What Are The Most Common Types Of Pet Scans For Prostate Cancer
- PSMA PET Scan: Now FDA approved, they are used to locate, stage, and restage prostate cancer. PSMA PET scans have been FDA approved to be used after a diagnosis of prostate cancer in order to stage and determine if cancer has spread to other parts of the body. They have also been approved for use in locating and restaging recurrent prostate cancer for patients with biochemical recurrence.
- Axumin PET Scan: Currentlyin use primarilyfor the purpose of restaging recurrent prostate cancer in those patients with suspected biochemical recurrence.
- FDG PET Scan: May also be used for staging in particular cases of prostate cancer. In some instances, depending on the prostate cancer tumor type, FDG PET scans may be used for the restaging of recurrent prostate cancer as well.
Preparing For Your Ct Scan
A couple of hours before your scan you might need to stop eating and drinking. Tell your doctor if this is a problem for you: for example, if you have diabetes.
You might have a drink or an injection of contrast medium, or both. Contrast medium is a dye that helps body tissues show up more clearly on the scan.
Before you have the contrast medium, the radiographer asks if you have any medical conditions or allergies. Some people are allergic to the dye.
They also check the results of your most recent blood test. This is to make sure your kidneys are working well and able to flush the contrast medium out of your body. Youll have a blood test before the scan if you havent had one recently.
The radiographer explains how to drink the contrast. You usually drink the liquid slowly for about an hour before the scan.
Some people feel claustrophobic or closed in when theyre having a scan. Tell the radiographers before your appointment if you think youre likely to feel this way. They can take extra care to make sure youre comfortable.
What Does This Mean For Me
If you are newly diagnosed with prostate cancer that your doctor suspects has spread to other organs or you have completed treatment and your doctor suspects your cancer has spread, you may want to talk to your doctor if Ga 68 PSMA-11 PET testing could benefit you.
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How To Tell If Your Cancer Has Metastasized
Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.
Greater Accuracy And Changing Treatment
Approximately 300 men were enrolled in the Australian trial, all with newly diagnosed localized prostate cancer , and all were considered to have high-risk disease. For all men in the trial, the planned treatment was either surgery or radiation therapy to the prostate only.
Half the men were randomly assigned to initially undergo a CT and bone scan, and the other half to PSMA PET-CT.
Based on the imaging, PSMA PET-CT was 27% more accurate than the standard approach at detecting any metastases . Accuracy was determined by combining the scans sensitivity and specificity, measures that show a tests ability to correctly identify when disease is present and not present.
PSMA PET-CT was more accurate for both metastases found in lymph nodes in the pelvis and in more distant parts of the body, including bone. Radiation exposure was also substantially lower with PSMA PET-CT than with the conventional approach.
The trial investigators also tracked how imaging results influenced clinicians treatment choices. Based on imaging findings, the initial treatment plan was changed for 15% of men who underwent conventional imaging compared with 28% of men who underwent PSMA PET-CT.
Another key finding, Dr. Hofman noted, was that PSMA PET-CT was much less likely to produce inconclusive, or equivocal, results .
Thats important, he continued, because if you have a scan with equivocal findings, it often leads to more scans or biopsies or other tests.
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Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
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What Is It Like Having A Ct Scan
You may be asked to undress, put on a robe, and remove underwire bras, jewelry, piercings, or any other metal objects that may get in the way of the image. You may be asked remove dentures, hearing aids, hair clips, and so on, as they can affect the CT pictures.
A radiology technologist does the CT scan. Let the technologist know if you have a pacemaker, infusion port, or other implanted medical device. This will not keep you from getting a CT scan, but extra care can be taken if that area will be scanned.
The scanner is a large, doughnut-shaped machine. You lie on a thin, flat table that slides back and forth inside the hole in the middle of the scanner. As the table moves into the opening, an x-ray tube rotates within the scanner, sending out many tiny x-ray beams at precise angles. These beams quickly pass through your body and are detected on the other side of the scanner. You may hear buzzing and clicking as the scanner switches on and off.
You will be alone in the exam room during the CT scan, but the technologist will be able to see, hear, and talk to you at all times.
A CT is painless but you may find it uncomfortable to hold still in certain positions for minutes at a time. You may also be asked to hold your breath for a short time, since chest movement can affect the image.
During a CT head scan, your head may be held still in a special device. For CT colonography , air is pumped into the colon to help see the inner bowel surface. This can be uncomfortable.
How Long Does A Ct Scan Take
A CT scan can take anywhere from 10 to 30 minutes, depending on what part of the body is being scanned. It also depends on how much of your body the doctors want to look at and whether contrast dye is used. It often takes more time to get you into position and give the contrast dye than to take the pictures. After the test, you may be asked to wait while the pictures are checked to make sure they are clear and show all of the body part. If not, more pictures may be needed.
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Doctors Can See Prostate Cancer Anywhere In The Body With Psma Pet Imaging
For years, one of the most powerful molecular imaging tools, positron emission tomography , has frustrated doctors when it comes to detecting prostate cancer cells. Until recently, the available radiotracers the radioactive molecules doctors use to show cancer cells on PET scans did not routinely bind to this specific type of cancer.
We would know that a patients tumor had spread since their PSA was rising, but we wouldnt know where or how much and wed have to use our best guess when planning treatments, explained Daniel Appelbaum, MD, a radiologist and nuclear medicine physician at the University of Chicago Medicine. Now, however, a new radiotracer is capable of precisely and reliably tagging prostate cancer cells anywhere in the body. UChicago Medicine is one of the first institutions in Chicago to offer the PSMA PET scan and the only institution in the city to have participated in the CONDOR and OSPREY clinical trials that helped piflufolastat F 18, also known as Pylarify , gain FDA approval. It’s exciting because it’s the single best method we now have available to visualize prostate cancer in the body, said urologic oncologist Scott Eggener, MD. Knowing the anatomic location of prostate cancer can obviously help us make smarter treatment decisions for patients.
To now be able to see this all directly on a scan is a real game-changer in the fight against prostate cancer.
What Else Should I Know About A Ct Scan
- Although a CT scan is sometimes described as a slice or a cross-section, no cutting is involved.
- The amount of radiation you get during a CT scan is a good deal more than that with a standard x-ray.
- People who are very overweight may have trouble fitting into the CT scanner.
- Be sure to tell your doctor if you have any allergies or are sensitive to iodine, seafood, or contrast dyes.
- Tell your doctor if you could be pregnant or are breastfeeding.
- CT scans can cost up to 10 times as much as a standard x-ray. You may want to be sure your health insurance will cover this test before you have it.
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Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
When Is An Mri Appropriate
Magnetic resonance imaging or MRI uses strong magnetic fields instead of x-rays to produce images of parts of the body. MRI scans can be very helpful in looking at prostate cancer. By producing a very clear picture of the prostate gland, an MRI can show whether the cancer has spread outside the gland into the seminal vesicles or bladder. Unfortunately the cost of carrying out MRI examinations on every patient who might have prostate cancer extending beyond the prostate capsule would be enormous. Thus, from a diagnostic point of view, the important question is, When is an MRI really appropriate?
It is hard to give a precise answer to this question, but some form of MRI may be most apppropriate in a patient at clear risk for T3NxM0 or T4NxM0 disease. Such patients are unlikely to be able to receive surgery alone with curative intent. So, in order to determine whether treatment with curative intent is even possible, one needs to have the clearest possible understanding of the extent of the cancer before deciding how to proceed.
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A Note On Suspicious Results
A suspicious result indicates that the biopsy sample contained some abnormalities but no cancer was found. There are a couple of potential explanations for a suspicious prostate biopsy result, including:
- Prostatic intraepithelial neoplasia refers to changes within prostate cells that are abnormal, but not indicative of cancer. This condition is low-grade or high-grade, depending on how abnormal the cells are. Low-grade PIN is very common and isn’t associated with prostate cancer. High-grade PIN, however, is associated with a higher risk of prostate cancer. If you have high-grade PIN after a prostate biopsy, your doctor may recommend that biomarker tests be performed on the sample to learn more about the cells. Alternatively, another prostate biopsy may be suggested.
- Atypical small acinar proliferation indicates that the biopsy sample contains some cells that appear to be cancerous, but not enough to confirm the diagnosis. In most cases, this finding suggests that another prostate biopsy is needed.
- Proliferative inflammatory atrophy describes a prostate biopsy that reveals inflammation in the prostate and abnormally small prostate cells. While these cells arent cancerous, having PIA may be associated with an increased risk of developing prostate cancer.
Is The Use Of Psma Pet
Currently, FDA approval of PSMA PET-CT is for two groups of patients with prostate cancer.
These men include those who are initially diagnosed with prostate cancer with a risk for metastatic disease and also for men previously already treated for localized prostate cancer but who have a rising PSA which could indicate a tumor that has spread beyond the prostate, explained Dr. Samadi. Keep in mind that most cancers grow as obvious masses or tumors to these changes are easy to see. But prostate cancer is different. Prostate cancer cells often replace healthy prostate tissue so changes are not as obvious making a PSMA PET-CT a valuable diagnostic tool.
Take Time To Make A Treatment Decision
Most prostate cancers grow relatively slowly, so immediate treatment is rarely necessary. Many men can safely take months to decide what to do. The decision process can be complicated. The chosen treatment can significantly affect your life, which makes it especially important to take time to educate yourself and confidently choose the approach that is most appropriate for you.
Risk Factors You Can’t Control
Growing older is the greatest risk factor for prostate cancer, particularly after age 50. After age 70, studies suggest that anywhere from 31% to 83% of men have some form of prostate cancer, though there may be no outward symptoms. Family history increases a man’s risk: having a father or brother with prostate cancer more than doubles the risk. African-American men and Caribbean men of African descent are at high risk and have the highest rate of prostate cancer in the world.
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Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
Can A Ct Scan Show Metastasis
CTs are incredibly useful for diagnosing and staging cancer, checking whether it has come back, and monitoring whether a treatment is working. It’s very effective for surveying the entire body to look for places where the cancer has spread, such as the lungs, liver, or bone. These are called metastases.
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Bone Scans For Prostate Cancer Imaging
Neal Shore, MD, FACS: Is there any ongoing role for technetium-99m bone scan, Larry?
Lawrence Saperstein, MD: Thats a good question. We have the intermediate- and high-risk patients who are going to get the PSMA PET scans. Where does that leave us? With the low-risk patients getting the bone scan? That doesnt make sense. Ill defer of my clinical colleagues a bone scan historically probably was helpful in defining a baseline. Because its very insensitive. We see a lot of things on a bone scan. We see degenerative disease, as Steven said, we see old fractures, we see benign bone lesion. Establishing a baseline might be helpful, but I dont really see much utility overall.
Neal Shore, MD, FACS: OK. You ordered it, and here are your findings.
Steven Finkelstein, MD, DABR, FACRO: As you can see here there is a lesion in the prostate as was expected. The lesion on the rib is something that we wouldve called a false positive, correct, Lawrence?
Lawrence Saperstein, MD: Just 1 point getting back to that as for the audience, its important to understand this is a new modality and as we said there is a learning curve, and we want to be careful about overcalling things. These false positives or these normal variants are important to keep in mind and this is just an example of that.
Lawrence Saperstein, MD: Thats a great point. There are super modules on SNMMI website, so those will be worth looking at.
Transcript edited for clarity.
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