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Pet Scan For Prostate Cancer Recurrence

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What Is Psma Pet Scan

Tracking Recurrent Cancer | Ask a Prostate Expert, Mark Scholz, MD

The conventional imaging methods typically used for prostate cancer patents, including CT, MRI, and bone scan, have limitations when it comes to disease detection, according to Steve Huang, MD, Nuclear Medicine Department, Cleveland Clinic.

Compared with other imaging options, PSMA PET scan has greater sensitivity and can detect metastases sooner, allowing clinicians to better serve patients and make treatment decisions earlier, he says. PSMA PET scan makes it possible to see a smaller volume of cells, which allows oncologists to localize the disease and determine the best approach to treatment.

PSMA, or prostate-specific membrane antigen, is a protein on the surface of many prostate cells and it has been shown that radiotracers tagged to PSMA can identify early, low-volume sites of lymph node or distant metastases of prostate cancer, explains Dr. Tendulkar.

The first PSMA-targeted PET imaging drug for prostate cancerGallium 68 PSMA-11 was approved by the FDA in 2020 for patients with suspected prostate cancer recurrence and metastasis. This approval was based on phase III clinical trials that demonstrated a significant increase in accuracy for the detection of prostate cancer compared with standard imaging modalities. In 2021, a second FDA approval followed for Pylarify for the same indication.

Pet/ct For The Diagnosis Staging And Restaging Of Prostate Cancer

Michael Souvatzoglou1, Florian C Gaertner1, Sarah Schwarzenboeck1, Ambros J Beer1, M Schwaiger1and Bernd J Krause1,2

1Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany

2Klinik und Poliklinik für Nuklearmedizin, Universität Rostock, Germany

*Corresponding Author:

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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.

An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.

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The Initial Causes Pet Scan For Prostate Cancer Recurrence

One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.

Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.

If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.

The New Era Of Psma Pet Imaging


In the proPSMA trial Ga-PSMA-11 PETCT was compared to conventional imaging in patients with high-risk prostate cancer before curative intent surgery or radiotherapy. In this randomized study, the primary outcome was identifying either pelvic nodal or distant metastatic disease and Ga-PSMA-11 PETCT outperformed conventional imaging in accuracy , sensitivity and specificity , respectively . The diagnostic performance of DCFPyl PETCT was evaluated in the OSPREY trial in two cohorts: cohort A and cohort B . In cohort A, when lymph nodes were greater than 5 mm, the sensitivity was 60%, specificity 97.9%, positive predictive value 84.6%, and negative predictive value 92.2%. In cohort B with BCR, the PPV was 95.8% and NPV was 81.9% . Historically, CT imaging diagnostic performance in prostate cancer has a specificity of 82%, PPV of 32%, and NPV of 12%. Therefore, DCFPyl PETCT appears to outperform conventional imaging, except in sensitivity where results are similar . With improved diagnostic performance compared to conventional imaging, these two PSMA-PETCT scans can detect advanced prostate cancer earlier, which can lead to management change. Further studies are needed to evaluate and validate the utility of PSMA PETCT in this setting.

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Improved Technology For Identifying Metastatic And Recurrent Prostate Cancer

Priti Patel, CNMT, left, and Terence Wong, MD, PhD, right, meet with a patient before his PSMA PET/CT scan.

A new imaging technique is changing the way aggressive prostate cancer is identified and is making it easier for doctors to design more effective, individualized treatment plans. Duke Health was one of the first centers in the U.S. to offer prostate specific membrane antigen PET/CT imaging following FDA approval of a new radioactive tracer in May 2021. The new technology can identify cancer both in and outside the prostate gland and especially benefits men whose cancer has recurred and are at risk for it spreading to other parts of the body, even after previous treatments.

Role Of Pet Imaging For Biochemical Recurrence Following Primary Treatment For Prostate Cancer

Samuel J. Galgano, Roberto Valentin, Jonathan McConathy

Department of Radiology, Section of Molecular Imaging and Therapeutics, University of Alabama at Birmingham , , USA

Contributions: Conception and design: All authors Administrative support: All authors Provision of study material or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Abstract: Prostate cancer is one of the most common cancers in men worldwide, and primary prostate cancer is typically treated with surgery, radiation, androgen deprivation, or a combination of these therapeutic modalities. Despite technical advances, approximately 30% of men will experience biochemical recurrent within 10 years of definitive treatment. Upon detection of a rise in serum prostate specific antigen , there is great need to accurately stage these patients to help guide further therapy. As a result, there are considerable efforts underway to establish the role of positron emission tomography in the diagnostic algorithm of biochemically recurrent prostate cancer. This manuscript provides an overview of PET tracers used for the detection and localization of prostate cancer in the setting of biochemical recurrence with a focus on PET tracers that are currently being used in clinical practice in the United States.

doi: 10.21037/tau.2018.06.09

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General Example Of Pet Scan Use After A Prostate Cancer Diagnosis

PSMA PET and Functional Imaging – 2021 Prostate Cancer Patient Conference

It is important to note that while PET Scanning can be an essential tool in the assessment of prostate cancer, it is not always used on all patients, and there are many other imaging tests and procedures that may be recommended depending on the patients specific needs.

This is an example of a prostate cancer care that would include PET scanning.

  • Prostate cancer is detected by the results of screening PSA with a blood test or a DRE .
  • Prostate cancer is confirmed by a core needle biopsy with imaging either before or during the procedure.
  • In some instances, a PET scan may be used during the initial evaluation and treatment strategy. Prostate cancer is evaluated after a diagnosis using various imaging techniques to determine the extent or stage of cancer. While imaging modalities like MRIs are often used to stage prostate cancer, PET scanning has been used effectively to stage prostate cancer and new tests like PSMA PET scans continue to show promise in being the best future solutions during prostate cancer staging.
  • A PET scan is usually the most effective way to restage recurrent prostate cancer. After prostate cancer treatment, PET scanning may be used to determine the effectiveness of the treatment and is now commonly being used for the detection of biochemically recurrent prostate cancer for restaging. A specific PET radioactive tracer, Axumin, has been designed for this exact purpose of targeting and restaging recurrent prostate cancer.
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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.

    The Best Pet Scan For Finding Prostate Cancer Recurrence

    Bottom Line: This breakthrough scan is a lifesaver!


    Geo Espinosa, ND, LAc, naturopathic doctor, licensed acupuncturist and certified functional medicine practitioner in private practice, and clinical assistant professor and holistic clinician in urology, New York University Langone Medical Center, New York City. He is recognized as an authority in holistic urology and mens health and is author of Thrive, Dont Only Survive.

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    Prostatecancer recurs up to 40% of the time within ten years after initial treatment. Butuntil recently, there has not been a test that could detect a recurrence beforethe cancer is already at an advanced stageand harder to treat. Good news: A new kind of scan finds prostate cancer recurrence months or even yearsbefore other tests can. If you has been treated for prostatecancer, heres what you need to knowit could save your life.

    The good news is that there is now a new kind of PET scan that can detect recurrence at much earlier stages than any other test currently availablewith tremendous lifesaving potential. But first, some background on PET scans.

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    How Is Prostate Cancer Treated

    There are many treatment options for cancer limited to the prostate gland. You and your doctor should carefully consider each option. Weigh the benefits and risk as they relate to the aggressiveness and/or stage of the cancer as well as your age, overall health, and personal preferences. Standard treatments include:

    • Surgery : The surgeon makes an incision in the lower abdomen or through the perineum and removes the prostate. If they cannot remove the entire tumor, you may need radiation therapy. You will need to keep a urinary catheter in place for several weeks after the procedure. Possible side effects can include incontinence and impotence. Some surgeons may use three small incisions to do robot-assisted prostatectomy. This may result in a shorter hospital stay and quicker recovery. This procedure may be preferable for some patients, but not for all.
    • External beam therapy : a method for delivering a beam of high-energy x-rays or proton beams to the location of the tumor. The radiation beam is generated outside the patient and is targeted at the tumor site. These radiation beams can destroy the cancer cells, and conformal treatment plans allow the surrounding normal tissues to be spared. See the External Beam Therapy page for more information.
    • Active surveillance: No treatment, with careful observation and medical monitoring.

    Advanced treatment options may avoid or minimize some of the side effects associated with standard therapies. These options include:

    Medical History And Physical Exam


    If your doctor suspects you might have prostate cancer, he or she will ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.

    Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.

    After the exam, your doctor might then order some tests.

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    Prostate Specific Membrane Antigen Ligands

    PSMA is a transmembrane protein expressed by the prostate and overexpressed in prostate cancer . PSMA has long been a target for imaging patients with metastatic prostate cancer and was originally the target of indium capromab pendetide , a radiolabeled monoclonal antibody targeting the intracellular portion of the transmembrane PSMA protein. Although this was an improvement at the time over existing imaging techniques, the sensitivity and specificity of the examination were significantly limited due to the targeting of the intracellular portion of the PSMA protein which permitted radiotracer binding only in the setting of cellular apoptosis or necrosis . An additional practical limitation was that the kinetics of indium capromab pendetide mandated imaging at 57 days following radiotracer injection.

    Figure 6

    Psa Can Indicate Prostate Cancerrecurrence

    However, there isone situation in which a rising PSA can only mean that prostate cancer is backafter treatment. When the prostate gland is completely removed , radiated or ablated, its called radical treatment . When radical treatment issuccessful, there are no more functional prostate cells. Therefore, it isexpected that within a short time after radical treatment, a mans PSA will be undetectable.Noprostate cells, no PSA. Noprostate cancer cells, no PSA. This is why a man must have an annual PSA testafter PCa treatment. Its a safety check to make sure that the communicationdevice is on radio silence.

    However, adetectable PSA after radical treatment is the first blip on the PCa radarscreen. Before setting off an alarm, its normal to repeat the PSA test withina few weeks or months. If it is still detectable, or even a little higher,there is a suspicion that PCa is back. This is called biochemical recurrence because PSA is a biomarker for PCarecurrence. But the most important question is, Where is it? Before sending in a SWAT team, the medical detectives haveto pin down the location.

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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.

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    Pet/ct Vs Pet/mri For Prostate Cancer

    Biochemical Recurrence After Local Therapy: Assessment and Management

    PET/MRI scanners are being implemented throughout the world for routine clinical applications with increasing frequency. These scanners are capable of acquiring PET and MRI data simultaneously with the potential for more accurate image co-registration. In the setting of biochemical recurrence following both prostatectomy or definitive radiation therapy, MRI of the pelvis remains a cornerstone of evaluation for potential sites of local recurrence owing to its superior soft tissue contrast. Given the development of multiple PET radiotracers that show excellent sensitivity and specificity for recurrent prostate cancer , it is logical that PET/MRI may become the optimal imaging modality for patients with biochemically recurrent prostate cancer. Several studies have shown a high detection rate of PET/MRI for pelvic recurrence in the setting of biochemical recurrence . As PET/MRI scanners become increasingly common, further research is needed to demonstrate the added value of PET/MRI both in the pretreatment and posttreatment settings.

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