New Scan For Prostate Cancer

New Prostate Cancer Blood Test

If you have an abnormal PSA score, your doctor may recommend another newertest that gives a better sense of yourprostate cancer risk. The prostate health index is one such test that is a more accurateblood test and measures your risk for having prostate cancer. Its approvedby the FDA for men who have PSA scores between 4 and 10.

What are the benefits of the PHI test?

• Fewer unnecessary biopsies: Some men who have elevated PSA scores are unsure about getting an invasive biopsy. This tool can be used to better determine whether your risk is high enough to warrant a biopsy.
• More accurate: This test is better at detecting prostate cancer. It can also detect whether you have a more aggressive type of cancer. This information can guide doctors to a more targeted treatment plan for you.

If you score low on the PHI test, your doctor may recommend monitoring youover time to see if your levels rise enough to cause concern.

Why Are Breakthroughs Occurring More Frequently

The reason for the acceleration in the frequency of breakthroughs is the culmination of extensive basic research leading to a deeper understanding of cellular biology of prostate cancer. More specifically, the specific genetic mutations that cause uncontrolled cellular growth have been elucidated.

Mutated genes are what makes cancer cells different from normal cells. Now that these mutations can be identified, new medications can be designed to compensate for the abnormally functioning genes. Think of how a software patch might be written by a computer programmer to fix a computer glitch.

In prior years, before our arrival at our present-day understanding of cell biology, new medicines were the result of an arduous, trial and error developmental process. A randomly selected chemical would be administered to cancer cells growing in Petri dishes. If the chemical caused the cancer cells to die, it would be administered to animals with cancer. If the cancer regressed and the animal lived, it would be tested in humans. Successful human trials would then lead to FDA approval and the commercial availability of a new treatment.

Unlike the rationally-designed medications of recent times, the way that these medications discovered by trial and error function was often unknown.

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The new technique uses a tracer molecule that seeks out a protein found on most prostate cancer cells called prostate-specific membrane antigen, or PSMA. The tracer, which is injected into the bloodstream, lights up those cells during a PET scan.

A similar tracing agent, which also seeks out PSMA, was approved by the FDA in December for use at two California hospitals: the University of California, Los Angeles and the University of California, San Francisco. The facilities had been researching this kind of technology since 2015.

“We’ve been using it for many years and it works great,” said Dr. Thomas Hope, director of molecular therapy in UCSF’s Department of Radiology and Biomedical Imaging. “We can actually see where the disease is and now people are getting targeted radiation.”

“It’s redefining how we think about prostate cancer,” he said.

The new approval will be the first such tracer for advanced prostate cancer commercially available nationwide.

The scan isn’t meant to replace PSA testing, a common prostate cancer screening tool. PSA stands for prostate-specific antigen, a protein found in the blood. Instead, it’s meant for men who have already been diagnosed with the disease.

While Wei and other prostate cancer experts agreed that the imaging would give them more information about metastatic cancer, it remains unclear what they should do with the information.

And not all metastatic prostate cancers will threaten a man’s life.

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How To Get A Psma Pet Scan

• PSMA PET scans are offered at UCSF Radiology China Basin location in the San Francisco Bay area.
• For UCSF patients, please reach out to Radiology Scheduling directly to schedule your PSMA scan.
• For non-UCSF facilities referring patients that are new to UCSF, please fax the following to 353-7299 for patient registration to be completed prior to scheduling:
• Patient Exam Order
• Insurance Information and Authorization

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

Gleason score

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What Is The Psma Pet Scan For Prostate Cancer

The PSMA PET scan is a test that can help your doctor learn if and where prostate cancer has spread outside your prostate gland, including to your lymph nodes, other organs, or bones.

PET scans are a type of imaging test that use special dye with radioactive tracers to make cancer cells show up more clearly.

The PSMA PET scan uses radioactive tracers that bind to prostate-specific membrane antigen . This is a protein thats found in high levels on the surface of prostate cancer cells.

The Food and Drug Administration has recently approved the following PSMA-targeted tracers:

Researchers are studying other PSMA-targeted tracers, which might be approved in the future.

Is Psa The Same As Psma

The PSA test is different from the PSMA PET scan.

The PSA test is a blood test that measures the level of PSA in your blood. PSA is a protein produced by cells in your prostate gland. High levels of PSA are often a sign of prostate cancer.

The PSMA PET scan is used after PSA testing if your doctor isnt sure if or where prostate cancer has spread. It can more accurately pinpoint where prostate cancer cells are located throughout the body.

Your doctor may order a PSA blood test to:

• screen for prostate cancer if you dont have symptoms of the disease
• determine whether further tests are necessary to diagnose prostate cancer if you do have symptoms of the disease
• check for signs that prostate cancer has come back if youve received successful treatment for the disease

PSA blood test results are not enough to diagnose prostate cancer or learn whether it has spread or returned. If you have high levels of PSA, your doctor will order other follow-up tests to develop an accurate diagnosis.

Your doctor will only order a PSMA PET scan if they think you may have prostate cancer that has spread beyond the prostate gland.

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Psa Test: The Current Prostate Screening Standard

Before recommending when you should be screened for prostate cancer, yourdoctor will consider many factors, such as:

• Family history, particularly whether any of your family members have had prostate cancer
• Race, as African-American men have a higher risk of developing prostate cancer

If your doctor determines you should undergo screening, he or she will mostlikely recommend the PSA test. For more than 30 years, the PSA test hasbeen the gold standard in prostate cancer screening. This simple blood testmeasures how much prostate-specific antigen is in your blood.

When You Need Themand When You Dont

It is normal to want to do everything you can to treat prostate cancer. But its not always a good idea to get all the tests that are available. You may not need them. And the risks from the tests may be greater than the benefits.

The information below explains why cancer experts usually do not recommend certain imaging tests if you are diagnosed with early-stage prostate cancer. You can use this information to talk about your options with your doctor and choose whats best for you.

How is prostate cancer usually found?

Prostate cancer is cancer in the male prostate gland. It usually grows slowly and does not have symptoms until it has spread. Most men are diagnosed in the early stages when their doctor does a rectal exam or a PSA blood test. PSA is a protein made in the prostate. High levels of PSA may indicate cancer in the prostate.

If one of these tests shows that you might have prostate cancer, you will be given more tests. These tests help your doctor find out if you actually have cancer and what stage your cancer is.

What are the stages of prostate cancer?

Prostate cancer is divided into stages one to four . Cancer stages tell how far the cancer has spread.

Stages I and II are considered early-stage prostate cancer. The cancer has not spread outside the prostate. However, stage II cancer may be more likely to spread over time than stage I cancer. In stages III and IV, the cancer has already spread to other parts of the body.

Imaging tests have risks.

09/2012

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Axumin Pet Scanning For Prostate Cancer Care

Axumin is an FDA-approved agent used for Axumin PET scans for prostate cancer. Axumin is often able to image and restage recurrent prostate cancer better than any other conventional imaging techniques. Biochemical recurrence, typically suspected with rising PSA levels, is the standard in monitoring patients for suspected recurrent prostate cancer. Traditional imaging techniques are often limited in that they may detect a small lymph node or suspicious finding, but cannot further functionally characterize the molecular activity to determine the level of suspicion. The introduction of Axumin PET scanning has been a breakthrough, allowing physicians the ability to accurately locate and restage prostate cancer with precision, especially in the setting of suspiciously rising PSA levels.

How Do Axumin PET Scans Work?

An Axumin PET uses a radioactive tracer, given as an injection, that is linked to an amino acid which is absorbed by prostate cancer at a much more rapid rate than normal cells. The rapid uptake of Axumin by prostate cancer cells is then imaged by the advanced technology within the PET scan equipment. The PET scan images are then reviewed in order to determine if there has been any spread to other areas in the body.

How Does The Psma/pet Differ From Other Imaging

From the patient perspective, no additional side effects or treatments are associated with receiving this new technology. Maroni explains, This provides extra information that stages their cancer more accurately. Its not any quicker. More accurate? Very.

This provides extra information that stages their cancer more accurately.

Its not any quicker. More accurate? Very.

The standard imaging technique used to test for metastatic prostate cancer includes a diverse list of diagnostic testing that includes:

• Bone Scans Prostate Cancer can spread to areas outside the prostate gland. Advanced cancer can spread to the bones.
• Computed Tomography Scans Contrast injection follows a form of X-ray to provide a cross-section of the pelvic region.
• Magnetic Resonance Imaging Utilizes using powerful magnets to scan soft tissue and tumors for internal imaging.
• Positron Emission Tomography scans Injection of a radioactive tracer followed by scanning procedure.

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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 .

How Will This New Technology Change The Care Of Prostate Cancer Patients

This is a major advance in diagnostics for prostate cancer, which is a very common disease. It is the biggest advance in prostate cancer detection since the PSA test was developed in the 1980s, and it will benefit people across the spectrum of the disease. In fact, PSMA-based imaging has already been approved in other countries, and they have already migrated to this new approach.

Imaging has been the Achilles heel of prostate cancer because the disease is hard to detect after it has spread. For example, the disease often spreads first to the lymph nodes in the pelvis, but the only way to tell is when the node increases in size, after the cancer has been there a while. Prostate cancer also commonly spreads to bones, but you cannot see the actual cancer cells with conventional imaging methods. Before, the only way to tell it was there was indirectly by seeing the bone react to damage from the cancer cells by growing new layers of bone. With PSMA PET, we can now detect the cancer cells directly, and much earlier than we could with standard imaging.

There is an entire generation of clinical trials designed around this new type of imaging, including at MSK. The benefit this will bring to patients cannot be overstated, and we are very excited about the possibilities for the field.

Michael J. Morris discloses the following relationships and financial interests:

• Advanced Accelerator Applications USA

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Closer To The Holy Grail

Currently PSMA PET/CT is not intended to be a screening tool. It is for those who have been diagnosed with prostate cancer and who either have a higher chance of it spreading or who have a recurrence and a rising PSA level after initial treatment. It is for men with suspected metastatic disease in their pelvis — for instance, in their lymph nodes, or outside of their pelvis in more distant lymph nodes, bones, or organs.”

“Our goal is to identify these sites early and to improve cure rates even though theyve had a relapse, so being able to see the disease is important knowledge, said Dr. Armstrong. Dr. Wong agreed. This advancement is much closer to the holy grail of precision and personalized medicine and will have a big impact on patient decision making and treatment options.

Prostate Cancer: Advancements In Screenings

You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.

What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.

Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.

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Improved Survival Largely Safe For Patients

The VISION trial enrolled 831 people with metastatic castration-resistant prostate cancer. All of them had previously been treated with chemotherapy and other standard treatments, such as enzalutamide and abiraterone . In addition, all participants had PSMA-positive tumorsthat is, their tumors overproduced PSMAas determined by PSMA PET imaging.

Trial participants were randomly assigned to receive treatment with 177Lu-PSMA-617 along with their physicians choice of treatment, which had to be among several commonly used options for cancers no longer responding to other established treatments, or their physicians treatment choice alone.

Physicians’ choices of treatment could not include chemotherapy or radium-223 , a radiopharmaceutical specifically used to treat bone metastases in patients with prostate cancer. The typical options included enzalutamide or abiraterone as well as palliative treatments, like radiation and steroids, Dr. Morris explained in an interview. Under the trials design, doctors could adapt treatment as they felt necessary.

We were trying to mirror practices in this particular context, he said. If the patient needed a change, they could go from one treatment to another.

In addition to improving how long patients lived overall, participants treated with 177Lu-PSMA-617 also had improved progression-free survival, which is how long somebody lives without their cancer getting worse: 8.7 months versus 3.4 months.

When And Why Are Pet Scans Used For Prostate Cancer

• Staging: A PET Scan is used for patients with known prostate cancer in order to pinpoint its exact location and to determine the extent of disease and to determine a treatment strategy.
• Planning Treatment: In some instances, a PET scan may be used to specifically target certain high-risk areas for special treatment. There are occasions when a PET scan is the only diagnostic test that can identify these otherwise hidden areas of cancer spread.
• Evaluation During and After Treatment: A PET Scan can be used during and after treatment of prostate cancer to determine the effectiveness or response of specific drugs and therapies.
• Ongoing Cancer Care After Detection of Biochemically Recurrent Prostate Cancer Restaging:A PET scan allows physicians to locate and assess the extent of recurrent prostate cancer. Specifically, a new radiopharmaceutical called Axumin has a superior ability to detect recurrent prostate cancer, even in very early stages and in patients with low PSA levels.

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