Spots on Jim's Ribs

The following is what I copied from Jim's PET results -- June 19, 2024 through Texas Health:

History: Malignant neoplasm of prostate; elevated PSA.

Findings: Focal intense abnormal increased tracer uptake from midline rightward at ventral mid-prostate gland level.

Intense abnormal increased tracer uptake (much greater than background) at posteromedial left 9th rib and posteromedial left 7th rib. No well-defined sclerotic or lytic bony lesional correlates at these bones by attenuation correction CT. 

Presumed PSMA (prostate-specific membrane antigen) avid bony metastic disease at a couple of left ribs (bone metastasis cancer condition that occurs when cancer cells spread from their original site to the bones. The term "avid" can refer to how well a PET scan can detect the extent of active malignancy in the bones.) No definitely abnormal increased tracer uptake (with respect to physiologic background) at abdominopelvic lymph nodes.

When someone has avid bony metastatic disease at a couple of left ribs, it means that cancerous cells from another part of the body have spread to the ribs on the left side, and these areas show increased metabolic activity, often indicative of active tumor growth or aggressive disease. 

Let's break down the terms:

• Metastatic disease: This means cancer cells have broken away from the original tumor and spread to other parts of the body.
• Bony: The cancer has spread to the bones.
• Avid: In this context, "avid" indicates that the metastatic lesions in the ribs show significant uptake of a tracer substance during imaging scans, such as a PET scan. This heightened uptake typically reflects high metabolic activity, which can signify active cancer cell proliferation.
• Couple of left ribs: Specifically points to the location of the metastatic lesions. 
• What does this mean? This indicates that the primary cancer has spread to the bones, specifically affecting two ribs on the left side, and these metastatic lesions are actively growing or metabolically active

Variable intensity tracer activity elsewhere appears to be within physiologic limits of normal. Additional incidental findings by attenuation correction CT include: inflammatory paranasal sinusitis sequelae. Atherosclerotic disease includes coronary artery involvement. Low-grade type patchy modestly increased density at mostly dependent lung zones (e.g., subsegmental atelectasis and/or post inflammatory sequelae). 

According to AI Overview, subsegmental atelectasis in the lung bases refers to a mild form of lung collapse affecting small portions of lung tissue, typically appearing as thin, linear opacities at the lung bases on imaging. It's often asymptomatic and usually doesn't indicate a serious underlying condition, often resolving on its own.

Several scattered variably sized low-density liver lesions, incompletely characterized but possibly cysts. Colonic diverticulosis. Scattered arthritic and chronic appearing other bony features.

Impression: Features are most compatible with PSMA avid malignancy at the prostate gland and a couple of left ribs.

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Imaging Report (June 19, 2024)

 

Texas Health Fort Worth

700 5th Ave

Fort Worth, TX 76104

Ph: 817-250-3568 Fax: 817-250-3544

NAME: James Kerch ACCT ID:

MRN: 2000327657 ROOM/BED:

DOB: 7/27/1952 E Number: E11724624

AUTHORIZING PHYSICIAN: Michael Waters

ORDERING PHYSICIAN: Needed), Thr*External Provider (Signed Paper Order

CC PHYSICIAN:

 

 

Your Result Images

View Your Images Here

Important Disclaimer: Computer aided detection markers are for radiologist use only and are not indicative of findings. Please contact your provider directly if you have questions about your results.

Study Result

Narrative & Impression

EXAM: PET/CT F-18 rhPSMA tumor imaging HISTORY: Malignant neoplasm of prostate. Elevated PSA. Acute. Initial encounter.  Staging. TECHNIQUE: PET/CT images acquired from skull vertex caudad through proximal  thighs. Images acquired on a PET/CT Scanner utilizing CT attenuation correction  techniques, at a usual delay after intravenous administration of 8.7 mCi F-18 rhPSMA  (Posluma). PET/CT images reconstructed and presented in axial, sagittal and coronal planes for  review. CT images acquired for attenuation correction and anatomic localization  (but not a diagnostic CT and not interpreted independently). COMPARISON: None available. FINDINGS: Focal intense abnormal increased tracer uptake from midline rightward at  ventral mid prostate gland level. Maximum SUV 14.3, avidity about 2 cm AP by 1.6 cm  transverse by 1.7 cm craniocaudad by PET. Compatible with PSMA avid prostate gland malignancy. Intense abnormal increased tracer uptake (much greater than background) at  posteromedial left ninth rib (maximum SUV 4.8) and posteromedial left seventh rib (maximum SUV 4.7). No well-defined sclerotic or lytic bony lesional correlates at these bones by attenuation correction CT. Presumed PSMA avid bony metastatic disease at  a couple of left ribs. No definitely abnormal increased tracer uptake (with respect to physiologic  background) at abdominopelvic lymph nodes. Variable intensity tracer activity elsewhere appears to be within physiologic limits of  normal. Additional incidental findings by attenuation correction CT include: Inflammatory paranasal sinusitis sequelae. Atherosclerotic disease including coronary artery  involvement. Low-grade type patchy modestly increased density at mostly dependent  lung zones (e.g. subsegmental atelectasis and/or postinflammatory sequelae).  Several scattered variably sized low-density liver lesions, incompletely characterized  but possibly cysts. Colonic diverticulosis. Scattered arthritic and chronic appearing  other bony features. Impression: IMPRESSION: Features are most compatible with PSMA avid malignancy at the prostate gland and  a couple of left ribs. -Electronically Signed By: Rodney Bowman, MD -Electronically Signed On: 6/19/2024 8:08 AM Report Ends

Signed

Electronically signed by Bowman, Rodney Russell, MD on 6/19/24 at 0808 CDT

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October 20, 2025. New CT / PET

Imaging Report

 

Texas Health Fort Worth

700 5th Ave

Fort Worth, TX 76104

Ph: 817-250-3568 Fax: 817-250-3544

NAME: James Kerch ACCT ID:

MRN: 2000327657 ROOM/BED:

DOB: 7/27/1952 E Number: E11724624

AUTHORIZING PHYSICIAN: Matthew Lee Cavey, MD

ORDERING PHYSICIAN: Cavey, Matthew Lee, MD

CC PHYSICIAN:

 

Your Result Images

View Your Images Here

Important Disclaimer: Computer aided detection markers are for radiologist use only and are not indicative of findings. Please contact your provider directly if you have questions about your results.

Study Result

Narrative & Impression

EXAM: PSMA PET/CT imaging   HISTORY: Prostate cancer status post radiotherapy November 2024,  subsequent encounter   TECHNIQUE: PET images from the top of the skull through the pelvis are  acquired utilizing CT attenuation correction techniques, approximately  one hour after intravenous administration of 8.7 mCi Posluma  (flotufolastat F18-PSMA/ glutamate carboxypeptidase II). The simultaneously acquired CT slices are obtained for attenuation correction and anatomic localization purposes with low-dose technique, using neither oral nor intravenous contrast enhancement.   COMPARISON: 06/18/2024 PET/CT   FINDINGS: As a reference, standardized uptake values (SUV, normalized  to body weight) of mean liver background are measured at 4.3, with  mean salivary uptake measured at 4.7.   In the head and neck, physiologic uptake in the salivary and lacrimal  glands. No cervical lymphadenopathy or suspicious nodal uptake.  Unremarkable thyroid tissue.   In the chest, normal caliber of the aorta and main pulmonary artery. No pericardial effusion. No mediastinal or hilar lymphadenopathy or suspicion nodal uptake. No suspicious pulmonary nodules. No axillary/subpectoral lymphadenopathy.   In the abdomen, multiple simple hepatic cysts, some hypodensities are too small to be further characterized. Hepatomegaly, measures 20.3 cm at the mid clavicle line. Increased in size of the liver and spleen compared to prior PET/CT.   Otherwise physiologic distributions of isotope in the liver, spleen, bowels without suspicious lesion. The expected variable tracer activity is seen within gastrointestinal and urinary tracts. Unremarkable gallbladder. Colonic diverticulosis without inflammation. No lymphadenopathy or  suspicious nodal uptake in the abdomen.   In the pelvis, prostatomegaly, with fiducial markers in place. Resolution of previously seen focal uptake in the prostate gland. No new suspicious focal uptake in the prostate. No lymphadenopathy or suspicious nodal uptake in the pelvis or inguinal region.   In the visualized extremities, physiological uptake in the soft tissue.   In the bones, interval resolution of previously seen focal uptake at left posterior seventh and ninth rib. Otherwise physiologic uptake in the bone marrow. No suspicious focal uptake.   IMPRESSION: 1. Resolution of previously seen focal uptake in the prostate gland. No new suspicious focal uptake in the prostate.   2. Interval resolution of previously seen focal uptake at left posterior seventh and ninth rib.   3. No evidence of new PSMA-avid metastatic disease (relating to the prostate).   4. Increasing size of the liver and the spleen (splenomegaly), now with hepatomegaly (i.e., enlarged liver), please correlate clinically.   -Electronically Signed By: Chenxi Wu, MD -Electronically Signed On: 10/21/2025 8:26 AM     Report Ends

Study Signed

Electronically signed by Wu, Chenxi, MD on 10/21/25 at 0826 CDT

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October 30, 2025. We had a conference call with Jim's oncologist today and he confirmed that the prostate cancer is gone as well as the spots on his ribs. It's still hard to figure it out from the pictures as we are not experts on reading them.

We could not get a complete testosterone panel because Labcorp dropped the ball and did not do them when Jim got his recent blood work. His PSA is zero, so Dr. Cavey wants Jim to get tested again in six months. He said that the Camcevi shot, which knocks out testosterone levels, should still be getting out of his system and hopefully his T will come back up.

We have another telemed conference set with Dr. Cavey on October 30, 2026.

Jim has T herbs to take to help his T come back up, but he also has to adopt a healthier life style (stop drinking, start exercising more).