I met with my uro today. He had my PSMA-PET scan reviewed by an interventional radiologist who said it is too risky to biopsy the node in question. My uro said that the node was suggestive of metastasis only because it was >0.8 cm (1.3 cm in fact) – it did not take up more tracer than other nodes. He suggested we watch and wait, repeating the PSA every 3 months and monitoring the kinetics). This could be a reactive node (enlarged for benign reasons, e.g. infection, inflammation).
I’ll see my R.O. to discuss treatment options and report back if there is agreement.
I messaged my R.O. if she agreed with the reasoning of my uro and myself to watch and wait another 3 months based on:
Interventional radiologist determined that the iliac node in question is too risky to biopsy
This node (only) was enlarged, but not tracer-avid, and therefore may just be a reactive node
No other adverse findings were noted on the PSMA-PET scan
Current PSA is fluctuating but not rising (most recent PSA was lower than it was back in February)
My R.O. said in a reply “I think we can wait and see the new PSA numbers.”
At my visit this week, my uro reminded me that about one in ten men have adverse effects from SRT that are moderate/bothersome or worse. However, I won’t hesitate to have RT if need be.
“Twice we measure, then we cut”, this is the carpenters’ moto. Now, with my other hat on, that of a seasoned electrical engineer, I can tell you that if you are going to decide by a sole creterion - that of a node dimension - make certain that the measurement is as accurate as it can be. Also, keep in mind that PET CT scanners are in the lower range regarding spatial resolution, hence accuracy, out of most modern imaging machines as they are not made with this as prime target in mind. If you have access to an MRI 5Tesla or more, this will be your best shot.