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Pet Scan And Prostate Cancer

What Do My Scan Results Mean

Detecting prostate cancer with PSMA PET

Your TNM stage is used to work out if your cancer is localised, locally advanced or advanced. This can help your doctor see how far it has spread and which treatment might be suitable for you.

Cancer that’s contained inside the prostate. Sometimes called early prostate cancer. Possible TNM stages are:

  • T stage: T1 or T2
  • N stage: N0 or NX
  • M stage: M0 or MX.

Cancer that’s started to break out of the prostate, or has spread to the area just outside it. Possible TNM stages are:

  • T stage: T1 or T2
  • N stage: N1
  • T stage: T3 or T4
  • N stage: N0 or N1
  • M stage: M0.

How Is Psma Pet Imaging Different From Current Prostate Cancer Imaging

  • Current standard technique called fluciclovine PET, involves physicians injecting patients with a synthetic radioactive amino acid.
  • PSMA PET imaging is a FDA approved scan with more precise detection of prostate cancer for better treatment planning and targeted care.
  • More effective in pinpointing and eliminating tumors not only in the prostate but also throughout the pelvis and the body in cases where the tumors have migrated.
  • Imaging with PSMA PET was able to detect significantly more prostate lesions than fluciclovine PET in men who had undergone a radical prostatectomy but had experienced a recurrence of their cancer.

Why You Might Have A Pet

You might have a PET-CT scan to check if your prostate cancer has come back after treatment. It is unusual to have a PET-CT scan when you are first diagnosed.

Before the scan, you have a small amount of a radioactive tracer as an injection into your bloodstream. There are 2 main types of radioactive tracer that you can have. They are called choline and prostate specific membrane antigen .

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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.

How Does The Psma Pet Work Technical Aspects

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This imaging technique is based on a small-molecule PSMA binding chemical attached to a radioactive reporter. The PET tracer is consequently composed of the PSMA-binding and the radioactive reporter . This tracer, resulted by means of the conjugation of the aforementioned elements, is introduced in the patients circulation. The main property of this conjugate is that it accumulates at prostate cancer sites, highlighting the areas that are affected by the tumor. An imaging camera makes these areas visible and records the places where the PET tracer accumulated. The unbound conjugate is rapidly cleared from circulation.

This FDA approval is based on intensive studies made at the Universities of California, San Francisco, and Los Angeles. These studies, funded by the Prostate Cancer Foundation, demonstrated the level of sensitivity this imaging technique is having. All the clinical trials have proved that it can be used in order to detect recurrent prostate cancer in men with high PSA levels after prostate cancer treatment and even for detecting metastases in men first diagnosed with high-risk prostate cancer.

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What Is A Pet Scan And Why Is It Used For Prostate Cancer

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  • What is a PET scan? A PET Scan, short for Positron Emission Tomography Scan, is an imaging technique that uses radioactive tracers to clearly image targeted areas in the body. It is primarily used in the diagnosis, initial staging and treatment strategy, to assess the effectiveness of therapy and for restaging, or the evaluation for recurrent disease after treatment.
  • Why is a PET scan used for prostate cancer? PET scanning is used for prostate cancer because of its superior ability to target and capture images of prostate cancer on a cellular level. This allows for more accurate staging and restaging in the overall prostate cancer treatment strategy. With new radiotracers being developed and studied, PET scanning continues to lead the way in what will be possible for imaging during treatment of prostate cancer.

PET scanning has revolutionized the way prostate cancer is imaged because of its ability to target cancer on a cellular and molecular level. PET Scanning uses a radioactive tracer that is absorbed and visualized in cancerous cells related to the prostate. This makes a PET scan a better choice than more conventional imaging modalities that only evaluate an anatomical snapshot of abnormalities rather than the functional aspects of a PET scan.

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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.

Detecting And Diagnosing Prostate Cancer

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Prostate cancer is often detected during the course of a routine prostate exam and/or the PSA blood test, but diagnosing it may require other procedures.

PSA test: PSA is a protein found in prostate cells that helps to keep semen liquified. Most cases of prostate cancer develop in these cells, so an elevated PSA count may be a sign of prostate cancer. However, PSA results are more of an indicator than a firm diagnostic tooltheres not a certain PSA score that means a man has prostate cancer. Instead, there are various ranges that are considered average for different age groups. If the PSA score is elevated for your age, further testing may be recommended.

PSA levels are measured as ng/mL. According to the ACS:

  • Men with a PSA level between 4 and 10 have about a 25 percent chance of having prostate cancer.
  • Men with a PSA level higher than 10 have more than a 50 percent chance of having prostate cancer.

Not all men with high PSA levels have prostate cancer. High levels may also be caused by a urinary tract infection, prostatitis or benign prostatic hyperplasia, all of which are noncancerous conditions. Conversely, men with a low PSA level may still develop prostate cancer.

PSA tests are not an indication of how aggressive the prostate cancer may be. Many prostate cancers are slow-growing and dont require immediate treatment.

The National Comprehensive Cancer Network suggests these screening guidelines and recommendations for men older than 45:

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Description Of The Test

Gallium 68:

The gallium 68 is injected into a vein. It takes about an hour for the material to spread throughout the body. The actual scan take about 30 minutes.

Choline C-11/F-18:

A radioactive form of choline is injected into a vein. Prostate cancer cells quickly absorb the choline. It breaks down quickly. The scan is done right away.

How Is A Prostate Ultrasound Done

When you get to the facility for the test, an ultrasound technician may ask you to take off your clothes and change into a gown. Then, the technician will ask you to lie down on your back or side on an examination table and bend your knees.

To perform a transrectal ultrasound , the technician covers a small imaging tool called a transducer with ultrasound gel to help the tool broadcast good images. Then, the technician slowly inserts the transducer into your rectum and moves it around gently to get images of your prostate from various angles. For a biopsy, the technician will slowly insert a needle alongside the transducer into your prostate to remove the tissue.

Your rectum might feel like its swelling while the transducers inside, and the gel can feel damp and cold. Let the technician know if youre uncomfortable during the procedure. Your technician may use local anesthesia or a sedative to help you feel you more comfortable.

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A Note On Suspicious Results

A suspicious result indicates that the biopsy sample contained some abnormalities but no cancer was found. There are a couple of potential explanations for a suspicious prostate biopsy result, including:

  • Prostatic intraepithelial neoplasia refers to changes within prostate cells that are abnormal, but not indicative of cancer. This condition is low-grade or high-grade, depending on how abnormal the cells are. Low-grade PIN is very common and isnt associated with prostate cancer. High-grade PIN, however, is associated with a higher risk of prostate cancer. If you have high-grade PIN after a prostate biopsy, your doctor may recommend that biomarker tests be performed on the sample to learn more about the cells. Alternatively, another prostate biopsy may be suggested.
  • Atypical small acinar proliferation indicates that the biopsy sample contains some cells that appear to be cancerous, but not enough to confirm the diagnosis. In most cases, this finding suggests that another prostate biopsy is needed.
  • Proliferative inflammatory atrophy describes a prostate biopsy that reveals inflammation in the prostate and abnormally small prostate cells. While these cells arent cancerous, having PIA may be associated with an increased risk of developing prostate cancer.

Determining Whether Prostate Cancer Is Aggressive

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If a biopsy sample is found to contain cancer, the pathologist analyzing the specimen takes a deeper look at the cancer cells to determine how aggressive the disease is likely to be.

If the cancer cells appear significantly abnormal and dissimilar from healthy cells under a microscope, the cancer is considered more aggressive and expected to advance quickly. Conversely, cancer cells that look relatively similar to healthy cells indicate that its less aggressive and may not spread as fast.

Prostate cancers are assigned a Gleason score depending on how abnormal the cells look..

Gleason score: Gleason scores range from 2 to 10, going from least to most aggressive prostate cancers.

There are different types of cancer cells in a prostate tumor, so the final Gleason score is determined by adding the scores of the two main areas of the tumor.

First, the primary part of the tumor is assigned a number between 1 and 5. Lower numbers indicate that the cells appear relatively similar to healthy cells, while higher numbers show that the cells are abnormal-looking. Then, another number between 1 and 5 is assigned to describe the second most prevalent area of the tumor.

Finally, the two numbers assigned to the different parts of the prostate tumor are added. So, if most of the tumor is given a 4, and some of the tumor is more aggressive and given a 5, the final Gleason score would be 9.

There are many biomarker tests, including:

  • Oncotype DX® Genomic Prostate Score
  • Prolaris
  • ProMark®

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Has The Radiotracer Used In Psma Pet Scans Been Approved By The Fda

The radiotracer piflufolastat, also known as Pylarify, is safe and FDA-approved. Side effects are rare and temporary and may include headache and a change in taste. Piflufolastat is a radionuclide dye, so it contains a small amount of radiation. The amount is similar to the exposure you receive during a CT scan and the tracers radioactive element is entirely gone from your body within a few days.

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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What Are The Advantages Of Mri

Where MRI really excels is showing certain diseases that a CT scan cannot detect. Some cancers, such as prostate cancer, uterine cancer, and certain liver cancers, are pretty much invisible or very hard to detect on a CT scan. Metastases to the bone and brain also show up better on an MRI.

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How To Tell If Your Cancer Has Metastasized

PSMA PET and Functional Imaging – 2021 Prostate Cancer Patient Conference

Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.

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Is Psa The Same As Psma

The PSA test is different from the PSMA PET scan.

The PSA test is a blood test that measures the level of PSA in your blood. PSA is a protein produced by cells in your prostate gland. High levels of PSA are often a sign of prostate cancer.

The PSMA PET scan is used after PSA testing if your doctor isnt sure if or where prostate cancer has spread. It can more accurately pinpoint where prostate cancer cells are located throughout the body.

Your doctor may order a PSA blood test to:

  • screen for prostate cancer if you dont have symptoms of the disease
  • determine whether further tests are necessary to diagnose prostate cancer if you do have symptoms of the disease
  • check for signs that prostate cancer has come back if youve received successful treatment for the disease

PSA blood test results are not enough to diagnose prostate cancer or learn whether it has spread or returned. If you have high levels of PSA, your doctor will order other follow-up tests to develop an accurate diagnosis.

Your doctor will only order a PSMA PET scan if they think you may have prostate cancer that has spread beyond the prostate gland.

Lymph Node Biopsy As A Separate Procedure

A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.

Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.

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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.

Preparing For Your Ct Scan

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A couple of hours before your scan you might need to stop eating and drinking. Tell your doctor if this is a problem for you: for example, if you have diabetes.

You might have a drink or an injection of contrast medium, or both. Contrast medium is a dye that helps body tissues show up more clearly on the scan.

Before you have the contrast medium, the radiographer asks if you have any medical conditions or allergies. Some people are allergic to the dye.

They also check the results of your most recent blood test. This is to make sure your kidneys are working well and able to flush the contrast medium out of your body. Youll have a blood test before the scan if you havent had one recently.

The radiographer explains how to drink the contrast. You usually drink the liquid slowly for about an hour before the scan.

Some people feel claustrophobic or closed in when theyre having a scan. Tell the radiographers before your appointment if you think youre likely to feel this way. They can take extra care to make sure youre comfortable.

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