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Journey Update March 2019


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PSA up from 38ug/L to 82ug/L in 3 months 

Testosterone down from 08 – 07 in same period! 

History: Rising PSA in a background of carcinoma of the prostate. 
Findings: Comparison is made with the previous FDG PET/CT of 02/05/17.  
Head: The ventricles, cisterns and sulci are normal. There are no abnormal attenuations, mass effects or abnormal enhancements with contrast. Intracranial FDG activity is normal.  
Neck: The parotid and submandibular glands are normal. There is no pharyngeal or laryngeal lesion. The thyroid is normal. There is a 9 mm FDG avid left level 4 cervical lymph node consistent with a nodal metastasis. There are no enlarged or FDG avid cervical lymph nodes elsewhere. FDG uptake throughout the neck is otherwise normal. 
Thorax: There are enlarged FDG avid pretracheal, right paratracheal and aortopulmonary window mediastinal lymph nodes demonstrating intense increased FDG uptake (SUV maximum 18) consistent with nodal metastases. They measure up to 20 mm in diameter. Small but FDG avid lymph nodes are also noted at the left pulmonary hilum and between the oesophagus and descending thoracic aorta in keeping with further nodal metastatic disease.  
No enlarged or FDG avid axillary lymph nodes. There is no pulmonary nodule or mass. There is no pleural or pericardial effusion.  
Abdomen & Pelvis: There are multiple enlarged FDG avid retroperitoneal, right retroocular and bilateral iliac lymph nodes consistent with multiple nodal metastases. There is also a prominent FDG avid left iliac lymph node. The presence of a suprapubic catheter is noted.  
The prostate is enlarged and there is a large focus of increased FDG uptake within the prostate, predominantly left lobe, in keeping with primary carcinoma. This appears larger and more intense when compared to the previous examination. 
The liver is normal with no focal intrahepatic lesion and demonstrates normal FDG activity. There is normal FDG uptake within the spleen, pancreas and kidneys. There is no FDG avid bowel lesion.  
Musculoskeletal: Multiple sclerotic lesions are seen throughout the spine, pelvis and ribs, some showing low grade increased FDG uptake but findings are consistent with widespread bony metastases. These show significant progression when compared to the previous examination. 
1. Prostatomegaly. Increase in the size of the FDG avid tumors within the prostate.  
2. Extensive FDG avid cervical, thoracic, abdominal, pelvic and left inguinal lymphadenopathy in keeping with widespread nodal metastatic disease.  
3. Progressive widespread skeletal metastases. Including right hip and one spot in each long bone 




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