Watch “PSMA After Recurrence, and PSMA Specificity | Answering YouTube Comments With Mark Scholz, MD | PCRI” on YouTube

This video was released today, and the timing could not have been more perfect. Dr. Scholz does make the distinction between the Axumin and PSMA PET scans, confirming that the PSMA PET is more likely to pick up my cancer’s location at my PSA level.

Day 3,910 – Bone Scan Results

As a baby boomer, I grew up with Spock. Both of them.

First, there was Dr. Benjamin Spock, the noted pediatrician who told my parents—and millions of other parents—how to raise and care for their kids. Then, of course, there was the Star Trek Spock, whose existence was rooted in Vulcan logic.

Now I’m not a Trekkie, but if you’ve read any part of this blog, you do know that facts, figures, and logic are high on my priority list, too. I thought, “What better way is there to outline the possible scenarios and decisions that are ahead of me than to put them all in a flow chart.” So here goes:

So let’s step through this.

We start with the CT and Bone scans that happened over the last two weeks. The first question is, “Did those scans determine the location of the prostate cancer (PCa)?”

If the answer is yes, then the next question is, “Was the prostate cancer in the prostate bed and/or pelvis?”

PCa in Prostate Bed/Pelvis

If the answer is yes, the PCa is in the prostate bed and/or pelvis, then Salvage Radiation Therapy (SRT) with or without Androgen Deprivation Therapy (ADT) (Hormone therapy) offers the last possible chance of a true cure. Of course, there are risks associated with SRT that would impact your daily quality of life: bowel control, bladder control, and lack of sexual function. Additionally, depending on which study you look at, SRT may be successful only 30% to 70% of the time. (Green bubble above.)

PCa is Not in Prostate Bed/Pelvis

But if the answer is no, the PCa is outside of the prostate bed and pelvis, that means the PCa is now distant and likely metastasized. If that’s the case, there is no cure and the PCa can only be managed with hormone therapy and perhaps chemotherapy. (Orange bubble above.)

CT and Bone Scans do not Locate the Prostate Cancer

We’ve talked at some length that neither the CT scan nor the bone scan have the sensitivity to pick up the cancer’s location based on my PSA level of 0.21 ng/mL. It was very likely that neither would pick up the cancer at that first decision point on the flow chart, so further investigation is required by using the Axumin or PSMA PET scan.

CT and Bone Scan Results

In fact, neither the CT nor the bone scan picked up the location of the cancer:

No definite scintigraphic evidence of metastatic bone disease and no evidence of a widespread osseous process

So that’s actually good news with the bone scan. It shows that it has not metastasized to the bones, which is definitely a good thing. (Or, at least if there is metastasis to the bones, it’s at a level that’s unable to be picked up by the sensitivity of the scan.)

Next Steps

We follow my red arrows above and run the Axumin or PSMA PET scans (or both) to see if either of those can pick up the location of the cancer. I’ll have that discussion with the urologist on 3 August 2021, and we’ll see when we can get them on the calendar.

If the Axumin and/or PSMA find the cancer in the prostate bed/pelvis, then we go back to the section above and land on SRT as the option. But if it’s found outside the prostate bed/pelvis, then we go back to the other section where we just manage with ADT. (If the lesion outside the pelvis is well-defined, it may be something that could be zapped in its location. Something to explore.)

If the Axumin or PSMA PET scan cannot locate the PCa, then things get fuzzy fast.

Sure, we could go ahead and blindly complete the salvage radiation therapy, hoping that we’re zapping in the correct place. Or, we could continue to monitor for a while longer and then retest to see if the cancer can be pinpointed.

This may have been a bit of an oversimplification of what’s ahead for me, but I’m hoping that it makes sense to you.

Be well!

Day 3,908 – Bone Scan

Today was the day for my bone scan, with two appointments to make it all happen.

The “Juice”

I had a 10:15 a.m. appointment to get the radioactive juice (oops, contrast) injected into my system so that it had time for the scheduled 1:45 p.m. scan.

I’ve learned over the years that you have to have a little fun with those sticking needles into your arm, so I asked the nuclear medicine technician, “Has anyone ever started belting out Debbie Boone’s You Light Up My Life as you inject this stuff?”

He looked perplexed, but was old enough to know the song I was referring to.

“Uh, nope. You would be the first.”

“There’s no way I’m singing. I clear dogs from a three county radius when I do.”

He chuckled, turned the valve on my IV, and let the juice “light me up.”

The cool thing was that I checked in at the front desk at 9:50 a.m. and was walking out of there at 10:15 a.m., the time of my appointment. All done.

The Scan

As I was leaving the morning appointment, the tech told me to drink plenty of fluids, and to come back at 12:45 p.m. instead of 1:45 p.m. Not a problem.

As we walked back to the scanner, he said, “Let’s get some pictures.”

“Oh. Just like my high school yearbook, except those were taken using a Daguerreotype camera.”

Without skipping a beat, he chimed in, “By Matthew Brady?”

Of course, being a native Illinoisan with an affinity for all things Abraham Lincoln and, to a lesser extent, the American Civil War, that resonated with me. [For my international readers, Matthew Brady was a photographer who pioneered photojournalism during the Civil War, and took a number of portraits of President Abraham Lincoln.]

That caused me to relay a story of when I was working at the San Diego Natural History Museum, and, when a kid learned I was from Illinois, he asked, in all earnestness, “Did you go to school with Abraham Lincoln.” Ouch!

As far as the scan was concerned, it went well. Strap me in, slide me in, and poof, we’re done in about 45 minutes or so (I never really looked at the clock to time it). But he did want to get a second run of my pelvic region. Apparently, my bladder filled with radioactive juice and he didn’t have a clear image of what was going on. After a quick trip to empty my bladder, we got a much better view.

Of course, I had to ask, “Did you see anything like Petco Park lit up at night?” [Petco Park is the baseball stadium for the San Diego Padres professional baseball team.]

He reluctantly deferred to waiting for the doctor’s interpretation, but then he offered, “I didn’t see anything.”

“Good. I won’t hold you to that,” I said.

I’ll start looking for the results online over the weekend and will post when I read them.

Have a great weekend and be well!

Day 3,906 – UCLA PSMA Update

It’s been a week since I submitted the form on the UCLA website for a referral for the PSMA PET scan, and I hadn’t heard anything back, so I called them this morning.

When I mentioned that I submitted the form about a week ago, the agent said, “Oh. Yeah. We can’t book appointments using the form on our website. We need to take that down.” Uh. Okay. Good to know.

To schedule the PSMA scan:

  • The referring physician needs to call the scheduling number: +1 310-794-1005.
  • UCLA Nuclear Medicine will fax a referral form to the doctor to complete and return.
  • It will take 24-48 hours to process the returned form.
  • They’ll work with the patient to select a date for the scan.

They are currently scheduling appointments in September, so there’s a bit of a delay which isn’t all that surprising.

Now all I have to do is convince my doctor at the VA to go through the process once we get the bone scan results back. I’m not sure how that will go, but you can bet I’ll push pretty hard to make it happen.

If they insist on doing the Axumin scan at the VA first, I guess I’m okay with that. But if that comes back negative, I’ll really press for the PSMA PET scan. I’m just not all that keen on having all this radioactive juice injected in me over the course of a few weeks.

We’ll see how things go.

Be well!

Day 3,901 – CT Scan Results

Let’s start with the BLUF:

No definite evidence of locally recurrent or metastatic disease within the abdomen or pelvis.

(If you don’t know, BLUF = Bottom Line Up Front).

There was one 9 mm kidney-shaped lymph node that caught their attention, but didn’t think it to be remarkable.

They also commented on a bunch of my other organs and bits and pieces, but nothing seemed too out of the ordinary for any of them aside from a few dents and scratches from 63+ years of normal wear-and-tear and countless miles/kilometers.

The fact that the CT scan didn’t pick anything of substance up is a good thing and a bad thing. Good because it didn’t see anything; bad because it didn’t see anything. The likelihood of it detecting the lesions at my PSA level were small, and we knew that going into this. So even though we didn’t see anything, that doesn’t necessarily mean that it’s not there.

I did get a chuckle out of one line in the report:

Multidetector CT abdomen/pelvis was obtained after the uneventful administration of intravenous contrast.

Uneventful for who??? The radiologist? Sure. I did everything in my power to not puke all over their $300,000 scanner. 😲


I expect we’ll have the same result with bone scan next week, but time will tell.

That’s all for now.

Be well!

Day 3,900 – Requested Info from UCLA on PSMA PET Imaging

Just a quick update…

This morning, I went onto the UCLA website and filled out the form to request more information about the Ga68 PSMA PET scan and perhaps even schedule an appointment with them. We’ll see how long it takes for them to respond. I’m gue$$ing it may be pretty quickly as they want to get more people using their test and facility. Ju$t a hun¢h.

“Cynic, table for one. Cynic.”


That contrast used in the CT scan yesterday really kicked my butt. The juice was injected into me shortly after 2 p.m., and as I was heading to bed around 9 p.m., I could still feel some of the side effects from it.

I did drink a lot of liquids to help purge it from my system and that translated into multiple runs to the toilet through the night last night. Oh well. It all caught up with me around 2 p.m. this afternoon when my ability to focus just ran head-on into a brick wall. I hung it up at the office and came home.

I just checked for the scan results online, and nothing posted yet. I suspect it will be on the weekend that I’ll be able to see them. Of course, they’re usually written in such a away that a lay person has trouble comprehending what’s on the page. We’ll give it a try, though, when the time comes.

That’s about it for today. Hopefully, the next post has news about the PSMA test or the CT scan results, or both.

Until then, be well!