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Psma Pet Scan Prostate Cancer

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Detecting prostate cancer with PSMA PET

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Targeting Psma: Not Just For Imaging

Like a number of other radiopharmaceuticals, 177Lu-PSMA-617 has two components: a drug that delivers the therapy to cancer cells and a radioactive particle. In the case of 177Lu-PSMA-617, the delivery vehicle is PSMA-617, a drug that latches onto a protein called PSMA that is often found at high levels on the surface of prostate cancer cells. The radioactive component is lutetium-177, which is being tested as a part of multiple radiopharmaceutical drugs.

As Dr. Morris explained, PSMA-617 is extremely adept at finding and locking on to the PSMA protein on cells. Once it binds to PSMA on a cancer cell, the whole molecule is internalized by the cell and the cell is exposed to a lethal dose of radiation from lutetium-177, he said.

The PSMA protein is also at the heart of a new type of imaging procedure called PSMA PET. This form of PET imaging is just starting to be used in men with prostate cancer to determine whether their cancer has spread, or metastasized, beyond the prostate. In the last several months, FDA has approved two such drugs, known as radiotracers, for PSMA PET imaging.

Things To Know About Psma

If you have your ear to the ground regarding all things prostate cancer you may have heard some buzz about PSMA-PET and want to know more. On the other hand, maybe youve never heard of PSMA-PET before in your life. Weve got you covered either way, here are the 5 things you need to know about the newly FDA approved PSMA-PET scan.

  • What is PSMA-PET? Lets start with PSMA, PSMA stands for prostate-specific membrane antigen. That may sound intimidating, but essentially it is a protein that is found mainly on prostate cancer cells. PET stands for positron emission tomography, which again is not as intimidating as it sounds, really all it is, is a scan that uses a special dye with radioactive tracers that allow doctors to scan for cancer or other diseases. So in essence PSMA-PET is an exciting new body scan that can help doctors see and track otherwise hard-to-find prostate cancer, potentially earlier, and in much smaller amounts compared with imaging that is currently used.
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    What Is The Psma

    In a PSMA-PET scan, doctors use an injectable radioactive tracer to bind to PSMA lesions anywhere in the body. This helps illuminate or light up the prostate cancer tumors during PET scans so doctors can better visualize the cancer. In clinical trials, PSMA-PET scans were highly effective at detecting prostate cancer throughout the body and significantly more likely to find metastatic tumors than current standard-of-care CT scans or bone scans, says Dr. Hope, who was part of the UCSF research team conducting the trials.

    How A Psma Pet Scan Works

    PSMA PET/CT visualizes prostate cancer recurrence early, impacts ...

    A positron emission tomography scan tracks a small amount of a radioactive compound or tracer as it moves through your body.

    Most PET scans use a type of sugar as a tracer. PSMA PET scans use a tracer to help pinpoint. There are two availablr, piflufolastat F 18 injection or gallium 68 PSMA-11.

    It targets a protein called prostate-specific membrane antigen . You can find it on all prostate gland cells, but cancer cells have far more PSMA than normal. The tracer binds to it and lights up on the scan, even in tiny amounts. This helps your doctor pinpoint whether and where your cancer has spread.

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    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.

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    Closer To The Holy Grail

    Currently PSMA PET/CT is not intended to be a screening tool. It is for those who have been diagnosed with prostate cancer and who either have a higher chance of it spreading or who have a recurrence and a rising PSA level after initial treatment. It is for men with suspected metastatic disease in their pelvis — for instance, in their lymph nodes, or outside of their pelvis in more distant lymph nodes, bones, or organs.”

    “Our goal is to identify these sites early and to improve cure rates even though theyve had a relapse, so being able to see the disease is important knowledge, said Dr. Armstrong. Dr. Wong agreed. This advancement is much closer to the holy grail of precision and personalized medicine and will have a big impact on patient decision making and treatment options.

    Can Psma/pet Be Used For Therapy Assessment

    PSMA PET Scan Used For Prostate Cancer Memorial Cancer Institute

    A few preliminary studies have recently begun to address the possible role of PSMA PET/CT for response assessment to systemic therapies or radiation in metastatic PCa. Response assessment with PSMA PET/CT may be superior to conventional CT. However, larger prospective trials are clearly needed to further evaluate and better define the role of PSMA PET/CT in assessing response to anti-cancer therapies.

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    Impact Of Psma Pet/ct On Staging

    Per patient, the tumour N and M stage based on the composed conventional staging was compared to the tumour stage based on the additional information of the PSMA PET/CT. Differences in observed staging frequencies were tested for independence using a Chi-square test . For both N and M staging, upstaging was defined as a change from negative to equivocal or positive, or from equivocal to positive. Downstaging was defined as a change from positive to equivocal or negative, or from equivocal to negative.

    Furthermore, the level of confidence in the correct assessment of the tumour stage based on the imaging findings was defined. This was done according to above mentioned N and M staging three-category systematics. For both N and M staging, increase in LoC was defined as a change from equivocal to positive or negative. Decrease in LoC was defined as a change from positive or negative to equivocal.

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    For Research Use Only.

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    Is There A Diagnostic Benefit Of Late

    To assess the diagnostic value of an additional late-phase PET/CT scan after urination as part of 68 Ga-PSMA-11 PET/CT for the restaging of patients with biochemically recurrent prostate cancer .

    EJNMMI Research

  • Q.Clear is a Bayesian penalised likelihood reconstruction algorithm available on General Electric Positron Emission Tomography -Computed Tomography and PET-Magnetic Resonance scanners…

    Authors: Daniela Ribeiro, William Hallett, Oliver Howes, Robert McCutcheon, Matthew M. Nour and Adriana A. S. TavaresCitation:EJNMMI Research 202212:11Content type: Original researchPublished on: 20 February 2022

  • To assess 68Ga-PSMA PET/CT for detection of low- and intermediate-risk prostate cancer , high-risk PCa in comparison with mpMRI, respectively, and to determine which of low- and intermediate-risk PCa are mor…

    Authors: Chuanchi Zhou, Yongxiang Tang, Zhihe Deng, Jinhui Yang, Ming Zhou, Long Wang and Shuo HuCitation:EJNMMI Research 202212:10Content type: Original researchPublished on: 11 February 2022

  • A Different Way To Detect Metastases

    PSMA Scan for prostate cancer

    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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    What Happens After My 68ga Psma Pet

    How do I get my results?

    A nuclear medicine radiologist will review your images, along with your medical history and any previous imaging. Your referring doctor will receive a report within 48 hours of the examination. If your results are urgent, or you have a same day appointment with your doctor we will arrange for your results to be available immediately following the scan. Please arrange a follow up appointment with your referring doctor to discuss the results.

    Post procedure:

    Following your 68Ga-PSMA PET-CT scan you can return to all normal daily activities. You are advised to minimise contact with pregnant women and children for 2 hours after your appointment. You are able to drive following this examination unless you have had sedation, in which case you will require someone to drive you home.

    Risks and side effects:

    A PET-CT scan is a safe and routine procedure. The radioactive tracer required for this scan has been used across the world for many years and has no side effects. The amount of radioactivity administered is small and will be flushed out of your system by the end of the day.

    What Happens During A Psma Pet Scan

    Its simple, and you dont have to prepare beforehand for the procedure:

    • Once you arrive at the clinic, youll change into a hospital gown and receive an intravenous injection in your arm that contains the radiotracer. Youll wait roughly one hour so that its absorbed throughout your body.
    • Youll be brought to our PET imaging machine, where youll lie still for roughly 20 minutes as the machine scans your body. Once this is complete, you may leave.
    • The scans are sent to the nuclear medicine physician to evaluate. That report and the PET images are then reviewed by your cancer doctor.

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

    New GE Discovery IQ PET Scanner

    • 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.

    General Example Of Pet Scan Use After A Prostate Cancer Diagnosis

    PSMA PET and Functional Imaging – 2021 Prostate Cancer Patient Conference

    It is important to note that while PET Scanning can be an essential tool in the assessment of prostate cancer, it is not always used on all patients, and there are many other imaging tests and procedures that may be recommended depending on the patients specific needs.

    This is an example of a prostate cancer care that would include PET scanning.

  • Prostate cancer is detected by the results of screening PSA with a blood test or a DRE .
  • Prostate cancer is confirmed by a core needle biopsy with imaging either before or during the procedure.
  • In some instances, a PET scan may be used during the initial evaluation and treatment strategy. Prostate cancer is evaluated after a diagnosis using various imaging techniques to determine the extent or stage of cancer. While imaging modalities like MRIs are often used to stage prostate cancer, PET scanning has been used effectively to stage prostate cancer and new tests like PSMA PET scans continue to show promise in being the best future solutions during prostate cancer staging.
  • A PET scan is usually the most effective way to restage recurrent prostate cancer. After prostate cancer treatment, PET scanning may be used to determine the effectiveness of the treatment and is now commonly being used for the detection of biochemically recurrent prostate cancer for restaging. A specific PET radioactive tracer, Axumin, has been designed for this exact purpose of targeting and restaging recurrent prostate cancer.
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    Psma Pet Scanning For Prostate Cancer Care

    PSMA PET scans are now FDA-approved and ongoing studies continue to suggest that it will be an even more valuable imaging tool used for both staging and restaging prostate cancer in the near future. The specifics of PSMA will hopefully allow for even more accurate imaging and the earliest possible detection when performing PET scans for prostate cancer.

    When Is A PSMA PET Scan Used For Prostate Cancer?

    Now FDA approved, we are currently performing PSMA PET Scans at our facility for the following purposes.

    • Staging: Patients with a first-time diagnosis of prostate cancer benefit from using a PSMA PET scan because of its superior ability to detect cancer spread offering the best possible future treatment options.
    • Restaging: Patients with suspected biochemically recurrent prostate cancer, meaning patients with elevated PSA levels after definitive therapy, benefit from using PSMA PET scans because of its ability to precisely locate recurrent prostate cancer and detect cancer spread. For both of these reasons, PSMA PET scans offer the best treatment options for recurrent prostate cancer.

    How Do PSMA PET Scans Work?

    How To Receive A Psma Pet Scan And Prostate Cancer Care At Ucla Health

    UCLA Health provides comprehensive and customized care for men with prostate cancer. Our physicians use the PSMA PET scan alongside radiation therapy, chemotherapy, surgery, and all other treatment modalities offered to make sure men receive the best possible care from diagnosis to treatment to follow-up.

    To ensure the best treatment possible, UCLA Healths nuclear medicine physicians, medical oncologists, radiation oncologists, radiologists, urologists and surgeons optimize care for each person receiving treatment. The prostate cancer care at UCLA Health is backed by multidisciplinary tumor boards with physicians from different specialties and subspecialties, along with genetic counselors and representatives from allied health services. Together, these specialists and experts meet once a week to talk about each new cancer patient and the path forward for their specialized treatment.

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    Influence Of Androgen Deprivation Therapy On Psma

    Vaz et al. attempted to investigate the impact of ADT on PSMA-expression . In spite of the rareness of PSMA PET/CT in cases being treated by ADT and the absence of consensus for such an indication, short term ADT seems to enhance the intensity of pathological PSMA-expression. Contrariwise, long term ADT reduces the uptake of the tracer, maybe also due to treatment response and corresponding restriction of the lesions extent and higher possibility for partial volume effects. Hence, the European Association of Urology guidelines, recommended proceeding with PSMA PET/CT when a patients PSA gets over 0.2 ng/ml as restaging, optimally prior to ADT onset. In the opposite direction, taking in consideration the reinforcement of PSMA-expression by short-term ADT, the sensitivity of PSMA PET/CT could be increased in cases of biochemical recurrence with PSA inferior to 0.5 ng/ml. It is imperative that further work is needed to reach to global consensus of the medical community on this topic.


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