Recurrence? (Update)

I finally was able to get in with Fred Hutch in Seattle. Really liked the new MO.

I am currently living in a rv waiting for my house to be built.So I don't have my exact first medical diagnosis
I was dx 2017 @53yrs

Psa 67

4+5 met to pelvic side wall

Hormones 2yrs

45 session's whole pelvic radiation 

Zytiga and Prednisone 18 months 


I responded well to all treatments (except the side effects) and psa fell to undetectable for a couple years. Unfortunately I thought if it was going to be later down the road if I the cancer came back. I  quit doing my psa tests  for several month's. I had a psa test 5/26/23 and it was 7.630 exactly a week later 6/2/23 it is 7.450 

I had my bone scan, CT and PSMA scans and I am not sure what to make of them. Could someone please tell me what they mean? Would just hormone treatments take care of it. Or with spot radiation with hormones? Or chemo added? Or?

Sorry for all the questions and some maybe
will not be able to be answered until more test

Below is my PSMA results any help will be greatly appreciated

Impression
1. Positive for prostate cancer.
2. Intense Tracer expressing bilateral retroperitoneal, common iliac chain nodes indicating metastasis.
3. Mild tracer uptake in mid sternum, suspicious for metastasis as well.
4. No tracer uptake in the prostate bed.
5. Likely granuloma this lung disease with calcified lymph nodes of mild tracer expression, right upper lobe peribronchial tracer uptake. Underlying emphysema. Recommend continued CT chest follow-up of lung findings.
Narrative EXAMINATION: F-18 DCFPyL PET/CT IMAGING DATE OF STUDY: August 11, 2023
CLINICAL INDICATION: BCR prostate cancer Staging. COMPARISON: CT, 8/3/2023 TECHNIQUE: Extent: Top of the skull to proximal thighs. At 60 minutes after injection of F-18 DCFPyL intravenously, nondiagnostic noncontrast, nonbreathhold CT images were obtained for attenuation correction and fusion with emission PET images for anatomical localization. RADIOPHARMACEUTICAL: 9.3 mCi F-18 DCFPyL i.v. Injection site right proximal femoral artery FINDINGS: PET numbers refer to PET image series 12 and PET/CT axial fused image series 1202 and CT numbers to series 3 in PACS. Prostate cancer findings: References for uptake intensity levels: * No uptake: Less than blood pool intensity * Mildly intense uptake: Greater than or equal to blood pool intensity and less than liver intensity * Moderately intense uptake: Greater than or equal to liver intensity and less than salivary glands * Markedly intense uptake: Equal to or greater than salivary gland intensity Prostate tumor characteristics: No definite uptake in the prostate. location, extent, and distribution pattern of prostate cancer metastases: Lymph node regions: Internal iliac: No. External iliac: No. Common iliac: Bilateral. Right common iliac chain node measuring 4 mm on image 295 CT and maximum SUV of 8.1. Left common iliac lymph node with maximum SUV of 7.6 and corresponding to 3 to 4 mm node on image 298. Obturator: No. Presacral: No. 2 small symmetrical hypermetabolic foci

I am sorry to post all of that asking for answers. I dont want someone to answer item by item. I just can't tell if it's saying wide spread disease or located mainly in one area and some other possible sites. I Google it and it makes me more confused.

The good thing is Seattle has several clinical trials my MO thinks I will qualify for. My follow up for the scans is on the 23rd.

Thanks

Thank you for your response

I could not tell what it was saying

I will let you know what happens on the 23rd

Thanks again to all on this forum