Options For Dealing With Recurrence
With a persistently increasing PSA, the suspicion for recurrence increases. The most important factor in assessing your long-term outcome is determining the location of the prostate cancer cells producing the PSA. Advanced imaging techniques, such as MRI and PSMA PET/CT, are often helpful in learning where the cancer is located, and in the case of post-radiation recurrence, repeat biopsy may be required.
If a man underwent surgery as an initial treatment, revisiting the post-operative pathology report may help to identify what contributed to the recurrence. If there was still cancer present , the cancer was aggressive , or genomic profiling of the tumor showed high-risk features, several options are available:
- EBRT to the prostate bed with or without the pelvis.
- EBRT accompanied by hormone therapy. The duration of hormone therapy will depend on the PSA level just prior to radiation and to a lesser extent on the Gleason score and staging of the cancer.
- Systemic treatment using hormone therapy, other treatments for those at risk for metastatic disease, or a combination.
- Active surveillance if the remaining cancer appears insignificant. You and your doctor can decide whether to intervene more aggressively and, if so, when.
If you’re seeking additional or different approaches, you may be eligible to participate in an appropriate clinical trial . You can research this with the help of your doctor.
Types Of Imaging Studies
If your healthcare provider suspects your cancer might be spreading, they will likely order more imaging tests. A common imaging workup may include a bone scan and a CT scan of the abdomen and pelvis. An MRI might be done as well. Some research centers are also using magnetic MRIs or PET scans to further refine the staging of prostate cancer.
Prostate Cancer Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
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.
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Ct Scans Of The Abdomen
If you are having a CT scan of your abdomen, you might be asked:
- to drink a liquid contrast medium some time before the scan
- to drink more of the liquid contrast or water in the x-ray department
- not to eat or drink after midnight the night before the scan
You usually have the contrast medium by injection and also as a drink. This helps to show up the gut more clearly in the scan.
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.
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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. We’ve seen AI tools that can improve an ECG’s 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 Melbourne’s RMIT University and St Vincent’s 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.
Why Ct Scans Just Won’t 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?
But…you 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 don’t 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 free… …Right?
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 Marge and Gary Hildebrand, client Damian Latch, client and colon cancer survivor
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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.
Side Effects Of Radical Prostatectomy
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.
For more information on erectile dysfunction and treatment, see Managing Erectile Dysfunction A Patient Guide.
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When Further Treatment Is Needed
While prostate cancer diagnosis and treatment have improved significantly in recent years, the cancer can still recur. That’s 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.
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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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.
Prostate Cancer Risk Assessment
Prostate cancer represents a wide spectrum of disease. Some prostate cancers progress and need treatment, while others grow slowly, if at all, and can be managed conservatively with a system of careful monitoring called active surveillance. It is important to learn the characteristics of your cancer before making treatment decisions. There are many ways to determine prostate cancer risk, most of which incorporate information from several parameters, including the PSA, Gleason score and tumor extent .
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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.
What Are The Advantages And Disadvantages Of Having An Mri Scan Before A Biopsy
Advantages
- It can give your doctor information about whether there is cancer inside your prostate, and how quickly any cancer is likely to grow.
- Its less likely than a biopsy to pick up a slow-growing cancer that probably wouldnt cause any problems in your lifetime.
- It can help your doctor decide if you need a biopsy if theres nothing unusual on the scans, this means youre unlikely to have prostate cancer that needs to be treated. You may be able to avoid having a biopsy, and its possible side effects.
- If you do need a biopsy, your doctor can use the scan images to decide which parts of the prostate to take samples from.
- If your biopsy finds cancer, you probably wont need another scan to check if it has spread, as the doctor can get this information from your first MRI scan. This means you can start talking about suitable treatments as soon as you get your biopsy results.
Disadvantages
- Being in the MRI machine can be unpleasant if you dont like closed or small spaces.
- Some men are given an injection of dye during the scan this can sometimes cause mild side effects.
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How Is Prostate Cancer Diagnosed And Evaluated
Your primary doctor will ask about your medical history, risk factors and symptoms. You will also undergo a physical exam.
Many patients undergo regular prostate cancer screening before symptoms appear. Screening may involve one or more of the following tests:
- Prostate-specific antigen : This test analyzes a blood sample for levels of PSA, a protein the prostate produces. Higher PSA levels could indicate cancer is present.
- Digital Rectal Exam :This test examines the lower rectum and the prostate gland to check for abnormalities in size, shape or texture. The term “digital” refers to the doctor’s use of a gloved, lubricated finger to conduct the exam.
If screening test results are abnormal, your doctor may perform the following imaging tests:
Hormone Therapy With Radiation
Prostate cancer cells need testosterone to grow. Hormone therapy aims to drastically lower testosterone levels to slow the cancer’s progression. Although it does not cure the cancer on its own, hormone therapy improves the effectiveness of radiation for high-risk disease and is often recommended in conjunction with radiation therapy for men with intermediate- or high-risk localized disease. However, hormone therapy may have significant side effects. These include loss of libido , hot flashes , changes in mood or memory, loss of bone and muscle density, body fat gain, and adverse effects on sugar or cholesterol metabolism. When offered as short-term therapy in conjunction with radiation, it is often well tolerated. How long a patient should receive hormone therapy remains controversial and depends on how aggressive his cancer is.
Learn more about hormone therapy.
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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.
Preparation For A Ct Scan
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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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.
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