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.
Utilization Of Salvage And Systemic Therapies For Recurrent Prostate Cancer As A Result Of 18f
- Wei LiuAffiliations
- Louise EmmettAffiliationsDepartment of Nuclear Medicine and Theranostics, St. Vincents Hospital and University of New South Wales, Sydney, Australia
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, CanadaDepartment of Radiation Oncology, University of Toronto, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, CanadaDepartment of Radiation Oncology, University of Toronto, Toronto, CanadaInstitute of Health Care Policy and Evaluation, University of Toronto, Canada
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, CanadaDepartment of Radiation Oncology, University of Toronto, Toronto, Canada
- Tracy SextonAffiliations
- Michael LockAffiliations
- Department of Radiation Oncology, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, CanadaTechna Institute, University Health Network, Toronto, Canada
- Susan ArcherAffiliations
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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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Do I Need To Prepare For My Scan
There is no specific preparation for this scan. You may eat and drink normally.
Please consider leaving all jewellery at home as we will need you to remove metallic objects for the scan if possible. We suggest wearing something loose and comfortable. If required, a hospital gown can be provided for the scan.
Biochemical Recurrence Without Metastatic Disease After Exhaustion Of Local Treatment Options
Prognosis
4. Clinicians should inform patients with PSA recurrence after exhaustion of local therapy regarding the risk of developing metastatic disease and follow such patients with serial PSA measurements and clinical evaluation. Clinicians may consider radiographic assessments based on overall PSA and PSA kinetics.
5. In patients with PSA recurrence after exhaustion of local therapy who are at higher risk for the development of metastases , clinicians should perform periodic staging evaluations consisting of cross-sectional imaging and technetium bone scan.
6. Clinicians may utilize novel PET-CT scans in patients with PSA recurrence after failure of local therapy as an alternative to conventional imaging or in the setting of negative conventional imaging.
Treatment
7. For patients with a rising PSA after failure of local therapy and no demonstrated metastatic disease by conventional imaging, clinicians should offer observation or clinical trial enrollment.
8. ADT should not be routinely initiated in this population . However, if ADT is initiated in the absence of metastatic disease, intermittent ADT may be offered in lieu of continuous ADT.
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Early Evaluation And Counseling
1. In patients with suspicion of advanced prostate cancer and no prior histologic confirmation, clinicians should obtain tissue diagnosis from the primary tumor or site of metastases when clinically feasible.
2. Clinicians should discuss treatment options with advanced prostate cancer patients based on life expectancy, comorbidities, preferences, and tumor characteristics. Patient care should incorporate a multidisciplinary approach when available.
3. Clinicians should optimize pain control or other symptom support in advanced prostate cancer patients and encourage engagement with professional or community-based resources, including patient advocacy groups.
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.
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Performance Status And Predicted Life Expectancy
Performance status and predicted life expectancy are both critical elements to incorporate into individualized clinical decision-making in men with advanced prostate cancer. Performance status remains a key factor in treatment decision-making, particularly among men with advanced prostate cancer. Indeed, performance status has been found to be strongly associated with survival among men with mCRPC, 35-38 and has been used to define index patients in prior versions of this guideline. Performance status generally describes an individual patients level of functioning and how ones disease impacts a patients activities of daily living. The first of two commonly used scales to evaluate performance status include the Eastern Cooperative Oncology Group scale from 0 to 5 where 0 is fully functional and 5 is dead. The second is the Karnofsky scale where 10 represents a moribund individual and 100 represents an individual with no limitations.
Multidisciplinary Nature Of Treatment In Todays Advanced Prostate Cancer Care Paradigm
As the therapeutic landscape evolves to include increasingly complex combinations of systemic therapies with or without local therapies, advances in imaging, and germline and somatic genetic testing, treating men with advanced prostate cancer is increasingly one that must embrace multidisciplinary management approaches. Team members should include urologists, medical oncologists, and radiation oncologists at a minimum when supporting treatment decisions for advanced disease. Additional specialists may also include genitourinary pathology, genetic counseling, palliative care, and holistic specialists, as appropriate, in addition to primary care. Best practices must also include clinicians comfortable describing the use of germline and somatic genetic testing, and when advanced imaging techniques could be optimally used or avoided. Radiologists and nuclear medicine specialists are valuable in helping to accurately interpret scans. Palliative care team members may also play a key role when treating men with symptomatic metastatic disease. Palliative care itself is an interdisciplinary, holistic approach to managing an advanced disease such as prostate cancer with a guarded prognosis. It can include controlling symptoms that are physical, psychological, spiritual, and social. The goal of palliation is to prevent and relieve suffering and to support the best possible QOL for the patient and family.
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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
Molecular Basis Of Ga
Tumor progression and metastasis is linked to cellular metabolism. Cancer cells, being highly proliferative, show significant alterations in metabolic pathways such as glycolysis, respiration, the tricarboxylic acid cycle, oxidative phosphorylation, lipid metabolism, and amino acid metabolism. Metabolites like peptides, nucleotides, products of glycolysis, the TCA cycle, fatty acids, and steroids can be an important read out of disease when characterized in biological samples such as tissues and body fluids like urine, serum, etc. The cancer metabolome has been studied since the 1960s by analytical techniques such as mass spectrometry and nuclear magnetic resonance spectroscopy. Current research is focused on the identification and validation of biomarkers in the cancer metabolome that can stratify high-risk patients and distinguish between benign and advanced metastatic forms of the disease. In this review, we discuss the current state of prostate cancer metabolomics, the biomarkers that show promise in distinguishing indolent from aggressive forms of the disease, the strengths and limitations of the analytical techniques being employed, and future applications of metabolomics in diagnostic imaging and personalized medicine of prostate cancer.
Emmanuele A Jannini, Vincenzo Tombolini, Eleonora Carosa
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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.
Automated Synthesis Of 68ga
First, module prepared by connecting the reagents to the appropriate tubes and by filling the reactor with the 20 l of PSMA-11 peptide solution in water at the concentration of 1 mg/ml and 2 ml of 1.5 M HEPES buffer solution as it is shown in Figure 2.
Schematic automated procedures for synthesis of 68Ga-prostate-specific membrane antigen-11
After the initial check of the Scintomics GRP module software, the preparations are complete. For choosing the best concentration of eluent, the generator was eluted by 5 mL HCl with various concentrations from 0.1 to 1.0 M and the activity of the eluted 68Ga was measured using high-purity germanium detector. Regarding the using SOP for production of 68Ga-PSMA-11 in our department, elution with 5 ml 0.5 M HCl performed as the more suitable solvent for the labeling process. 511 and 1016 keV peaks indicated in the Gamma spectrum of eluted 68GaCl3 .
Gamma spectrum of eluted 68GaCl 3-Ray test Mucha
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Early Differences In Dynamic Uptake Of 68ga
- J. olde Heuvel,
Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Visualization, Writing original draft, Writing review & editing
Affiliations Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands, Robotics and Mechatronics, Technical Medical Centre, University of Twente, The Netherlands
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Affiliation Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Roles Formal analysis, Methodology, Writing review & editing
Affiliation Department of Medical Physics, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Roles Conceptualization, Supervision, Writing review & editing
Affiliation Robotics and Mechatronics, Technical Medical Centre, University of Twente, The Netherlands
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Roles Conceptualization, Funding acquisition, Supervision, Writing review & editing
Affiliation Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
Searches And Article Selection
A research librarian conducted searches in Ovid MEDLINE , Cochrane Central Register of Controlled Trials , and Cochrane Database of Systematic Reviews . An updated search was conducted prior to publication through January 20, 2020. The methodology team supplemented searches of electronic databases with the studies included in the prior AUA review and by reviewing reference lists of relevant articles.
The methodology team developed criteria for inclusion and exclusion of studies based on the Key Questions and the populations, interventions, comparators, outcomes, and settings of interest. The population was patients with advanced prostate cancer as described in Table 3. Treatments included first and second line antiandrogens, immunotherapy, chemotherapy, radiation therapy, surgery, radiopharmaceuticals, and surveillance strategies. Comparisons were against placebo, no therapy, or another active intervention and intermittent versus continuous therapy. Outcomes included overall survival , prostate cancer mortality, progression-free survival , prostate-specific antigen progression-free survival , failure-free survival, metastases-free survival, time to metastases, time to progression, skeletal events, and adverse events.
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Do I Need To Confirm My Appointment
No, but the tracer we use will be ordered for you and cannot be used for any other patient. It is important you inform the department if you are unable to attend your appointment. Please help us to conserve valuable NHS resources.
Your scan will take place in the PET-CT department of Addenbrookes Hospital. It is vital that you arrive on time for your appointment as the radioactivity has a very short shelf life. If you are late for your appointment we may not be able to proceed with your scan.
Please call us on to confirm / change your appointment and to inform us if you:
- are pregnant, breast feeding, or have young children at home
- have any disability or special needs requiring ramp access
- have been told you have difficult veins to cannulate
- weigh over 100kg
- are claustrophobic
- have any difficulty lying flat for 20 minutes
- have any other appointments on the same day
Stable And Rising Uptake In Pca
Visualization of the individual prostate tumor TACs revealed a distinct difference between the patients. Three lesions showed a stable uptake profile after five minutes, whereas three lesions had increasing tumor uptake over time. This effect is not yet described in literature, we think, mainly because previous literature reported the mean TAC of all patients, thus obscuring this effect. The difference in TAC shape might be explained by multiple causes, such as systemic distribution of 68Ga PSMA-11, tumor biology, technical differences and tumor perfusion, which each will be discussed below.
After intravenous injection of 68Ga-PSMA-11, it is distributed proportionally through all tissues by the systemic blood flow, so a reduced tumor accumulation might be explained by a limited systemic supply of 68Ga-PSMA-11. When comparing the uptake in the common iliac artery and gluteal muscle, there was no clear difference between both patient groups stable:4.3 vs. rising:4.2 gluteal SULmean stable:0.4 vs. rising:0.4). Therefore, it is unlikely that the difference in tumor uptake is explained by a reduced systemic supply of 68Ga-PSMA-11.
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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.
Peer Review And Document Approval
An integral part of the guideline development process at the AUA is external peer review. The AUA conducted a thorough peer review process to ensure that the document was reviewed by experts in the diagnosis and management of Advanced Prostate Cancer. In addition to reviewers from the AUA PGC, Science and Quality Council , and Board of Directors , the document was reviewed by representatives from ASTRO, SUO, and ASCO as well as external content experts. Additionally, a call for reviewers was placed on the AUA website from December 2-16, 2019 to allow any additional interested parties to request a copy of the document for review. The guideline was also sent to the Urology Care Foundation and representation from prostate cancer advocacy to open the document further to the patient perspective. The draft guideline document was distributed to 96 peer reviewers. All peer review comments were blinded and sent to the Panel for review. In total, 44 reviewers provided comments, including 34 external reviewers. At the end of the peer review process, a total of 522 comments were received. Following comment discussion, the Panel revised the draft as needed. Once finalized, the guideline was submitted for approval to the AUA PGC, SQC, and BOD as well as the governing bodies of ASTRO and SUO for final approval.
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