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Inconclusive scans

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User
Posted 30 Jun 2025 at 22:21

Husband’s PSA on the rise (surgery 5yrs ago followed by adjuvant RT). Was <0.1 for over four years, then jumped  to  0.2. MRI and CT were inconclusive. At 0.4 he had a PSMA PET scan in April which showed an indeterminate area on spine and they recommend repeating the scan in six months.

He sees Oncologist in a week to discuss formal report - is there anything we should be pushing for?

Thank you.

User
Posted 15 Jul 2025 at 09:17
It's easy to get a second opinion from the Royal Marsden privately. It costs a few hundred quid but you will get the latest most effective recommendations which you can use to challenge your current treatment if necessary.

User
Posted 01 Jul 2025 at 01:57
Has hubby been having HT and if stopped when? Dr may want to wait for another PET scan to check more certainty re precise location and whether any other suspicious areas. Depending on findings some radiation may be a possibility together with some HT. But his Dr is best placed to suggest most appropriate way forward. Do let us know what he says following imminent appointment.
Barry
User
Posted 01 Jul 2025 at 12:40

Hi Lexi, sorry to hear about the increase in PSA and the inconclusive scan. I would push for more frequent PSA testing. My gallium PSMA scans seemed to accelerate the rise in my PSA . The research professor at our local support group had not heard of that happening. Take care.

Thanks Chris 

 

User
Posted 02 Jul 2025 at 01:31
Oncologists can have different ideas on pescribing HT in such circumstances but they know the individual patient best and we generally trust our Consultant's judgement. It will be interesting to learn what your Husband's Consultant has to say.
Barry
User
Posted 02 Jul 2025 at 05:53
Questions I would ask:

Was the adjuvant RT prostate bed only? Or were lymph nodes in wider pelvis area treated too?

Can't they MRI or biopsy the possible spinal lesion?

Can they just blast the spinal lesion and not wait?

User
Posted 02 Jul 2025 at 21:17
Lexi26, my case doesn't quite relate to your husband's, I had surgery without adjuvant RT but then after a rise in PSA had HT and salvage RT six years later. However what might be relevant was the advice of the oncologist when my PSA rose above 0.2 that he saw no point in me having a scan. He said that in his experience scans couldn't be relied on to provide information when PSA was less than 0.5 and that it would be best to start the salvage treatment at a lower PSA.

(Basically, with PSA at 0.3 or 0.4 he wouldn't take a negative scan as meaningful, there would be too much risk in not going ahead with salvage treatment, so there was no point in a scan which didn't guide the clinical approach).

User
Posted 05 Jul 2025 at 00:09
So he still has the option of wider pelvic nodes irradiation.

I would also ask about the benefit of early chemo.

User
Posted 14 Jul 2025 at 23:20
Why no repeat PSMA scan? Didn't they say he should have another in 6 months?
User
Posted 15 Jul 2025 at 00:08

The oncologist has dismissed the possible "indeterminate lesion on spine" but does not appear to have suggested any location as a source for the psa rise.

I'd be pushing for the oncologist to give an opinion on where the cancer is recurring and what treatment might be possible. Recurrence in the vicinity of the prostate [-bed in your husband's case] can be treated with focal therapies and specific lymph nodes can also be treated with very focused RT. A PSMA PET scan is the obvious path but biopsies are another option. 

I welcome being corrected here, but going on to HT now seems like kicking the cancer down the road where treatment might be possible. HT will shrink tumours which can make it harder to pick them up with scans, so it's better to have scans prior to HT. Also, as you no doubt know, HT does nothing to remove cancer, it only puts it into a holding pattern.

What is your husband's impression of the oncologist?

[Injections are a normal way of giving HT, usually one month but sometimes 3 months. The first injection is preceded by a shot to counter the tendency of HT to produce a sharp testosterone rise before it starts to drop]

Jules

Edited by member 15 Jul 2025 at 02:35  | Reason: Not specified

User
Posted 15 Jul 2025 at 07:50

I don't think you'll need a prescription for calcium supplements. It's a relatively cheap off the shelf item. It's worth checking cholesterol levels prior to HT as it can cause them to rise but it's relatively easy to counter with statins. Your husband will almost certainly gain weight and lose muscle mass, along with libido of course.

What I don't get here is, what is the plan? HT is quite likely to drop your husbands psa level to a "less than detectable" measurement and that could hold for a very long time, basically until the cancer becomes 'immune' to the HT. At that point HT is off the table for future use if needed.

Bicalutamide + prostap is a heavy duty treatment for "2 or 3 rogue cells" and ... very much a personal opinion here ... I'd be looking at finding and treating the cancer ASAP because the HT doesn't solve the problem and can be extremely unpleasant [not for all people though].

Jules

 

 

User
Posted 15 Jul 2025 at 10:44

Originally Posted by: Online Community Member
It's easy to get a second opinion from the Royal Marsden privately. It costs a few hundred quid but you will get the latest most effective recommendations which you can use to challenge your current treatment if necessary.

I was thinking along similar lines, even if it fully supports opinion of Current Oncologist worth knowing  highly rated Marsden Oncologist concurs and best is being done.

Barry
User
Posted 15 Jul 2025 at 14:33

Lexi, after surgery,SRT and SABR treatment to two lymph nodes on two separate occasions, my PSA started to rise. I had Bicalutamide,a few weeks later I started on zoladex, which was changed to decapeptyl for political reasons 4 months after the first injection I started apalutamide.

Not sure why there is such a difference in treatment regimes.

Thanks Chris 

User
Posted 15 Jul 2025 at 23:32
Not sure how much integration there is between hospitals in Scotland and England but in the latter even scans can be what they term 'Called Over' which enables one hospital to receive them electronically from another. I had UCLH do this to the Royal Marsden quite some time ago.
Barry
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User
Posted 01 Jul 2025 at 01:57
Has hubby been having HT and if stopped when? Dr may want to wait for another PET scan to check more certainty re precise location and whether any other suspicious areas. Depending on findings some radiation may be a possibility together with some HT. But his Dr is best placed to suggest most appropriate way forward. Do let us know what he says following imminent appointment.
Barry
User
Posted 01 Jul 2025 at 12:40

Hi Lexi, sorry to hear about the increase in PSA and the inconclusive scan. I would push for more frequent PSA testing. My gallium PSMA scans seemed to accelerate the rise in my PSA . The research professor at our local support group had not heard of that happening. Take care.

Thanks Chris 

 

User
Posted 01 Jul 2025 at 17:49

Barry he has never been prescribed HT. His oncologist said in my husband’s case when going for adjuvant RT at 14 weeks post op that HT would have no added benefit.

We meet him again next week to discuss.

PSA has been 3 monthly since the rise Chris.

Thanks

User
Posted 02 Jul 2025 at 01:31
Oncologists can have different ideas on pescribing HT in such circumstances but they know the individual patient best and we generally trust our Consultant's judgement. It will be interesting to learn what your Husband's Consultant has to say.
Barry
User
Posted 02 Jul 2025 at 05:53
Questions I would ask:

Was the adjuvant RT prostate bed only? Or were lymph nodes in wider pelvis area treated too?

Can't they MRI or biopsy the possible spinal lesion?

Can they just blast the spinal lesion and not wait?

User
Posted 02 Jul 2025 at 21:17
Lexi26, my case doesn't quite relate to your husband's, I had surgery without adjuvant RT but then after a rise in PSA had HT and salvage RT six years later. However what might be relevant was the advice of the oncologist when my PSA rose above 0.2 that he saw no point in me having a scan. He said that in his experience scans couldn't be relied on to provide information when PSA was less than 0.5 and that it would be best to start the salvage treatment at a lower PSA.

(Basically, with PSA at 0.3 or 0.4 he wouldn't take a negative scan as meaningful, there would be too much risk in not going ahead with salvage treatment, so there was no point in a scan which didn't guide the clinical approach).

User
Posted 04 Jul 2025 at 21:15

PSA today 0.7 so it's increasing quickly.

It was only prostate bed that was irradiated Franci. I'll ask on Wednesday about MRI for spine as the recent one was pelvis.

Thanks for your input.

Edited by member 04 Jul 2025 at 21:16  | Reason: Typo

User
Posted 05 Jul 2025 at 00:09
So he still has the option of wider pelvic nodes irradiation.

I would also ask about the benefit of early chemo.

User
Posted 14 Jul 2025 at 21:59

Had appointment with Oncologist. Doubling time is 3.9 months so time to start HT.  He said he had no concerns about the “indeterminate lesion on spine”. The earlier CT was chest, abdo and pelvis and was inconclusive. I asked about a bone scan but he didn’t think beneficial.

He said would commence on Prostap, I asked if any HT tablets and was told no. Husband collected prescription today and there was Bicalutamide too. Going to email for clarification.

Is it usual to have injections alone?

User
Posted 14 Jul 2025 at 23:20
Why no repeat PSMA scan? Didn't they say he should have another in 6 months?
User
Posted 15 Jul 2025 at 00:08

The oncologist has dismissed the possible "indeterminate lesion on spine" but does not appear to have suggested any location as a source for the psa rise.

I'd be pushing for the oncologist to give an opinion on where the cancer is recurring and what treatment might be possible. Recurrence in the vicinity of the prostate [-bed in your husband's case] can be treated with focal therapies and specific lymph nodes can also be treated with very focused RT. A PSMA PET scan is the obvious path but biopsies are another option. 

I welcome being corrected here, but going on to HT now seems like kicking the cancer down the road where treatment might be possible. HT will shrink tumours which can make it harder to pick them up with scans, so it's better to have scans prior to HT. Also, as you no doubt know, HT does nothing to remove cancer, it only puts it into a holding pattern.

What is your husband's impression of the oncologist?

[Injections are a normal way of giving HT, usually one month but sometimes 3 months. The first injection is preceded by a shot to counter the tendency of HT to produce a sharp testosterone rise before it starts to drop]

Jules

Edited by member 15 Jul 2025 at 02:35  | Reason: Not specified

User
Posted 15 Jul 2025 at 05:45

Thanks for your prompt replies as always.

The oncologist said husband wasn’t “straightforward” and was in a “grey area” as MRI and CT haven’t shown anything in pelvis, no lymph node involvement. He said the area on spine could be an old fracture (??) When I commented that the PSA is telling us that there’s something there he said yes but possibly just 2-3 rogue cells.

He said he didn’t think repeating PET in 6 months would matter but as PSA rising better to start HT now. He said husband was on “cusp” with a doubling time  of 3.9 months and if it was more than 4 more months he’d have recommended waiting.

Been under his care since 2020. There were no calcium supplements with prescription that were mentioned and Bica unexpectedly.  This we need to chase for clarification.

User
Posted 15 Jul 2025 at 07:50

I don't think you'll need a prescription for calcium supplements. It's a relatively cheap off the shelf item. It's worth checking cholesterol levels prior to HT as it can cause them to rise but it's relatively easy to counter with statins. Your husband will almost certainly gain weight and lose muscle mass, along with libido of course.

What I don't get here is, what is the plan? HT is quite likely to drop your husbands psa level to a "less than detectable" measurement and that could hold for a very long time, basically until the cancer becomes 'immune' to the HT. At that point HT is off the table for future use if needed.

Bicalutamide + prostap is a heavy duty treatment for "2 or 3 rogue cells" and ... very much a personal opinion here ... I'd be looking at finding and treating the cancer ASAP because the HT doesn't solve the problem and can be extremely unpleasant [not for all people though].

Jules

 

 

User
Posted 15 Jul 2025 at 09:17
It's easy to get a second opinion from the Royal Marsden privately. It costs a few hundred quid but you will get the latest most effective recommendations which you can use to challenge your current treatment if necessary.

User
Posted 15 Jul 2025 at 10:44

Originally Posted by: Online Community Member
It's easy to get a second opinion from the Royal Marsden privately. It costs a few hundred quid but you will get the latest most effective recommendations which you can use to challenge your current treatment if necessary.

I was thinking along similar lines, even if it fully supports opinion of Current Oncologist worth knowing  highly rated Marsden Oncologist concurs and best is being done.

Barry
User
Posted 15 Jul 2025 at 11:08

Hi Jules 

As he's had CT, MRI and PET scans which were all inconclusive oncologist said could watch and wait till Christmas but expected PSA to be over 1 next time and would require treatment.

He said Prostap only so not starting the Bica until speak to CNS to clarify .

Thanks 

User
Posted 15 Jul 2025 at 14:33

Lexi, after surgery,SRT and SABR treatment to two lymph nodes on two separate occasions, my PSA started to rise. I had Bicalutamide,a few weeks later I started on zoladex, which was changed to decapeptyl for political reasons 4 months after the first injection I started apalutamide.

Not sure why there is such a difference in treatment regimes.

Thanks Chris 

User
Posted 15 Jul 2025 at 20:31

Originally Posted by: Online Community Member
It's easy to get a second opinion from the Royal Marsden privately. It costs a few hundred quid but you will get the latest most effective recommendations which you can use to challenge your current treatment if necessary.

we live in Scotland. Is it available as an online consultation I wonder.

 Will have a Google.

Thanks 

User
Posted 15 Jul 2025 at 23:32
Not sure how much integration there is between hospitals in Scotland and England but in the latter even scans can be what they term 'Called Over' which enables one hospital to receive them electronically from another. I had UCLH do this to the Royal Marsden quite some time ago.
Barry
User
Posted 17 Jul 2025 at 03:55

Originally Posted by: Online Community Member
but expected PSA to be over 1 next time and would require treatment.

Yes, looking at the psa figures, the rate of increase is certainly rising and into the marginal zone.

All the best to both of you, you're in a difficult place right now. I realize it's only 3 months since he had a PSMA PET scan but his psa has gone up from .4 to .7 so maybe Marsden as others have suggested, might think there's a chance of a PSMA PET scan showing up something now.

This might be above their scope, but the specialist nurses here might be able to offer some options.

Jules

User
Posted 19 Jul 2025 at 00:09

Yes they do remote consultation at the Royal Marsden. You gave to send all your records and scans etc.

 
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