About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
What Body Areas Are Seen During An Mri Of The Abdomen And Pelvis
Body organs that can be seen during an MRI of the abdomen and pelvis include:
- Stomach, intestines , liver, gallbladder, pancreas, and spleen. These organs help break down the food you eat and get rid of waste through bowel movements.
- Kidneys, ureters, bladder, and urethra . These organs make urine and allow you to urinate.
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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.
What Is A Ct Scan
A CT scan is a test that uses x-rays and a computer to create detailed pictures of the inside of your body. It takes pictures from different angles. The computer puts them together to make a 3 dimensional image.
CT stands for computed tomography.
You usually have a CT scan in the x-ray department as an outpatient. A radiographer operates the scanner. The whole appointment can take up to an hour and a half depending on which part of your body they are scanning.
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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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How Does A Ct Scan Work
In a way, CT scans are like standard x-ray tests. But an x-ray test aims a broad beam of radiation from only one angle. A CT scan uses a pencil-thin beam to create a series of pictures taken from different angles. The information from each angle is fed into a computer, which then creates a black and white picture that shows a slice of a certain area of the body much like looking at a single slice from a loaf of bread.
Special contrast materials can be used to get a clearer picture. These can be swallowed as a liquid, put into a vein, or put into the intestines through the rectum as an enema.
Doctors are now taking CT technology one step further in a technique called virtual endoscopy. They can look at the inside surfaces of organs such as the lungs or colon without actually having to put scopes into the body. The 3-D CT images are arranged to create a black and white view on the computer screen. This looks a lot like it would if they were doing an actual endoscopy.
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Who Interprets My Scans
It is also important to understand that every medical imaging performed is read by a physician, and a dictated written report is issued. This interpreting physician will be either a radiologist or a nuclear medicine physician.
So although the scan may be ordered by a urologist, medical oncologist or radiation oncologist, the physician who interprets the imaging is someone different. He or she is an M.D. trained in a different area of medicine , and does not see patients in a clinic. Their job is to read, decipher and translate imaging into a dictated written report, which they provide to your ordering clinical physician.
The difference between radiology and nuclear medicine is basically whether or not a radiopharmaceutical is used. These injections are designed to adhere to certain types of tissues , and reveal a spot or uptake in that area.
For example, the bone scan is nuclear medicine, and cancer in the bone is revealed as a hot spot, or excess uptake of the radiopharmaceutical. PET scans are also nuclear medicine, and there are many different types of radiopharmaceuticals used which dictate the type of PET scan. F18 and FDG18 are currently utilized for bone imaging in the U.S. for prostate cancer.
A CT scan, on the other hand, may also involve an injection, but it is not a radiopharmaceutical, so CT is radiology, not nuclear medicine. MRI is radiology, even if an injection is used . Ultrasounds and X-rays are radiology.
The Future Of Psma Pet
This is a solid study and reflects the real-world experience with PSMA PET-CT in other countries, Dr. Pomper said. Because there are several PSMA-targeted tracers, a next step will be to have them approved for use in the United States outside of clinical trials, he added.
He predicted that, eventually, the different PSMA tracers will be tested head to head.
The Australian trial adds to a growing body of research on improving the detection of metastatic tumors in men with prostate cancer. One imaging agent, fluciclovine F18 which targets prostate cancer cells in a different way than PSMA-targeted tracersis already approved in the United States for use in men with previously treated prostate cancer that appears to be progressing .
PSMA PET-CT is also being studied in this group of men, Dr. Shankar said. One small clinical trial that directly compared PSMA PET-CT with fluciclovine F18 PET-CT showed that the PSMA-targeted scan found more metastatic tumors, regardless of their location. NCI is funding a similar but larger clinical trial.
Dr. Pomper noted that PSMA also is found at relatively high levels in the vasculature of a number of other cancersincluding kidney, thyroid, and breastso hes hopeful that PSMA PET-CT might be useful beyond prostate cancer.
Urologists and radiation oncologists in many places are already ordering this scan as the standard of care, he said.
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This Video Describes The Process
Note that in the USA the breakpoint for having a concern is a PSA of 4. In the UK, this number varies with age between 3 and over 5 .
© Copyright Prostate Edinburgh 2020-22 A company incorporated in Scotland, Company No SC564971. Email : Prostate Edinburgh
Are you a man over 50 years of age? Do you know your PSA? If not, then please take steps to find it out, and track it if in the normal range.
What Happens Before The Cat Scan
If a dye is required for your CAT scan, you may be instructed to have a blood test first. The purpose of the blood test is to make sure your kidneys will be able to get rid of the dye. Not getting this blood test may delay your CAT scan appointment.
Drink only clear liquids after midnight the night before your scan. Clear liquids include things you can see through . Examples include clear broth, tea, strained fruit juices, strained vegetable soup, black coffee, and ginger ale. You may also eat plain Jell-O.
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Aim And Contribution Of This Research Work
CNN is an efficient deep learning network architecture that has recently found great applicability in the medical domain. It has shown excellent performance on medical image applications, including bone scintigraphy and nuclear medical imaging, and can offer a positive impact on diagnosis tasks.
Nowadays, the main challenge in bone scintigraphy, as being one of the most sensitive imaging methods in nuclear medicine, is to build an algorithm that automatically identifies whether a patient is suffering from bone metastasis or not, based on patients whole body scans. It is of utmost importance that the algorithm needs to be extremely accurate due to the fact that patients lives could be at stake. Deep learning algorithms whose potential lies in the fact that they can improve the accuracy of cancer screening, have been recently investigated for nuclear medical imaging analysis. Recent studies in BS and PET have shown that a deep learning-based system can perform as well as nuclear physicians do in standalone mode and improve physicians performance in support mode. Even though BS is extremely important for the diagnosis of metastatic cancer, there is currently no research paper regarding the diagnosis of prostate cancer metastasis from whole body scan images that applies robust and more accurate deep CNNs.
The innovations and contributions of this paper are well summarized as follows:
Nuclear Bone Scan Procedure
The first step in the procedure is the injection of the tracer material. A technician will do this through a vein in your arm or hand. You might feel a sting from the IV.
Then, you wait for the tracer to travel through your body and bind to your bones. That can take 2 to 4 hours.
Your doctor might order a scan before your body absorbs the tracer for comparison, especially if you could have a bone infection. If youâre having two scans, the first will happen right after the injection.
While your body is absorbing the nuclear material, youâll need to drink 4 to 6 glasses of water to flush extra tracer from your body. Youâll use the restroom before the test so any concentration in your urine doesnât cause a misleading picture.
For the scan itself, youâll lie on a table while a camera takes pictures. Youâll have to remain very still for certain portions of the scan, and you may have to change positions several times. The scanning may take up to an hour. Itâs not painful, but lying on the table may become uncomfortable.
Your doctor may also order a type of test called single-photon emission-computed tomography . The camera rotates around your body to make more detailed images.
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Pet/mri Basics And Image Acquisition
PET/MRI imaging systems can be either in tandem or integrated. Tandem systems have the MRI and PET machines located either in adjacent rooms or side-by-side in the same room with a moveable patient table between . Tandem PET/MRI units such as the Phillips Ingenuity were the initial systems developed because the magnetic field generated by the MRI machine did not interfere with the PET unit. Due to the large footprint and cumbersome nature of tandem PET/MRIs, these have largely been supplanted by their integrated counterparts. A major hurdle of integrated or simultaneous systems is the fact that the photomultiplier tubes used in traditional PET scanners cannot function within a strong magnetic field. The development of avalanche photodiodes, photon detectors insensitive to magnetic changes, was the breakthrough that allowed development of and commercialization of modern integrated PET/MRIs . While one drawback of avalanche photodiodes is the inability to measure time of flight, silicon photomultiplier detectors have been developed to circumvent this limitation .
Existing relevant experience on the multi-faceted use of PET/MRI in prostate cancer is summarized in Table 1.
Table 1
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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Treatment Planning For Radiation Therapy
Radiation therapy is one of the main prostate cancer treatment methods that can be used in low stage up to high stage of disease and even in bone metastasis of prostate cancer. According to patients condition and stage of disease, radiation therapy performs alone or in combination with other therapy methods like surgery or hormonal therapy.
There are two kinds of radiation therapy methods: External beam radiation therapy and Brachytherapy . Radiation therapy can use in low risk patients for curing the cancer completely and it calls radical radiotherapy. In higher stage of prostate cancer and when bone metastasis are existence and patients suffer from pain radiation therapy is used for shrinking cancerous cells on nerves systems and bones to decrease pain . After radical prostatectomy radiation therapy is useful for preventing and decreasing cancer recurrence and distal metastasis. In intermediate to high risk patients, radiation therapy can be used in combination with hormonal therapy before or after radical prostatectomy . MR images can be used reliably for treatment planning of radiation therapy.
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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.
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Why Should I Have An Mri Scan
Consultants usually identify prostate cancer and measure its growth rate using MRI scans although non-problematic cancers are typically found using biopsy. Whenever biopsies detect prostate cancer MRI scans can be used retrospectively and facilitate quicker patient treatment planning and to clarify if and where further biopsy should be taken.
In-depth studies on MRI scanning and the powerful magnetic fields involved have shown no risks to patients, making the procedure one of the safest stages of treatment available. Ongoing global research and development is already producing breakthrough technologies with scanners that can accommodate a patients medical condition or limitation.
Patients can often be accompanied by a close friend or family member throughout their MRI scan listening to music via headphones for the duration is also a popular option. Its important to remember that the MRI procedure is physically painless and any mild discomfort thats experienced during the scan is short-lived and gone the same day.
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