MRI vs PSMA PET scan
I'm newly diagnosed with prostate cancer with a Gleason score of 9. I had a MRI, followed by a biopsy and PSMA pet scan. I understand that PSMA petscan is the gold standard for identifying the location and spread of the cancer cells.
The MRI states that the focal invasion is evident into the seminal vesicle, and the extraglandular invasion extents in the rectoprostatic fat. The MRI stage is at T3b. Google defines stage T3b as "T3b means the cancer has spread into the tubes that carry semen (seminal vesicles)."
And the PET scan states "Focal avid metabolic uptake within the right prostate gland from the base to the apex compatible with suspicious findings on MRI. No evidence for adenopathy. No suspicious uptake in the osseous structures."
PET scan doesn't talk about the invasion to seminal vesicles or the extraglandular invasion extending in to rectoprostatic fat. Can anyone please throw some light on this? THANKS!
@connor I can only relate my experience.I did have a Gleason 9 and T2 but it was contained. I did undergo surgery and it was thought to be taken care of - Some 5 years later it came back and I needed 40 radiation treatments+ hormone therapy - so far all is good regarding PSA levels.
While a Gleason9 is a concerning - todays treatments are rather impressive as are the more advanced detection techniques like the PSMA scan you experienced to find potential hot spots in other locations.
What treatment options have been discussed at this point? If it is to be radiation and hormone therapy and you have questions I did a video journal on my 8 weeks of treatment. It can be found under "my journey" on www.TheProstateCancerCoach.com - Good luck and please keep us posted Dennis(ProstateCancer.net TEAM)
Thank you very much for your encouraging words. I'll check out your video journal.
I am going in for the PSMA pet scan tomorrow. I have a Gleason score of 9 and the thoughts of my doctors is that it has spread and surrounding areas as well. I will know more tomorrow and will get back with you. I have had two biopsies, a PET scan, a Bone Scan, a Pelvic MRI (not pleasant) and now the PSMA Pet Scan. I am in Houston so I dropped the original urologist and got in to MD Anderson.
I will keep you posted as every case of prostate can caer is different. However, we seem somewhat similar (I will know for sure tomorrow). I believe that for now, for my symptoms, surgery is out and it will be a combination of radiation, hormones, and chemotherapy.
TedSo sorry to hear that you are also going through what I'm going thru'. It is tough on the family as well. Since mine is locally advanced (may have invaded the seminal vesicles), my urologist has given me an option of both radiation and surgery. He said even with the surgery route, I may still end up needing the radiation down the road. I have radiation consultation next week and then meeting with my doc about surgery. I'm also trying to get a second opinion from a reputed Urologist Oncologist in UCSF who specializes in prostate cancer. Everything moves slowly... from getting the referral from my PCP, getting the preauthorization from the insurance company and the getting the specialist approval.
What kind of radiation therapy your doc is advising you to have? I read a lot about this targeted seed implants in which radioactive material is planted inside the body (Brachytherapy). If any one in this forum has any experience with it, please share with the rest of us. All the best to you.If there is an indication of spread the approach is, as you described, radiation, hormones and potentially Chemo. For me the radiation was pretty much a non event and my anticipation was worse than the treatments.
Yes ... we are different and how we react can vary. When it came to hormone therapy I was hit with all of the possible reactions . One caution is watch what you are eating. That innocent extra donut etc that none of us pay attention to has a way of staying with your waistline and is very difficult to impossible to work off . I went from 168 lbs to almost 196 lbs rather rapidly and could not lose a single pound for 15 months after my "so called 6 month" shot wore off. New pants in larger sizes were not optional. LOL. Hot flashes were frequent and a I discover that fan in the bedroom was a blessing for sleeping.
I also underwent chemo -- not for the prostate cancer but for non-hodgkins lymphoma that developed 2 years later. With chemo treatment I discovered that hydration was critical and I needed to up my consumption to over 80 oz a day to keep all things working.
One hint is speak up and keep your MD's well informed when on chemo. If you feel something is not right let them know. Things can change very quickly with chemo and macho is not your best friend. Good luck . Dennis(ProstateCancer.net TEAM)
Hi
. Your confusion is understandable. What you may want to ask your doctor about is if the seminal vesicle invasion was discovery was in the MRI guided biopsy. As discussed in this article, it can be discovered in this combination procedure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178323/. This may not be inconsistent with the PSMA not showing seminal vesicle invasion. As noted in this article, while the PSMA is good at detecting cancer in this location, it is not perfect: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178323/. As mentioned, the PSMA is excellent at finding the prostate cancer at more remote locations. At this point it sounds like your spread is outside the prostate is localized. Of course, only your doctor can explain the specifics of your tests. Please feel free to keep us posted on how you are doing. Wishing you the best. Richard (ProstateCancer.net Team) Thank you so much for the reply. I'll check out the links provided by you. My current feeling is that I just can't wait to get rid of the prostate and the seminal vesicle . I'm meeting with doc next week and I'll have more updates. Sounds like you have handle on this and while not easy I found it best to just take it one step at a time. Do keep us posted. Dennis(ProstateCancer.net TEAM)
