PET CT SCAN REPORT

RonRowdy

Here are some statements from my report. Comments??

There is a physiologic distribution of activity in the brain. If further evaluation of the brain is clinically indicated, PET CT is limited and MRI is the recommended modality.

The SUV max in the right parotid gland is 40.02.

The SUV max in the mediastinal blood is approximately 2.5.

The representative SUV max for the liver is 6.87.

The prostate gland measures about 4.6 cm transverse and demonstrates a PSMA avid nodule the central portion of the gland near the base with SUV max of 23.33, consistent with prostate cancer.

RonRowdy

I obviously have prostate cancer, confirmed by high PSA and a biopsy. My urologist insists that the cancer has not spread, even though the PET scan shows high SUV values in the other organs.

Wheel

The PSMA Pet SUV uptakes can often occur in other organs for various reasons. If it was all focused on one organ that might be more suspicious. Their could be a whole other reason with such diffuse SUV’s around your system. It appears nothing in lymph nodes which is reassuring as that is where it typically spreads first. Not knowing any other details of how extensive your biopsy showed cancer in the cores and Gleason scores , or how long your PSA has been up or your symptoms that led you to your biopsy and how long time has passed a year, or as with some people on their first PSA ever they see a massive number and the cancer had not been looked at for years leading to much more significant metastatic disease. Your Urologist might be able to explain why those SUV values show up in such a diffuse fashion and he is sure it has not spread and if some other inflammatory issues are up for another condition then I would think a complete blood work up with Sed rates and CRP to check inflammation in your body. I have not seen one with that many SUV values. Good luck!

Old Salt

Like what Wheel wrote, we need to know a lot more about the biopsy (Gleason scores and more) and your PSA history.

I do believe that uptake in the salivary glands is common and nothing to worry about. Moreover, moderate uptake by the liver is also common (according to AI/Copilot).

RonRowdy

Thanks for the comments! My age is 81. PSA Nov 2023 was 28.9, Jun 2024 was 38.2, and a prostate biopsy was done on 7/17/24; only 2 of the 12 samples were malignant. Biopsy report highlights:

(A) Prostate Needle Core Biopsies "Left Base": MINUTE FOCUS OF PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 6 (GRADES 3+3). (1% of total biopsy length). (Fragmented). Negative staining with both high molecular weight cytokeratin and p63 in suspicious glands favors the diagnosis of adenocarcioma of the prostate. In addition, the diagnosis of prostatic adenocarcinoma is supported by the positive staining for racemase (P404S), which is preferentially expressed in prostate cancer. All controls show appropriate immunoreactivity.

(I)Prostate Needle Core Biopsies "L Lat Apex": MINUTE FOCUS OF PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 7 (GRADES 3+4). THE PROPORTION OF GLEASON GRADE 4 COULD NOT BE ACCURATELY ASSESSED IN THIS SMALL TUMOR FOCUS. (GRADE GROUP 2) (2% of total biopsy length). (Fragmented). Grade groups range from I (most favorable) to 5 (least favorable). Pierorazio etal. BJU Int III: 753-60, 2013. Epstein etal. EUR UROL 69: 428-35, 2016. Negative staining with both high molecular weight cytokeratin and p63 in suspicious glands favors the diagnosis of adenocarcioma of the prostate. In addition, the diagnosis of prostatic adenocarcinoma is supported by the positive staining for racemase (P404S), which is preferentially expressed in prostate cancer. All controls show appropriate immunoreactivity.

Wheel

Ron,

Your biopsy was not bad, one core a Gleason 6 and one a favorable Gleason 7(3+4). Clearly your high PSA definitely warranted the Biopsy, however high PSA numbers don’t necessarily equate to cancer throughout or even high Gleason scores. The biopsy is what helps determine the aggressiveness with the Gleason score and its Gleason 8,9 and 10 considered advanced. I was thinking maybe your cores were filled those numbers. You could ask your urologist for a urine marker test called ExoDx that you do at home(collection of urine you send off for a review of cancer markers )to help suggest your risk of your cancer being low and turning high or high. Also Genomic testing of your biopsy tissue such as Decipher to rule out likely high intermediate or advanced grade cancer but those two positive cores and Gleason is not overall bad Gleason scores that do not to me correlate with all that SUV activity in your Pet scan. I would ask your urologist since he is confident the other areas are not prostate metastasis could their be another issue going in that you need to see your General Doctor about for additional blood work. I would definitely follow up with your GP for review of the Pet activity but it is possible it’s not related as your Urologist suggests.

Wheel

Ron,

I don’t know if prior to your biopsy you had a MpMRI of the prostate. If so what is called a fusion MRI biopsy is often done to ensure multiple cores are taken from any suspicious areas identified in the MRI in addition to the random cores of the biopsy they take. A totally random biopsy even if grid conducted can possibly miss areas of cancer. Again a good sign is any additional SUV uptake is not limited to one organ or area and more reassuring is nothing in the lymph nodes.

RonRowdy

Thanks for the comments! They are wonderful! I'm not real confident of a long life. I was in the military for 21 years and have had sort of a rough life. I have ischemic heart disease, but it has been controlled since first diagnosed 18 years ago. At age 81, I perceive various body organs wearing down. I feel as if I'm likely to die with prostate cancer rather than die from it, and I tend to want to opt for "active surveillance" rather than having treatment. My urologist says that he agrees, especially considering the biopsy report, but he is leery about my case because of the high PSA. He has referred me to a radio oncologist to help me make a decision about radiation treatment.

Thanks again for the comments!

Wheel

good luck!

Old Salt

I agree that there seems to be a discrepancy between your PSA (high) and the biopsy result ('only' two small relatively low-grade lesions). The latter have been described as 'MINUTE', but they could extend beyond the biopsy 'sliver'. I see your point of considering surveillance and think that getting input from a radiation oncologist is excellent. Clearly, you have time to 'sort it out'. In the meantime, best wishes.

RonRowdy

Thank you very much!