have a "cure" ? Can a body even survive without LN's?

I still think I would do a deal with the devil before agreeing to ADT.

I will have to wait to hear what the RO says on the 28th.