Wednesday, December 7, 2022

Pet Scan For Recurrent Prostate Cancer

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What Is Psma Pet Scan

Fluciclovine (18F) PET/CT Impact on Clinical Management of Recurrent Prostate Cancer

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.

Will An Abdominal Ct Scan Show Back Problems

Our study suggests that abnormalities of the lumbar spine can be accurately detected on abdominal CT studies. The sensitivity, specificity, ppv, npv and accuracy of abdominal CT in lumbar spine evaluation on a per patient/per finding basis were 89.7/95.3%, 97.3/100%, 99.0/99.2%, 76.6/99.8% and 91.7/99.8%, respectively.

Why Ct Scans Just Wont Cut It

On top of that, there are other reasons why cancer diagnoses and treatment plans based on a CT scan are far less accurate and effective than those based on better tests that are available to you now!

So when your cancer diagnosis and treatment plan is based on a CT scan, its appropriate for you to want more information and to wonder if there might be something more you can do to have better confidence and control over what is happening to you.

A cancer diagnosis is overwhelming for the best of us!

It makes perfect sense that if youve gotten a cancer diagnosis, you might feel too overwhelmed with emotion to want to start to tackle the logistics involved in getting the best possible treatment. Where would you even start, right?

Butyou probably already know exactly what you DONT WANT! And that is a good start

  • You dont want to constantly be wondering whats happening in your body.
  • You dont want to be worrying if your treatment is the right one or if its working.
  • You dont want to be anxious all the time, because you dont know if your cancer is starting to grow elsewhere or if your tumors are shrinking.
  • And you sure as heck dont want to be wondering for the rest of your life if you are truly cancer freeRight?

We understand how you feel, and we are here to help you. You do not need to do this alone.

We believe that knowledge is power.

Nina Ostend, client Damian Latch, client and colon cancer survivor

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Psma Pet Imaging Of Recurrent Prostate Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Recruitment Status : Active, not recruitingFirst Posted : June 29, 2017Last Update Posted : August 2, 2022
Condition or disease
Drug: Ga-HBED-iPSMA PETDiagnostic Test: PET/CTDiagnostic Test: MRI Phase 2
Layout table for study information

Study Type :
PSMA PET Imaging of Recurrent Prostate Cancer
Actual Study Start Date :
  • Disease localization by PSMA PET/MR
  • PSA relapse free survival in patients undergoing PSMA PET/MR guided SRT
  • Incidence of Treatment-Emergent Adverse Events assessed by common terminology criteria for adverse events The safety and tolerability of 68Ga-HBED-iPSMA will be followed by assessing the incidence, nature and severity of toxicities by common terminology criteria for adverse events
  • Information from the National Library of Medicine

    Layout table for eligibility information

    Ages Eligible for Study:

    When Further Treatment Is Needed

    11C

    While prostate cancer diagnosis and treatment have improved significantly in recent years, the cancer can still recur. Thats why it is essential that you and your doctor continue to monitor your PSA on a quarterly basis for some period of time, no matter how successful your treatment seems to be. Patients usually can consider a number of treatment options to treat or control recurrent cancer. Choosing among them requires a new decision-making process.

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    What Are The Benefits Of Psma Pet Treatment At Ucsf

    • FDA approved imaging technique for prostate cancer.
    • The PSMA PET scan can identifiy cancer that is often missed by current standard-of-care imaging techniques.
    • The PSMA tracer can also be used in conjunction with CT or MRI scans.
    • UCSF is only one of two medical centers in the U.S. that offers the FDA approved PSMA PET.
    • PSMA PET is more effective and precise for localizing mestatic prostate cancer.
    • UCSF researchers, along with colleagues at UCLA, studied PSMA PET for several years to better precisely locate prostate cancer.
    • PSMA PET works using a radioactive tracer, called 68Ga-PSMA-11, which is manufactured on site at UCSF.

    Emerging And Experimental Pet Radiotracers For Prostate Cancer

    Gastrin-releasing peptide receptor is a current investigational target for prostate cancer imaging . GRPR is overexpressed in prostate cancer cells, but demonstrates lower levels of expression in benign prostate tissue . Increases in GRPR expression have been shown to be present in 63100% of intraprostatic prostate cancers and 5085% of nodal and osseous metastases . To target and image GRPR overexpression, several peptide-based bombesin and gastrin-related peptide analogs have been developed and labeled with a number of radioisotopes . A recent study examined the use of RM2-PET/CT in patients with known biochemical recurrence and negative or equivocal fluoroethylcholine-PET/CT and demonstrated that RM2-PET/CT was helpful in localizing the recurrence in a majority of the cases . An additional study examining the use of a 68Ga-labeled bombesin analog for PET/CT in patients with both initial diagnosis of prostate cancer and biochemical recurrence demonstrated a sensitivity of 88%, specificity of 81%, and accuracy of 83% for primary prostate cancer and 70% sensitivity for detection of metastatic lymph nodes . The same bombesin analog also correctly identified two of three cases of local recurrence both in the prostatectomy surgical bed and regional lymph nodes when compared to acetate-PET/CT . Similar to PSMA ligands, bombesin agents are being examined for their potential theranostic capabilities in delivering targeted radiation via alpha-emitters or beta-emitters .

    Figure 7

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

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

    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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    Pet/ct Vs Pet/mri For Prostate Cancer

    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.

    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.

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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.

    Are you looking to learn more about PSMA PET scanning for prostate cancer? If you are in need of a PSMA PET Scan please join our priority list by

    Side Effects Of Radical Prostatectomy

    Imaging Locally Advanced, Recurrent, and Metastatic Prostate Cancer: A ...

    The most common side effects of the procedure are incontinence and erectile dysfunction . The incontinence, though common early after surgery, usually goes away. Whether erectile function returns depends on whether the nerves surrounding the prostate can be spared at surgery, patient age and baseline function. Men who are older or already have erection problems are most likely to have erectile dysfunction afterward.

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    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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    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:
    E-mail:

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    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.

    Preparation For A Ct Scan

    Prostate Cancer Initial Staging and Evaluation of Recurrent Disease with PSMA-Targeted PET

    Some CT scans need special preparation beforehand.

    For most scans, you have a drink or an injection of contrast medium, or both. This is a dye that shows up body tissues more clearly on the scan. You have the injection through a small thin tube in your arm. The tube is left in place until after your scan, in case you have any problems after having the injection.

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    What Does A Ct Scan Show

    CT scans show a slice, or cross-section, of the body. The image shows your bones, organs, and soft tissues more clearly than standard x-rays.

    CT scans can show a tumors shape, size, and location. They can even show the blood vessels that feed the tumor all without having to cut into the patient.

    Doctors often use CT scans to help them guide a needle to remove a small piece of tissue. This is called a CT-guided biopsy. CT scans can also be used to guide needles into tumors for some types of cancer treatments, such as radiofrequency ablation , which uses heat to destroy a tumor.

    Biopsy During Surgery To Treat Prostate Cancer

    If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .

    The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.

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    Highly Sensitive New Type Of Prostate Cancer Scan Gains Fda Approval

    What this means for patients:Today, a new type of prostate cancer scan known as 68Ga-PSMA-11 PET was approved by the FDA. This new PSMA PET scan can detect prostate cancer metastases much earlier, when they are much smaller, which may help to improve treatment of patients with prostate cancer.

    PSMA, short for Prostate Specific Membrane Antigen, is a protein that is found in relatively larger amounts on the surface of prostate cancer cells. PSMA PET is a new imaging technology that allows doctors to see PSMA using a PET scanner. Compared to the scans currently used for prostate cancer detection, such as CT, bone scans, and MRI, PSMA PET is more sensitive and can detect much smaller prostate cancer metastases. PSMA PET can now be used for initial and subsequent management decisions in patients with certain types of prostate cancer, in order to determine if and where they have metastases. Researchers are studying how PSMA PET may change treatment and, ultimately, patient outcomes like disease progression and survival.

    How does it work? The strategy is based on a small-molecule PSMA binding chemical attached to a radioactive reporter . This conjugate is introduced into the circulation of a patient where the conjugate accumulates at sites of prostate cancer and the unbound conjugate clears rapidly from circulation. The patients body is passed through an imaging camera that records areas where the PET tracer accumulated.

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