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My 1st PSMA results. Seems OK to me, but who knows about SUV#s?

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Posted 9/5/2024 11:51 AM (GMT -5)
I finally got my PSMA scan. I was wanting this 3+ years ago as my PSA was rising but bone and CT and even Auxumin scans continued to show nothing. (I was hoping for a spot or 2 that could be radiated). But it was not available here then. Finally, I was diagnosed stage 4/distant mets with the plain old bone/CT scans, strangely just a few months after the second Auxumin scan still showed nothing. (fall of 21)

Also, after my rapidly rising PSA went undetectable only about 30 days after being diagnosed and starting Orgovix and Erleada, they only repeated scans every 12 months(as long as PSA did not rise). But they stuck with bone and CT scans, which I have had 2 more of since diagnoses. Each one improved very significantly compared to the previous. The time for the 3rd was approaching, but out of the blue they scheduled me for a PSMA a few months early. I had that done yesterday.

I had been fantasizing about getting a NED(no evident disease), or the equivalent. I know cancer patients occasionally get a report like that, but I still did not. Still, it seems to me to be an extremely favorable report. After researching what the SUV numbers mean, I am on the verge of concluding on my own that what my numbers mean, along with having undetectable PSA for almost 3 years, is that I am NED. I would love to have some opinions on that, yay or nay.

I have one spot at the cervical/thoracic spine junction which is either new, or undetected on previous less sensitive scans, and has an SUV# of 4.5. The radiologist calls it indeterminate, possibly cancer or arthritis. I was surprised to see that this test can highlight arthritis, but that is what the doctor wrote. There is nothing else that I can see. All of the major spots(spine/arm) which lit up previous scans are not even mentioned. Lymph nodes are showing nothing. I will add more in next post. I’d love some of your thoughts.

Post Edited (BillyBob@388) : 9/5/2024 5:22:50 PM (GMT-4)

Posted 9/5/2024 11:52 AM (GMT -5)
Seems to me, if this is indeed a tumor it is either a new one or one that was too small to show up on the less sensitive scans. If the later, it has either increased, shrunk or remain unchanged, I will never know. But if it is a tumor, with an SUV of 4.5, that seems to indicate extremely low grade. I have seen one study (on 160 men) claiming 8 was a good cut off for determining clinically significant cancer that would require treatment. In addition, the studies I read indicated that “the median intraprostatic 68Ga-PSMA SUVmax was 26.1 (range=2.7-164); in the 15 men with not clinically significant PCa (ISUP grade group 1) median SUVmax was 7.5 “. So, my 4.5 is way below the median of men who do not have clinically significant PCa, correct? Am I reading that right? (though the range was as low as 2.5 for NOT clinically significant).

But when it comes to actual mets( is my spot a met, or arthritis?), “In addition, median SUVmax in the bone and node metastases was 52.7 (range=25.3-92.8) and 47 (range=24.5-65), respectively. Conclusion: 68GaPSMA PET/CT with a SUVmax cut-off of 8 demonstrated a good accuracy in the diagnosis of csPCa (100% in the presence of GG≥3)”. So the lowest met had an SUV# of 25, correct? Am I reading that right?

Thoughts? I will give more scan details in next post.
Posted 9/5/2024 11:56 AM (GMT -5)
2021 scan summaries(Bone)There is a tiny focus of intense radiotracer uptake involving the right side of the lower thoracic spine and this correlates with an area of bony sclerosis on the CT scan. A similar focus involves the right humeral head. FINAL REPORT --Impression: There are new bony lesions involving the thoracic spine and right humeral head highly suspicious for metastatic disease

........ (CT scan) "There are prominent left periaortic lymph nodes. A representative lymph node (image 87) measures 0.8 cm. This was not seen on previous study......There is development of multiple sclerotic densities noted within the osseous structures. These are seen in the lumbar spine and sacrum as well as the pelvis. FINAL REPORT --IMPRESSION: 1. Multiple sclerotic osseous densities versus are not seen on previous study concerning for metastatic disease. 2. Development of prominent left periaortic lymph nodes concerning for metastatic disease.".

Latest, far more sensitive scan:
"1. Indeterminate solitary radiopharmaceutical accumulation within the left transverse process of T1. This may be arthritic or neoplastic. 2. The majority of the sclerotic osseous metastases demonstrate no abnormal radiopharmaceutical accumulation. 3. No extraosseous abnormal radiopharmaceutical accumulation to suggest active metastatic disease.(BK adds AKA: zero in the soft tissues)
FINDINGS: Solitary radiopharmaceutical accumulation in the left transverse process of T1 with SUV of 4.1. ....... The vast majority of the sclerotic bone lesions demonstrate no abnormal radiopharmaceutical accumulation. ...accumulation. The large left renal cortical cyst deforming the kidney has an SUV of 0.5.... No abnormal radiopharmaceutical accumulation within lymph nodes.". ( Notice no mention of humerus- arm- or lower spine which were so prominent on the way less sensitive scans, apparently just gone away now)

Post Edited (BillyBob@388) : 9/5/2024 2:14:26 PM (GMT-4)

Posted 9/5/2024 5:12 PM (GMT -5)
BillyBob, when something is above my pay grade, my goto is Claude.ai or copilot.microsoft.com, two very good artificial intelligence engines. I put the report of the "more sensitive scan" into Claude.ai, I assume it was a PSMA Pet Scan, and asked for an interpretation.... Here below I have pasted the response that I received...

"This PSMA (Prostate-Specific Membrane Antigen) scan report describes findings in a patient with prostate cancer. Let me break down the key points:

Indeterminate finding:

There's a single area of increased radiopharmaceutical uptake in the left transverse process of the T1 vertebra.
This could be due to arthritis or cancer (neoplastic). It's not definitively diagnosed as cancer.


Existing bone metastases:

The report mentions "sclerotic osseous metastases," which refers to existing bone metastases.
Most of these bone lesions don't show increased uptake of the radiopharmaceutical.


No evidence of active metastatic disease outside the bones:

There's no abnormal uptake in soft tissues, suggesting no active metastases outside the bones.


Additional details:

The T1 lesion has an SUV (Standardized Uptake Value) of 4.1, which is moderately elevated.
A large cyst in the left kidney is noted, with a low SUV of 0.5 (not concerning for cancer).
No abnormal uptake is seen in lymph nodes.



Interpretation:
This scan suggests that the patient has known bone metastases from prostate cancer, but most of these appear to be inactive (not showing increased uptake). The single area of concern is in the T1 vertebra, which could represent a new metastasis or simply arthritis. The lack of uptake in soft tissues and lymph nodes is reassuring, suggesting the cancer is currently confined to the bones.
The findings indicate a need for further evaluation of the T1 lesion, possibly with additional imaging or follow-up scans. The overall picture suggests relatively stable metastatic disease, primarily in the bones, with no evidence of active spread to other organs. CopyRetryClaude can make mistakes. Please double-check responses. 3.5 Sonnet
Posted 9/8/2024 7:34 AM (GMT -5)
Thanks, Prato!
Posted 9/8/2024 10:35 AM (GMT -5)
Hi BillyBob, I thought to chime in - my father had 13yrs of stable bone mets. His original diagnosis included mets in lower vertebrae and pelvic bone. He only ever got classic HT and later Zytiga, no RALP, no RT. There were times when his scans were clean - what it essentially means, disease is stable, it is not doing any damage, it is dormant and inactive, meds are working. He lived an active life for 13 yrs, travelled, rode his bike, swam and walked. I have lost some friends unexpectedly during this time, much younger and who seemed healthy. I strongly believe just going on living fully additionally boosts somehow the immune system.
Posted 9/8/2024 1:16 PM (GMT -5)
Thanks for your thoughts, Speciallady!
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