PSMA PET scan 👉 no spread

Where things stand

Since the last update I went all-in on second opinions. Over the past few weeks I've seen specialists at two cancer centers — Northwell and Memorial Sloan Kettering — to pressure-test every option before I commit to one. That's two radiation oncologists, two surgeons, and a urology nurse practitioner who walked me through the whole map. The point of all of it was to make sure no one was giving me a reflex answer.

The short version of who said what:

• Dr. Glickman (Northwell, urologist), May 19 — delivered the biopsy results and set this whole round of opinions in motion. Ruled out just watching it, and laid out the three options: surgery, radiation, focal therapy.
• Dr. Setton (MSK, radiation oncologist), June 4 — proposed short-course radiation, with hormone therapy only if the pending tests bump my risk upward.
• Dr. Lipsztein (Northwell, radiation oncologist), June 4 — also proposed short-course radiation with extra dose aimed at the tumor, possibly with hormone therapy. Treating with intent to cure.
• Sara Levine, NP (MSK, urology), June 5 — walked through surgery versus radiation, graded my risk one notch higher than the others did (more on that below), and lined up MSK's own pathology and MRI re-reads plus the surgeon visit on June 18.
• Dr. Taneja (Northwell, surgeon who also does focal therapy), June 8 — reviewed my scans and slides himself, steered me away from focal therapy (more in section 03), and leaned slightly toward surgery given my age and health, without pushing it.

This weekend's event: a PSMA PET scan on Saturday, June 13. I had it for one reason — my biopsy showed two features (cribriform and IDC-P, both cell patterns that can signal more aggressive behavior) that made the team want to confirm nothing has spread beyond the prostate before we pick a treatment.

What we learned

Two things to report.

MSK re-read the April MRI. This isn't a new scan — MSK's own radiologists read the same April images so they'd be working from their own interpretation, not an outside report. Dr. Michael King signed it on June 10. What it says:

• The main lesion is confirmed: the high-suspicion (PI-RADS 5) spot on the right, about 1.6 cm. No change from before.
• It also names a second, smaller spot on the left — lower suspicion (PI-RADS 4), about 0.8 cm. This is the first read that calls the left side out as its own target. Smaller and less suspicious than the main one, but now it's on the record.
• The staging picture still looks contained: only a mild bulge where the tumor meets the prostate wall, with no clear break through it. Seminal vesicles clean, lymph nodes clean, bones clean.

The PET scan result. The headline is the one I wanted: no sign the cancer has spread beyond the prostate to anywhere else in the body — nothing in the bones, nothing in distant organs, no convincing lymph node. That was the whole reason for the scan, and on that question it came back clean.

Inside the prostate, two things showed up:

• The known right-side tumor lit up, as expected.
• So did the left-side spot the MRI re-read had flagged. The report can't yet say which it is — a second small cancer, or just inflammation — and it raised a possible, unconfirmed question of whether it reaches the base of the left seminal vesicle (one of two glands that sit just behind the prostate). Both prostate spots glow at low intensity, which is what you'd expect for my grade of cancer.

There are real reasons to lean toward inflammation on that left spot. The biggest: when they did the biopsy, they sampled the left side, and those cores came back benign — and a tissue sample is harder to argue with than a scan. The original April MRI saw nothing on the left at all; MSK's re-read flagged it later, but only at the lower-suspicion level. And the PET signal there is faint. When imaging lights up a spot that a needle has already called clean, inflammation is the more common explanation than a tumor the biopsy missed. It isn't a guarantee — a scan can occasionally catch something a biopsy needle skipped past — which is exactly why this is the first thing the doctors will sort out rather than something the scan settles on its own.

My care team hasn't formally reviewed the scan yet. That happens at the next appointment, and the left-side question is first on the list.

What it does (and doesn't) mean

A couple of options have come off the table. Active surveillance — just watching it — was already out. Focal therapy (treating only the cancerous part and leaving the rest of the gland alone) is now effectively out too. Dr. Taneja at Northwell, who does focal therapy himself and helped pioneer the MRI-Fusion biopsy method used on me, advised against it: the tumor is large enough that he'd have to treat most of the gland anyway, and the IDC-P feature means some of the cancer the scans can't see may also be aggressive. Treating only the visible part would be a gamble.

So it's whole-gland treatment, which means surgery or radiation. That's the decision.

One honest wrinkle: my own doctors don't fully agree on how to grade the risk. Most call it favorable intermediate risk; a couple lean toward unfavorable. That disagreement matters mostly for a single question — whether radiation would come paired with a few months of hormone therapy.

Two more tests are still out: Decipher and Artera, both run on the existing biopsy tissue to estimate how aggressively the cancer is likely to behave. Those take two to four weeks, and with the PET now done, they're the last inputs that settle the hormone-therapy question and, with it, a lot of the surgery-versus-radiation math.