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.
General Example Of Pet Scan Use After A Prostate Cancer Diagnosis
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.
How Is Prostate Cancer Treated
There are many treatment options for cancer limited to the prostate gland. You and your doctor should carefully consider each option. Weigh the benefits and risk as they relate to the aggressiveness and/or stage of the cancer as well as your age, overall health, and personal preferences. Standard treatments include:
- Surgery : The surgeon makes an incision in the lower abdomen or through the perineum and removes the prostate. If they cannot remove the entire tumor, you may need radiation therapy. You will need to keep a urinary catheter in place for several weeks after the procedure. Possible side effects can include incontinence and impotence. Some surgeons may use three small incisions to do robot-assisted prostatectomy. This may result in a shorter hospital stay and quicker recovery. This procedure may be preferable for some patients, but not for all.
- External beam therapy : a method for delivering a beam of high-energy x-rays or proton beams to the location of the tumor. The radiation beam is generated outside the patient and is targeted at the tumor site. These radiation beams can destroy the cancer cells, and conformal treatment plans allow the surrounding normal tissues to be spared. See the External Beam Therapy page for more information.
- Active surveillance: No treatment, with careful observation and medical monitoring.
Advanced treatment options may avoid or minimize some of the side effects associated with standard therapies. These options include:
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How A Psma Pet Scan Works
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 To Get A Psma Pet Scan
- PSMA PET scans are offered at UCSF Radiology China Basin location in the San Francisco Bay area.
- For UCSF patients, please reach out to Radiology Scheduling directly to schedule your PSMA scan.
- For non-UCSF facilities referring patients that are new to UCSF, please fax the following to 353-7299 for patient registration to be completed prior to scheduling:
- Patient Exam Order
- Insurance Information and Authorization
How The Information Provided By Axumin Is Utilized
The Axumin scan is approved for men who have developed a rising PSA after previous radiation or surgery. Historically, simple bone scans and CAT scans required PSA levels in the 10 to 50 range before enough cancer would be present to be detected on a scan. The beauty of the Axumin PET scan is that it offers the possibility of detecting small metastatic lesions in the lymph nodes with PSA levels in the 1 to 10 range.
The other potential application of the Axumin scan, apart from its usefulness for determining the area of PSA relapse, is for men who have undergone chemo-hormonal treatment for advanced metastatic disease. After treatment, men may achieve a sharp reduction in PSAperhaps from the 100s down to 10 or less. The Axumin scan can potentially single out an area of cancer in the body that is manifesting persistent metabolic activity, a sign that the cancer cells remain viable despite recent treatment with Lupron and Taxotere. If a relatively limited number of areas of persistent metabolic activity are detected, it is possible that such patients could benefit from spot radiation or other forms of treatment directed at the residual disease.
Realizing these limiting factors, it will be important for patients to identify centers that are using state-of-the-art equipment and have experienced physicians who are doing a larger number of scans. These centers of excellence are likely more knowledgeable to read these scans properly.
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Pet Scans May Improve Treatment For Esophageal Cancer
Clinical trial results presented at the Gastrointestinal Cancers Symposium in San Francisco suggest that the use of PET scans to assess a cancers response to initial chemotherapy may provide doctors with useful information to further tailor chemotherapy.
Standard treatment of patients with stage II-III esophageal and gastroesophageal junction cancers includes chemotherapy with radiation , followed by surgery. Physicians may use several different chemotherapy regimens without knowing which particular chemotherapy will be most effective.
In the current study doctors administered chemotherapy before chemoradiation and used PET scans after the initial chemotherapy to assess response to treatment in order to see if the early PET scan can help doctors make quick course corrections to maximize patient benefit from chemotherapy.
A total of 257 patients with stage II-III esophageal and GEJ adenocarcinoma were treated with one of two different chemotherapy regimens: either modified FOLFOX-6 or carboplatin/paclitaxel. A PET scan was repeated in all patients after a couple cycles of chemotherapy. If the PET scan demonstrated that the chemotherapy was working, no change in treatment was made. If the PET scan however demonstrated that the chemotherapy was not effective, the chemotherapy was changed to the other regimen.
The Evolving Role Of 18f
- 1State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- 2Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Positron emission tomography/computed tomography is widely used in prostate cancer to evaluate the localized tumor burden and detect symptomatic metastatic lesions early. 18F-FDG is the most used tracer for oncologic imaging, but it has limitations in detecting early-stage prostate cancer. 68Ga-PSMA is a new tracer that has high specificity and sensibility in detecting local and metastatic tumors. But with the progression of prostate cancer, the enhancement of glucose metabolism in progressive prostate cancer provides a chance for 18F-FDG. This review focuses on PET/CT in the detection and prognosis of prostate cancer, summarizing the literature on 18F-FDG and 68Ga-PSMA in prostate cancer and highlighting that 18F-FDG has advantages in detecting local recurrence, visceral and lymph node metastases compared to 68Ga-PSMA in partial progressive prostate cancer and castration-resistant prostate cancer patients. We emphasize 18F-FDG PET/CT can compensate for the weakness of 68Ga-PSMA PET/CT in progressive prostate cancer.
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Do Ct Pelvic Scans Detect Cancer
While pelvic CT scans can detect a variety of issues, they can be especially useful for detecting cancer. In particular, doctors can use this technology to look for tumors in this part of your body, but they can also use these scans to monitor the growth of tumors, to see how treatments are working, and to guide treatments.
A Negative Ct Scan For Prostate Cancer Isnt Anything To Get Too Hopeful About Because A Ct Scan Can Actually Miss Prostate Cancer
Yes, a CT scan can miss prostate cancer, says Jonathan W. Simons, MD, President and Chief Executive Officer of the Prostate Cancer Foundation, David H. Koch Chair.
Dr. Simons explains, A CT scan is fundamentally a three-dimensional X-ray of the body. It does not intrinsically distinguish between cancer and normal tissue.
We therefore rely on anatomical changes to tell us the probability something is normal or is cancer.
For example, if a lymph node is normal in size it still has the potential to have cancer in it.
However, if a lymph node is enlarged it has a much higher probability there is cancer present, although not guaranteed.
Any imaging modality cant identify microscopic disease, so a CT scan, MRI scan and PET scan can miss prostate cancer that may have spread.
The presence of prostate cancer can be indicated by an abnormally elevated PSA blood test result or by a digital rectal exam .
These tests do not diagnose a malignancy they can only raise suspicion. Diagnosis is made only via a biopsy of tissue extracted from the prostate gland.
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Progressive And Aggressive Prostate Cancer
After initial treatment as radical prostatectomy or androgen deprivation therapy , the disease progresses into metastasis, recurrence, or resistance to treatment. 18F-FDG PET/CT has been used as a commonly used means to observe the effects of treatment and surveillance together with CT, MRI, PSMA, and bone scan .
What Are The Most Common Types Of Pet Scans For Prostate Cancer
- PSMA PET Scan: Now FDA approved, they are used to locate, stage, and restage prostate cancer. PSMA PET scans have been FDA approved to be used after a diagnosis of prostate cancer in order to stage and determine if cancer has spread to other parts of the body. They have also been approved for use in locating and restaging recurrent prostate cancer for patients with biochemical recurrence.
- Axumin PET Scan: Currentlyin use primarilyfor the purpose of restaging recurrent prostate cancer in those patients with suspected biochemical recurrence.
- FDG PET Scan: May also be used for staging in particular cases of prostate cancer. In some instances, depending on the prostate cancer tumor type, FDG PET scans may be used for the restaging of recurrent prostate cancer as well.
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Types Of Imaging Studies
If your doctor 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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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.
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Pet Scans Improve Accuracy Of Staging Of Patients With Melanoma And May Lead To More Appropriate Treatment
Accurate staging of melanoma is important to determine the most effective treatment for the patient. The use of PET scans can improve accuracy in the detection of the presence and location of melanoma, which may ultimately lead to better treatment.
Researchers at Duke University evaluated the effectiveness of PET scans to detect melanoma in 95 patients. Clinical tests, including CAT scans, had determined that all of these patients had stage III melanoma, with no evidence that the cancer had spread. Following the staging, the patients all had a full body PET scan. Twenty percent of the areas detected by the PET scan were previously undetected cancer cells that had spread. These findings lead to a change in the planned treatment for 15% of these patients.
These findings indicate that PET scanning can be helpful in more accurately evaluating the extent of melanoma, which ultimately dictates the treatment strategy. The physicians conducting this study currently utilize PET scanning as initial staging for patients who have stage III melanoma. Any abnormality seen on PET is then evaluated further with a localized CAT scan to better define the abnormality. It seems reasonable that this approach should help maximize the detection of unsuspected cancer in staging patients with melanoma. Importantly, positron emission tomography scans now have a Medicare reimbursement for melanoma patients.
Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, he or she will ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.
Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.
After the exam, your doctor might then order some tests.
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What Do Clinical Studies Tell Us
There is growing evidence to indicate that the Gallium 68 PET scan is both accurate and clinically significant.
In a study featured in The Journal of Nuclear Medicine, Australian , researchers demonstrate that PET scans can identify which of these prostate cancer patients would benefit from salvage radiation treatment .
The research is novel because it looks at the impact of PSMA PET/CT on patient responses to treatment, not just on whether the PET scan results in changed management, explains Louise Emmett, MD, of the St. Vincents Hospital, Sydney, Australia. She elaborates, In the study, these patients underwent imaging with a PSMA PET scan and had treatment based on the results of the scan findings. The study then followed how these men were treated, and whether the treatment was effective.
The study demonstrates that PSMA PET can independently predict treatment response to SRT. Men with negative or fossa-confined PSMA have the highest treatment response to SRT, while men with cancerous nodes or distant disease have a poor response. In particular, a negative PSMA PET predicts a high response to SRT.
Emmett points out, The results of the study show that PSMA PET is more predictive of a treatment response than PSA level, surgical margins or seminal vesical involvement.
What Are The Advantages And Disadvantages Of Having An Mri Scan Before A Biopsy
- 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.
- 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.