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68 Ga PSMA Scan Results are in

bob33462
Posts: 78
Joined: Feb 2016

Had the PSMA scan on 7/25/16- at UCSF - back to Florida last night - received results today -

Head and neck - No foci of receptor positive metastatic disease.

Chest - No foci of receptor positive metastatic disease.

Abdomen/pelvis - Postsurgical changes of prostatectomy, with faint uptake in the region of the prostate bed.
A small lymph node along the left pelvic sidewall 8 x 7 mm with mild uptake with a maximum uptake of 5.2. Also, foci of PSMA uptake in the region of the bilateral distal ureters with small external iliac nodes. Activity cannot be differentiated from the ureters and nodes, and these could represent metastatic disease.

Musculoskeletal - No foci of receptor positive metastatic disease.

Will discuss with my RO and possibly a consult with a MO.

Happy nothing in the skeleton, but still have nodes and ureters to contend with.

Started Casodex today - Lupron next week --

Bob

bob33462
Posts: 78
Joined: Feb 2016

Sorry, I did leave out the radiologist comment at the end " the 8mm left node - PSMA uptake is suspicious of metastatic disease."

vonzie66
Posts: 2
Joined: Jul 2016

I am a cancer survivor. The chemo left me lacking of all functions. I was left depressed, paranoid, just down. Don't give up. There are people out there who really do care if you are alive.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3225
Joined: May 2012

Vonzie,

Yours was a wonderful post. It helped me, I'm sure it will help Bob as well. Often, shortest is best.

max

bob33462
Posts: 78
Joined: Feb 2016
VascodaGama's picture
VascodaGama
Posts: 2957
Joined: Nov 2010

Bob,

It is great to know about the positive result of the PET scan. The bandit was identified Sealed and you can pursue a treatment confident of success. You need to discuss the options with a radiologist. Which protocol and field of attack is best to deal with its locations?
One should have in mind about the probability (rather small) of having micrometastases not identified by the scan. The field of attack can be wider than just a spot. The scale regarding the PSMA uptake goes upto 7, and yours is indicated as 5.2. This may be the biggest collony while the prostate bed (faint) may represent micrometastases. Get the best but avoid any possible collateral damage from an RT choice.

 Best of lucks.

VGama

Your full story about the Ga-68 PSMA PET is here; https://csn.cancer.org/node/303009

 

bob33462
Posts: 78
Joined: Feb 2016

VG - Thank You!

bob33462
Posts: 78
Joined: Feb 2016

I will be having a 3-T MRI on Friday, August 12th. My RO will use those results and compare to the 68 Gallium PSMA PET/CT to do my sRT planning.

I have been taking Casodex 50mg for a 9 days now and will start Lupron August 17th and stay on Casodex for a week after that. The RO has agreed to wait 60 days while on Lupron treatment before starting radiation. Initially he did not want to wait, but I explained that I thought the hormone would weaken and radio-sensitize the cancer cells allowing the radiation to work more efficiently. He agreed that the hormone would weaken the cancer cells and also agreed with the radio-sensitizing. Not sure why he initially did not think waiting would make a difference? 

Bob

 

 

VascodaGama's picture
VascodaGama
Posts: 2957
Joined: Nov 2010

Bob,

You are correct. RT two months since the start of HT is better. I can see that your level of knowledge/understanding on matters of PCa now pairs those of your radiologist. Wouldn't you be able of the above comment (contesting) he would have followed his (or the machine's) schedule starting RT now at the prejudice of HT benefits.
3T MRI will still add more information for the isodose planning. All these steps are the best you can do for a concrete success. I would recommend you to get details of the protocol.

My SRT of 2006 (IMRT) was 68Gy in 37 fractions (every day except Sundays), but recent techniques deliver higher doses above 72Gy. We held consultations every week along the two months of treatment. Sometimes the RO would show me live data operating maps (in MRI pictures) explaining the areas for irradiation (lymph nodes, etc). Without the prostate to serve as reference or fiducials, they marked tattoos on my abdomen for the alignment of my body on the stretcher which would be rechecked live at the operator’s room. The movement allowance was two millimetres which would stop the delivery automatically if any.

The daily sections become a routine. One hour in advance I would drink lots of water to fill the bladder (it helps in minimizing the side effects), then I would drive to the hospital, dress a light gown and lay face up on the machine while the beam head would move around me stopping here and there. All actions and movements were controlled by the RO and staff in their rooms. It would take approximately 10 to 15 minutes (3 minutes under radiation). I never felt fatigue (played golf on weekends) or nausea. I had a sensation of burning pain on my fifths’ week of treatment when urinating and the stool became much liquefied with traces of blood (proctitis). These side effects were treated along three month post RT.

You doing it well. Just wonderful.

Best,

VG

 

bob33462
Posts: 78
Joined: Feb 2016

VG - Thanks for your comments!

MRI Results - 8/12/2016
FINDINGS:
Patient is status post radical prostatectomy. There is no evidence of abnormal T2 signal mass, restriction or enhancement in the prostatectomy bed.

Seminal vesicles: Normal.

Bladder: Concentric wall thickening with trabeculations suggestive of chronic bladder outlet obstruction.

Lymphadenopathy: No significant lymphadenopathy by size criteria.

Bones: Marked heterogeneous bone marrow signal intensity which limits evaluation for metastases. T2 hyperintense focus in the left sacrum measuring 1.7 cm. In addition, 2.1 cm hyperintense focus is noted in the left ischium.

MY COMMENTS:
Not sure if Casodex, even though just 50mg per day, has shrank cancer in nodes and bed so MRI didn't detect?
Found my voiding issue = bladder outlet obstruction - may get worse with radiation?

Bob

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3225
Joined: May 2012

Bob,

Most forms of radiation can potentially cause urinary stricture, but since time is relevant in your case, I personally would go ahead and get the radiation. Stricture, if it gets bad or worsens, is addressable in other manners.  Of course ask the doctor directly regarding this possibility.

max

Old Salt
Posts: 720
Joined: Aug 2014

Isn't the major advantage of the PSMA methodology that it is more sensitive than 'classical' imaging (such as MRI)?

bob33462
Posts: 78
Joined: Feb 2016

Old Salt-

Yes the 68 Ga  is much more sensitive - The RO wanted to have the MRI for RT planning to compare against the PSMA scan.

Bob

 

VascodaGama's picture
VascodaGama
Posts: 2957
Joined: Nov 2010

Bob,

This forum search engine is worthless. This is a great site but the admin never tried to improve its search feature. I looked for your “story” to reply as much accurate as possible and it took me long time to find your thread. (https://csn.cancer.org/node/300252)

Regarding your inquire; I think that the one month Casodex has not influenced cancer’s size. I agree with Old Salt’s opinion about the negative result from the MRI contrasting with the positive result of the PSMA PET. The later is more sensitive and should be trusted.
I would think that the lymph nodes in the left pelvis area are probably all affected (an area of 8x7mm) with some nodes (spots) “infested” with tumors (aggregated colony of cancerous cells). The MRI would only recognize these if they were bigger than 1.0 cm (7 mm in diameter for PET), at its best tumor to background ratio T/B and type of imaging isotope. In certain depth this size can increase to 1.5 cm. The small external iliac nodes standing next to the distal (lower portion) ureters are also identified. These should also receive RT if the radiologist finds the best angle to deliver the rays without collateral damages. You need to discuss with the RO about such a possibility and about what could go wrong (scars).
The prostate bed is a common site for SRT. That will include the bladder’s sphincter area (reattached to the urethra) which may cause stricture (commented by Max). Typically doctors wait 6 month since RP to allow proper healing of this area. That period corresponds well with your surgery of April, but you can inquire if that spot can be avoided or even if it is possible of using lower doses (Gy) and still get the full benefit.
The MRI finding of “Bladder: Concentric wall thickening with trabeculations suggestive of chronic bladder outlet obstruction”, this could be a tissue thickening caused by the reattachment of the urethra at surgery or a damage caused by the catheter. Surely radiating these tissues will cause inflammation that can cause problems in voiding. Do as Max suggest above.

Another point for discussion regards the MRI findings at the left sacrum (1.7 cm focus) and at the left ischium (2.1 cm hyperintense focus). MRI’s T2-weighted images are common but are difficult of being diagnosed properly. The focal lesions could relate to many things other than cancer. These are also called UBOs (Unidentified Bright Objects) by the radiologists. For instance, it could be due to neurometabolic diseases, or multiple sclerosis, or arthritis, etc. Your RO will find a meaning for the MRI result even if the PSMA PET is negative at those places. The images can explain something. Do you have a copy?

The RO will use the MRI machine two or three times along the IMRT period to map each field of radiation (organs move constantly). He must always compare it with the PET exam.

I hope you are successful and that you can turn the page of this critical chapter of your life for good.

Best,

VG

 

bob33462
Posts: 78
Joined: Feb 2016

Thank you for sharing your extensive in-depth knowledge with me and the rest of the site members.

Bob

bob33462
Posts: 78
Joined: Feb 2016

A few new studies I found on the 68 Ga PSMA Scan -

 

http://onlinelibrary.wiley.com/doi/10.1002/pros.23168/full

 

http://www.ncbi.nlm.nih.gov/pubmed/26683282

Bob

 

 

 

 

 

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