Which Method Is Best
To return to Craigs situation, his direct question to the urologist is warranted. Both scanning methods are game-changers for early detection of biochemical recurrence, because they facilitate treatment plans with the greatest chances for success. However, if his doctor has been following the research, he would be likely to prescribe Gallium 68 PSMA-11 rather than Axumin.
As of this writing, the use of Gallium 68 PSMA-11 appears to offer more accuracy than Axumin, with the possible exception of localized recurrence near the bladder. The timing is right for Craig. As of Dec. 1, 2020, Gallium 68 PSMA-11 is FD-approved for PET imaging of post-treatment prostate cancer patients whose PSA is rising . It is also approved for untreated patients who are suspected of having advanced or metastatic prostate cancer at the time of diagnosis.
With luck, Craigs scan will pinpoint one or two lesions that can be well managed by a urological oncologist, possible with curative effect. We join patients like our fictitious Craig whose advanced or recurrent prostate cancer can now be detected very early, thanks to Gallium 68 PSMA-11.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
Hormone Therapy With Radiation
Prostate cancer cells need testosterone to grow. Hormone therapy aims to drastically lower testosterone levels to slow the cancers progression. Although it does not cure the cancer on its own, hormone therapy improves the effectiveness of radiation for high-risk disease and is often recommended in conjunction with radiation therapy for men with intermediate- or high-risk localized disease. However, hormone therapy may have significant side effects. These include loss of libido , hot flashes , changes in mood or memory, loss of bone and muscle density, body fat gain, and adverse effects on sugar or cholesterol metabolism. When offered as short-term therapy in conjunction with radiation, it is often well tolerated. How long a patient should receive hormone therapy remains controversial and depends on how aggressive his cancer is.
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Pet Scanning For Prostate Cancer
If you or a loved one has been diagnosed with any type of cancer, there are often many questions left unanswered. For those diagnosed with prostate cancer, a doctor may suggest having a PET scan as a part of an overall plan for treatment and monitoring for any recurrence or progression of disease. We hope this article may be a resource and help answer a few of the most common questions that we receive regarding PET scanning for prostate cancer.
With prostate cancer being the second leading cause of cancer death in American men , new advances in early detection and high-quality imaging for staging and restaging of prostate cancer have become a top priority for the medical community. Comprehensive cancer care requires high-quality imaging and is the driving force behind rapid and ongoing advancements in imaging techniques used for prostate cancer. In recent years, PET scanning for prostate cancer has become an increasingly popular choice to clearly locate and assess the extent of prostate cancer. While there have been many improvements across many conventional imaging modalities such as TRUS, CT, and MRI, this article is intended to highlight the essential role of advanced imaging such as PET scanning for prostate cancer.
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Why Dont Older Scans Work
Prostate cancer, when it spreads, tends to spread sequentially, first to the lymph nodes in the pelvis then, as the PSA rises higher and higher, to the bones. With standard CT and MRI scans, detecting lymph node enlargement required tumors more than a half-inch in diameter. Axumin works by detecting the metabolic activity of the cancer rather than the tumors size. As such, it can detect tumors as small as a quarter-of-an-inch.
The Axumin PET scan is a spectacular technological advancement. In light of the recent advancements in radiation, which can now target lymph nodes safely with minimal side effects, Axumin provides the missing information the radiation therapist needs to accurately target the cancer.
What Are The Advantages And Disadvantages Of Having An Mri Scan Before A Biopsy
- It can give your doctor information about whether there is cancer inside your prostate, and how quickly any cancer is likely to grow.
- Its less likely than a biopsy to pick up a slow-growing cancer that probably wouldnt cause any problems in your lifetime.
- It can help your doctor decide if you need a biopsy if theres nothing unusual on the scans, this means youre unlikely to have prostate cancer that needs to be treated. You may be able to avoid having a biopsy, and its possible side effects.
- If you do need a biopsy, your doctor can use the scan images to decide which parts of the prostate to take samples from.
- If your biopsy finds cancer, you probably wont need another scan to check if it has spread, as the doctor can get this information from your first MRI scan. This means you can start talking about suitable treatments as soon as you get your biopsy results.
- Being in the MRI machine can be unpleasant if you dont like closed or small spaces.
- Some men are given an injection of dye during the scan this can sometimes cause mild side effects.
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Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
Increased Hope For The Future
The advent of improved cancer scanning with Axumin increases hope that other new types of scanning breakthroughs will be coming in the near future. For example, other types of PET scans, one in particular called PSMA, targets a specific molecule that is commonly present on the surface of prostate cancer cells. The potential advantage of PSMA extends beyond its usefulness for imaging it has a potential therapeutic application as well. PSMA ligands can be linked to more powerful radioactive substances that are strong enough to kill the cancer cells.
The prostate cancer community eagerly waited for scans to identify prostate cancers location in the body with the type of accuracy that these PET scans can achieve. These scans represent a remarkable breakthrough. Now that the FDA has approved this technology, insurance companies start exploring ways to offer coverage. Medicare was the first insurance company to cover it.
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What Is The Axumin Prostate Cancer Scan
Axumin is an FDA-approved PET/CT scan used to capture recurrent prostate cancer in men with rising PSA who had prostate cancer treated via surgery or radiation. Unlike CT or bone scans, which require accelerations of PSA levels to 10 50 to identify cancer, Axumin can be used in men whose levels are 10 and even well below, for earlier testing and discovery than ever before. Because it is a nuclear scan, Axumin can also determine the exact location of prostate cancer while it is still very tiny, and differentiate between a contained, local recurrence and a more aggressive, systemic recurrence that has metastasized to other areas, assisting in ideal treatment. In men with rising PSA after previous prostate cancer treatment, the test is 100% covered by Medicare.
The Axumin scan utilizes positron emission tomography with computed tomography, also called PET/CT, a nuclear medicine imaging tool that can pinpoint metabolic activity within the body. This painless, noninvasive test introduces a radiotracer into the body via injection in the arm, where it travels to cancer cells and areas of inflammation for rapid discovery. Because prostate cancers absorb amino acids at an accelerated rate compared to healthy cells, Axumin is able to link its radiotracer to amino acid activity, capturing recurring cancer in the prostate region, as well as other areas of the body where it may have spread.
The Implications Of A Psa Relapse
PSA has been on the market for over 30 years, and we have learned several important things about what a rising PSA after surgery or radiation means:
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Why Axumin Is So Important
Being able to detect early metastatic disease with a scan offers two important therapeutic advantages. First, the knowledge of where the cancer is located can help guide effective therapy to that specific area of the body and limit damage to other areas of the body. The scan detects where the cancer is not present and where treatment is not needed.
The second valuable contribution that an accurate scan offers is a deeper insight into the disease process itselfrevealing whether or not the cancer has metastasized, and if it has metastasized, to what degree.
Recurrent cancer signaled by a rising PSA is not always due to metastases. Sometimes the cancer remains near or in where the prostate used to be, so PSA is coming from cancer recurring in the prostate gland after radiation or in the prostate fossa after surgery , which is known as a “local recurrence.”
PSA can also be elevated due to growing cancer that has metastasized to the lymph nodes or bones. This is called a systemic recurrence. Systemic recurrences are tremendously more dangerous than local recurrences. Why? A metastasis shows that the cancer has the biologic capacity to spread around the bodya process that ultimately leads to death in more than half of prostate cancer patients. Thus, knowing the location of the recurrence answers an extremely important question: whether the recurrent disease is aggressive enough to metastasize.
Ai Tool Analyzes Ct Scans To Spot Prostate Cancer In Seconds
Continuous advances in artificial intelligence promise to shake up medical care in all kinds of exciting ways, with the ability to rapidly scan medical images and spot signs of disease far more efficiently than humans can. Scientists in Australia have now adapted this technology for the early detection of prostate cancer, with their software outperforming trained radiologists to detect cancerous growths in seconds.
For many medical ailments, an early diagnosis can greatly improve the treatments available and therefore the chances of overcoming them. Improvements in machine learning and computing power have led to highly capable forms of artificial intelligence that could be invaluable in this regard. Weve seen AI tools that can improve an ECGs ability to reveal heart dysfunction, more accurately predict survival rates of ovarian cancer and just this week, calculate diabetes risk by measuring fat around the heart.
The latest example of this comes from researchers at Melbournes RMIT University and St Vincents Hospital, who started with CT scans of asymptomatic patients both with and without prostate cancer. The scientists note that, generally speaking, CT scans are useful for detecting ailments like bone and joint problems, but it is difficult for radiologists to use them to detect prostate cancers.
The research was published in the journal Scientific Reports.
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Interpretation Of Axumin Scans
Interpretation for PET/CT examinations using Axumin are different from standard FDG PET/CT imaging. Axumin specific training is available and is recommended for every interpreting physician. Below is a general guideline for interpretation, taken from Blue Earth Diagnostics Axumin site:
Prostate Bed Focal uptake, visually equal to or greater than bone marrow, in sites typical for prostate cancer recurrence is suspicious for cancer. If focus of uptake is small , it may be considered suspicious if the uptake is visually greater than blood pool.
Prostate Bed Moderate focal asymmetric uptake, visually equal to or greater than bone marrow, is suspicious for cancer recurrence. If focus of uptake is small and in a site typical for recurrence, it may still be considered suspicious if the uptake is visually greater than blood pool.
- Diffuse and heterogeneous uptake visually greater than blood pool is suspicious for cancer.
- Diffuse and homogeneous uptake visually greater than bone marrow is suspicious for cancer.
Lymph Nodes Uptake, visually equal to or greater than bone marrow, is considered suspicious for cancer. If node is small and in a site typical for recurrence, it may still be considered suspicious if visually greater than blood pool. If borderline visually, quantitation using a node to background ratio may help.
Image interpretation is predominantly qualitative but, for areas of borderline increased uptake, an uptake ratio may be supportive.
Now Offering Axumin Pet Ct For Imaging Of Recurrent Prostate Cancer
Since one in seven men have prostate cancer, and a third of those treated will experience recurrence, early detection and treatment are important to their health. One main marker of prostate cancer is prostate cancer antigen , a protein that is often elevated in men with prostate cancer. When PSA in the blood indicates that the patient may have prostate cancer, a standard body or bone scan is usually done in order to see where the cancer is. However, these tests are unable to determine the location of cancer until PSA levels are increasingly elevated since the standard FDG PET CT scans are severely limited in uptake for prostate cancer. Axumin PET scans offer a significant advantage- the ability to detect recurrent cancer earlier on as well as a clearer picture of cancers progression, indicating whether or not or to what degree it has metastasized and where it is located.
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Options For Dealing With Recurrence
With a persistently increasing PSA, the suspicion for recurrence increases. The most important factor in assessing your long-term outcome is determining the location of the prostate cancer cells producing the PSA. Advanced imaging techniques, such as MRI and PSMA PET/CT, are often helpful in learning where the cancer is located, and in the case of post-radiation recurrence, repeat biopsy may be required.
If a man underwent surgery as an initial treatment, revisiting the post-operative pathology report may help to identify what contributed to the recurrence. If there was still cancer present , the cancer was aggressive , or genomic profiling of the tumor showed high-risk features, several options are available:
- EBRT to the prostate bed with or without the pelvis.
- EBRT accompanied by hormone therapy. The duration of hormone therapy will depend on the PSA level just prior to radiation and to a lesser extent on the Gleason score and staging of the cancer.
- Systemic treatment using hormone therapy, other treatments for those at risk for metastatic disease, or a combination.
- Active surveillance if the remaining cancer appears insignificant. You and your doctor can decide whether to intervene more aggressively and, if so, when.
If youre seeking additional or different approaches, you may be eligible to participate in an appropriate clinical trial . You can research this with the help of your doctor.
Axumin Pet Agent Added To Nccn Guidelines For Suspected Recurrent Prostate Cancer
Guidelines state PET/CT or PET/MRI with F-18 fluciclovine should be considered in clinical workup of patients with recurrent or progressing prostate cancer
February 21, 2018 Blue Earth Diagnostics announced that Axumin injection has been added to the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Prostate Cancer . These updated NCCN Guidelines state that F-18 fluciclovine positron emission tomography/computed tomography or PET/magnetic resonance imaging scans should be considered in the clinical workup of patients with recurrence or progression of their prostate cancer. This recommendation is based on uniform NCCN consensus that the intervention is appropriate.
Axumin is a novel molecular imaging agent indicated for use in PET imaging to identify suspected sites of prostate cancer recurrence in men who have elevated blood levels of prostate specific antigen following prior treatment. It is the first FDA-approved F-18 labeled PET scan agent indicated in patients with suspected recurrent prostate cancer.
Axumin received Transitional Pass-Through Status in the Hospital Outpatient Prospective Payment System 2017 Final Rule from the Centers for Medicare & Medicaid Services , effective since Jan. 1, 2017. This also provides a product-specific A-code for use with Medicare and private insurer patient claims. Axumin is currently available from 18 radiopharmacies throughout the United States, with additional manufacturing sites planned for 2018.
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