0:06

Prostate cancer with more, um, noal involvement.

0:11

This one here, just everything

0:18

just to see when you look at the here, um,

0:29

from the top, see there are

0:34

some lower cervical sub clavicular, no cervical lymph nodes.

0:38

And then when we go down there are

0:40

medicinal lymph nodes as well.

0:43

Para lymph nodes or aortic lymph nodes tracking down.

0:50

Then many large intensely PSMA avid retro

0:56

lymph nodes

1:04

and some therapy lymph lymph nodes, right?

1:07

So a lot of nodal disease,

1:14

right?

1:15

Interestingly so a lot of nodal disease.

1:17

This patient most probably had, um, mediation.

1:20

Tell little bit about the history of this patient.

1:26

We had castration, uh, since the, some

1:30

of the post had radi prostatectomy then uh,

1:33

salvage radiation therapy, um,

1:37

and coming with chemical recurrence.

1:39

This is why you see that the pelvis is more

1:43

or less clean, right?

1:50

And if you wanna know, if you wanna make sure

1:52

that there is radiation the same as we look at,

1:58

I like to look at the,

2:06

okay, something,

2:12

the reason I looked at this is

2:13

because look, here's like you have all these noal disease

2:16

and then a propped stopping here.

2:19

So this give me the, the feeling

2:22

that there isation done before.

2:25

This is why the nodal base is down for,

2:27

there is a course dissection here and prostatectomy here

2:31

and the prostatectomy bed.

2:32

This is what we see here is um, bladder or neck funneling.

2:37

Yeah, this is, so this is not recurrence,

2:38

this is just funneling after the prostatectomy.

2:42

It happens. Um, but this is not recurrent disease

2:46

and the prostatectomy bed or anything, everything is clean

2:50

and there is no dissection with nothing in the pelvis.

2:53

But this is really, if you look here in the pit only image,

2:56

the book is really, this is um,

3:00

Subjectivity in the ureter and then it's not.

3:03

This is the first node they see here.

3:05

See this is utic activity and there's the node here.

3:08

You start here. So, and here.

3:12

So not till the aorta, you start seeing something right

3:16

high up in theum.

3:18

So a lot of nodal disease in the abdomen,

3:21

the liver is clean as well.

3:24

Look how is that The liver is really clean

3:27

and the nodal disease tracking the me and left s region.

3:33

What is also important look at um,

3:41

zoom out so you can see

3:44

is we look at the bones, right?

3:46

Because prostate cancer loves the bone, right?

3:50

You have to make sure that there's no bone meds.

3:52

PMA wise, the pet only is negative and,

3:55

and PMA sensitive for bone mets.

3:57

It's not like xmen. We used to do do a lot of xmen

4:00

before the p cm A got a day approval

4:02

and Xmen had the limitation of um,

4:06

not being sensitive for bone meds.

4:09

So in Xmen, when we see

4:11

xmen act xmen AVID bone meds, it is bone meds.

4:14

But when we don't see any al validity in the bone,

4:18

it does not mean that there's no, uh, it had the full, uh,

4:22

negative uh, rate was high for ate.

4:25

So it doesn't exclude. There is, there's um,

4:28

bone metastasis that we're not seeing.

4:30

It's not the case with P-S-M-A-S-M-A sensitive

4:33

for bone, bone metastasis.

4:34

So, um, there's no piece morbidity.

4:38

But also we look at the bone itself here in the,

4:41

in the bone window there is really

4:44

nothing suspicious in the bone window.

4:46

So it looks like this patient is, doesn't have bone meta,

4:50

metastatic bone disease, osteo lesions.

4:53

We're seeing just strength of changes right now.

4:58

The next thing is the lung.

5:05

There were some nodules in the lung

5:08

which looked degenerative like, um,

5:13

sorry, disease.

5:16

There was some ERs disease. That's it.

5:19

There's nothing that looked metastatic diseases, the lung.

5:22

So basically this patient had

5:25

predominantly nodal disease.

5:29

That's it. This is all the patient had.

5:32

Um, BSA added nodal disease.

5:34

And the last thing I wanna talk about is this.

5:36

Here, this is contamination.

5:38

And when you see something like that, it's obviously

5:40

outside the patient, right?

5:42

And my trick here is I put the CT in the long window

5:45

and then you can see the hy pad

5:49

that the activities there to confirmation.

5:54

And that's it. This patient.