Posted 9/17/2022 5:13 AM (GMT 0)
Here are the scan results. I sure hope I'm reading this correctly. I am assuming "physiological" uptakes are not significant. This was also mentioned in my 2018 scan and seemed to not mean anything. It looks again like Oligometastatic disease?-- 2 nodes. I am hopeful these two can be handled via SBRT. Note: I was expecting pylarify scan but it looks like it was again Ga-68. Not thrilled about that, but it's done. I would appreciate any feedback on these results:
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PSMA PET TUMOR CLINICAL
INDICATION: Biochemically recurrent prostate cancer
Initial therapy: Radical prostatectomy
Recent therapy: Salvage RT + ADT
Most recent PSA values(ng/mL):
PSA: 2.0 Date: 9/8/2022
PRIOR PET/CT: 10/17/2018
CORRELATIVE ANATOMIC IMAGING: None
PROCEDURE:
Radiotracer: 68Ga-PSMA
Injected dose (mCi): 5.5
Intravenous injection site: left forearm
about sixty minutes following tracer administration, sequential
non-contrast-enhanced CT and PET imaging were performed from the vertex
of the skull to the mid thigh. Oral contrast (900 mL of 1% w/v barium
sulfate) was administered in divided doses 90, 60 and 5 min prior to
imaging.
FINDINGS:
Overall PET and CT image quality and inter-modality registration are
satisfactory.
Mediastinal blood pool SUVavg: 1.4
Hepatic parenchyma SUVavg: 7.2
Physiological radiotracer uptake in salivary glands, lacrimal glands,
liver, spleen, duodenum, proximal small bowel, kidneys, and urinary
activity.
A. Prostate bed:
PSMA-RADS: 1A. Status post prostatectomy. No abnormal PSMA radiotracer
uptake is noted in the prostate bed.
B. Pelvic lymph nodes (N+ disease):
Key lesion: present
Side: midline
location: common iliac
Size (maximum in cm): not measurable
Size (perpendicular in cm): not measurable
SUV max: 4.2
PSMA-RADS: 3A
Total number of positive pelvic lymph node lesions: 1
Additional locations: none
Screen shot(s): yes
Comment (pelvic lymph nodes): Mild persistent low level PSMA uptake
within an aortic bifurcation lymph node, which was previously larger
with more tracer uptake in 2018 (SUV max 4.2, previously 9.6); this
lymph node has been previously irradiated. Prior left common iliac lymph
node has resolved.
C. Soft tissue involvement (M+ disease):
Key lesion: present
Side: left
location:retroperitoneal
Size (maximum in cm): 0.5
Size (perpendicular in cm): 0.9
SUV max: 53
PSMA-RADS: 5
Total number of positive soft tissue lesions: 2
Other location: retroperitoneal
Screen shot(s): yes
Comment (soft tissue): Although the previously described multifocal left
para-aortic lymph nodes have resolved following radiation, there are 2
new nonenlarged lymph nodes with intensely increased PSMA expression,
one in the left periaortic region at the level of L2-L3 disc space, SUV
max 44.0, and another anterior to the distal aorta, SUV max 12.3.
D. Bone involvement (M+ disease):
PSMA-RADS: 1A. The osseous PSMA radiotracer uptake is physiologic and
unremarkable.
E. Incidental findings:
Kyphotic curvature of the thoracic spine. Small amount of pericardial
fluid. Status post cholecystectomy. Bilateral renal calcifications
likely represent nonobstructing calculi with the largest measuring up to
0.4 cm in the right and 0.5 cm on the left. Atrophic left kidney.
Fat-containing inguinal hernias.
INTERPRETATION:
1. Two new nodal metastases with intense PSMA expression in the lower
retroperitoneum/para-aortic region, as described in the report body.
Screen shots sent to the PACS.
2. Although uptake at prior irradiated lower retroperitoneal/pelvic
lymph nodes has largely resolved, there is low-level persistent PSMA
expression within an aortic bifurcation lymph node, which is
indeterminate for a residual site of nodal metastatic disease.
Screenshot of this lesion was also sent to PACS.
3. No definite findings of distant metastatic disease.
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Note: The findings are rated as benign/likely benign (PSMA-RADS-1/-2),
equivocal (PSMA-RADS-3), or likely cancer/definitively cancer
(PSMA-RADS-4/-5), as described in the PSMA-RADS classification schema
version 1.0 (Rowe SP, Pienta KJ, Pomper MG, Gorin MA. PSMA-RADS Version
1.0: A Step Towards Standardizing the Interpretation and Reporting of
PSMA-targeted PET Imaging Studies. Eur Urol. 2018;73:485-487)
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