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
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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.
When Further Treatment Is Needed
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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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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How Do Doctors Decide Which Imaging A Person Should Receive
We usually use CT first for most people, unless a tumor is much better seen on MRI. But we go back and forth as needed. If we see something on a CT scan were unsure about, we may recommend an MRI for further evaluation. If someone has several MRIs and is unable to lie still or hold their breath so we can get a good image, we may suggest a CT as an alternative. Were guided by the principle of whether the benefits of a test outweigh its risks. Thats what medical imaging is about.
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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, 18F-DCFPyl , and Ga 68 gozetotide , 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. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.
Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.
What Is Psma Pet Scan
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.
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What Are The Benefits Of A Prostate Mri
The MRI scan can help find a cancer of the prostate gland, especially if you have elevated or rising PSA.
If a cancer has already been found, the MRI images can show whether it has spread outside the prostate gland or not. This can have a very important impact on whether or not you have treatment, and if so, which type of treatment you receive.
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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.
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Preparing For Your Pet
For most PET-CT scans, you need to stop eating about 4 to 6 hours beforehand. You can usually drink water during this time. You might have instructions not to do any strenuous exercise for 24 hours before the scan.
Some people feel claustrophobic when theyre having a scan. Contact the department staff before your test if youre likely to feel like this. They can take extra care to make sure youre comfortable and that you understand whats going on.
Your doctor can arrange to give you medicine to help you relax, if needed.
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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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Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
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 .
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You May Be Asked To Drink Some Contrast Material That Moves Through Your Stomach And Bowel
A fludeoxyglucose f 18 injection.* pet/ct scan of the brain was performed on biograph vision. The total time it takes for a psma pet scan is about two hours. It seems that this test is the most advanced modern method to detect undetectable prostate membrane cells in my body. The study shows normal uptake in brain with excellent delineation of functioning cortex and sharp contrast between cortex and white matter. If you are having an fdg pet scan, you will be asked to rest quietly in a bed or arm chair, avoiding movement or talking for 90 minutes. During this time you will be alone as there is limited room for visitors, and it will prevent your friends or relatives from receiving unnecessary radiation exposure. You may be asked to drink some contrast material that moves through your stomach and bowel. Additionally there is sharp basal ganglial edge definition, especially the sharp margins and distinct separation of the head of caudate nucleus and. What will happen is the tracer will be. Improved diagnosis and new medications may lead to read more. Ive looked at 6+ discussions, webinars, videos, lectures about this effectiveness of this pet/ct scan. 13.06.2019 · im getting a psma pet/ct total body scan scheduled as soon as possible. What to expect from proton therapy.
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A Different Way To Detect Metastases
Most men diagnosed with prostate cancer have localized disease, meaning the cancer appears to be confined to the prostate gland. However, certain factors have been linked to a higher risk of the cancer eventually spreading .
Currently, in the United States and many other countries, most men diagnosed with high-risk localized prostate cancer undergo additional testing to see if there is evidence of metastatic cancer. For many years, that has been done with a conventional CT scan and a bone scan , the latter because prostate cancer often spreads to the bones.
But both imaging technologies have limitations. Neither is particularly good at finding individual prostate cancer cells, and thus can miss very small tumors. And bone scans can detect bone damage or abnormalities that were caused by something other than cancer , resulting in false-positive findings that can lead to unnecessary additional testing.
So, researchers have been developing and testing other imaging agents that can find prostate cancer cells specifically in the body, Dr. Shankar explained.
As their name implies, PET-CT scans combine a CT scan with a PET scan, another type of nuclear imaging test that requires patients to receive intravenous injections of a radioactive tracer that can be detected on the scan.
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Understanding Your Biopsy Results
A specialist doctor called pathologist looks at the prostate samples under a microspore. The results usually take about 2 to 4 weeks.
You might have a negative biopsy. This means that no cancer cells were found. Your doctor might recommend another biopsy even if the first was negative. They’ll discuss this with you. This is because in some cases biopsies can miss cancer.
A positive biopsy means that they have found cancer cells. A pathologist then grades each sample of prostate cancer cells based on how quickly they are likely to grow or how aggressive the cells look. You may hear this being called the Gleason score or Grade Group.
Doctors now use the Gleason score and other information to divide prostate cancer into 5 groups. This is called the Cambridge Prognostic Group .
It can be difficult to understand what the Gleason score, Grade Group and CPG mean in your situation. We have more information about this, and you can ask your doctor and specialist nurse if you have any questions.
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.
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Recent Advances: Molecular Markers
Currently, risk stratification for men who have recently been diagnosed with prostate cancer by biopsy is accomplished with the combination of prostate-specific antigen level, clinical stage, and Gleason score or Grade Group. The limitation of using these parameters for risk stratification is that collectively they do not address specific biologic features of prostate cancer, specifically the aggressiveness of tumor cells. In addition, many studies have shown that localized prostate malignancy can vary in potential for progression in different patients, despite similar risk-stratifying characteristics.
This problem has sparked the advent of research and use of biological/genomic assays to help risk stratify men diagnosed with localized prostate cancer. The theory behind utilizing genomic assays is to identify genes in biopsy specimens that potentiate cellular proliferation.
Cooperberg et al aimed to validate the application of the cell cycle progression score in identifying men at risk for recurrent disease after radical prostatectomy. The CCP score identifies genes that promote cellular proliferation. In this study, the CCP score was compared with the Cancer of the Prostate Risk Assessment post-Surgical , which risk stratifies recurrence after prostatectomy based on pre-procedural PSA, Gleason score, and clinical staging, and has been shown to have good accuracy.
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