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PET Scans: A High-Tech Look Inside Your Body

Posted on by intio

PET CT scans are often used to diagnose and monitor a variety of conditions, including cancer, heart disease, and brain disorders.

Before having a PET scan, your doctor may ask you to avoid certain foods or medications and possibly even fast for a few hours. This is to ensure the accuracy of the scan. You may also be asked to rest before the scan as physical activity can affect the results. It’s important to carefully follow your doctor’s instructions to get the most accurate scan possible.

PET scans are generally considered a safe and effective way to diagnose and monitor medical conditions, as the amount of radiation you are exposed to is low and the benefits of the scan typically outweigh any potential risks. However, it is important to speak with your doctor if you have any concerns before undergoing a PET scan, particularly if you are pregnant or breastfeeding, or if you have allergies or kidney problems. Your doctor can help you understand the potential risks and benefits of the scan and assist you in determining if it is the right choice for you.

PSMA PET Scan for Prostate Cancer

PSMA PET scans, a specialized type of imaging test, are becoming all the rage in Canada for detecting prostate cancer? While they may not be available everywhere just yet, they’re definitely worth considering if you’re interested in staying on top of your prostate health. To learn more about whether a PSMA PET scan might be a good fit for you, just chat with your doctor or a prostate cancer specialist. They’ll have all the scoop on availability and the potential benefits of these cutting-edge scans.

And that’s not all – there are all sorts of other exciting PET scans out there too! For example, dotatate PET scans use a special chemical called dotatate that’s injected into the body and absorbed by certain cells. The PET scan machine can then pick up on the dotatate and create beautiful images of the tissues and organs where it’s present. These scans are often used to search for cancer in the pancreas, thyroid, and other parts of the body.

And that’s just the tip of the iceberg – there are all sorts of specialized PET scans that can be used to look for specific types of problems or diseases. For instance, there are PET scans that can be used to search for Alzheimer’s disease and other forms of dementia, as well as scans that can be used to diagnose and monitor brain injuries and disorders. And if you’re feeling under the weather, there are even PET scans that can be used to look for infections, inflammation, and other types of diseases.

PET scans may seem intimidating, but they’re just one of the many tricks up a doctor’s sleeve when it comes to diagnosing and treating medical conditions. Think of them as just one piece of the puzzle. Doctors also use things like blood tests, x-rays, and biopsies to get a full picture of a patient’s health. And they don’t stop there – they take into account a patient’s medical history and other factors to determine the best course of action. So while PET scans may be part of the process, trust that your doctor has all the tools and information they need to get you back to feeling your best.

Are you curious about PET scans and how they can benefit your health?

Great news! PET scans are just one of the many tools that doctors and healthcare professionals use to diagnose and treat medical conditions. In fact, they’re often used in combination with other tests and procedures like blood tests, x-rays, and biopsies to get a complete picture of a patient’s health. So don’t hesitate, talk to your doctor about how PET scans can be a valuable part of your healthcare journey. And remember, knowledge is power when it comes to your health. Stay informed and be an active participant in your own healthcare to ensure the best possible care. Trust us, your doctor has all the tools and information they need to help you feel your best.

PET scans are a truly remarkable tool for doctors and healthcare professionals. Not only can they reveal the inner workings and structure of the body, but they can also provide valuable insights into diseases like cancer. By showing how the disease is affecting the body and how it’s likely to progress, PET scans can help doctors make informed decisions about the best course of action. And when it comes to monitoring the effectiveness of treatment, PET scans are a crucial asset.

But here’s the best part – PET scans are generally non-invasive and painless. No need for surgery or other procedures, just lay back and relax on a comfortable table while the scan is being performed. The only preparation required is usually to avoid certain foods and medications beforehand and to fast for a few hours. It’s a small price to pay for such an invaluable tool in the quest for optimal health.

PET scans are medical tests that can give doctors valuable information about your health, but it’s important to be aware of some of their limitations. One thing to consider is cost – if your insurance or healthcare plan doesn’t cover the cost of the PET scan, you might have to pay for it yourself or look for financial assistance. Another limitation is availability – not all hospitals or medical centers offer PET scans, so you might have to travel to have the test done.

It’s also important to be aware of the accuracy of PET scans.

While they can be very useful, they can sometimes produce false positive or false negative results. This means they may show a problem that isn’t actually there, or they may not show a problem that is present. To help make sure you get accurate results, it’s important to follow your healthcare team to instructions carefully and tell them about any allergies or medical conditions you have that might affect the accuracy of the scan.

Despite these limitations, PET scans can still be very helpful for both you and your doctor. If you have any questions or concerns about PET scans, or if you’re thinking about having one, it’s always a good idea to talk to your doctor. They can give you more information and help you make a decision about whether a PET scan is the right choice for you.

PET Scan vs. CT Scan: What’s the Difference?

Posted on by intio

PET Scans

PET scans are a form of medical imaging test that creates precise images of the body’s organs and tissues by using a small amount of radioactive material, known as a radiotracer. A specific camera is used to detect radioactivity and provide photographs of the body once the radiotracer is injected into the subject’s body.

Contrarily, CT scans use X-rays to provide precise images of the body’s tissues and organs. The patient lies on a huge equipment called a CT scanner that has a hole in the middle while the scan is being done. A detailed 3D representation of the body is produced as the equipment spins around the subject while simultaneously taking a number of X-ray photographs.

Advantage of PET Scans

One key advantage of PET scans is their ability to provide functional information about the body’s tissues and organs. While CT scans can show the structure of these tissues and organs, PET scans can show how well they are functioning. This is because the radiotracer used in PET scans accumulates in areas of the body with increased metabolic activity, such as cancer cells or certain areas of the brain associated with diseases or disorders. This allows PET scans to detect problems at an early stage, when they may not yet be visible on CT scans.

For instance, PET scans can be used to find cancer early. In contrast to healthy cells, cancer cells typically have a greater metabolic rate, and the radiotracer used in PET scans builds up in body regions with higher metabolic activity. This means that PET scans are a crucial tool in the diagnosis and treatment of cancer since they frequently detect cancer before it is detectable on CT scans or other imaging procedures. PET scans can also assist in detecting cancer recurrence and monitoring the efficacy of cancer treatment.

Other illnesses, such heart disease and brain abnormalities, are also detected and diagnosed by PET scans. For instance, PET scans can be used to identify abnormalities in the brain brought on by diseases like Parkinson’s and Alzheimer’s. They can also be used to find heart issues, like damage to the heart muscle following a heart attack. PET scans can be used to diagnose heart illness by measuring blood flow to the heart and locating regions of the organ that aren’t receiving enough oxygen. This can aid medical professionals in choosing the patient’s best course of therapy.

PET scans provide certain additional benefits over CT scans in addition to their diagnostic capabilities. For instance, compared to CT scans, PET scans do not subject the patient to as much radiation. Despite the fact that both PET and CT scans expose patients to some radiation, PET scans normally use less radiation than CT scans do. For patients, such as youngsters and pregnant women, who may be at risk of radiation-related side effects, PET scans are a safer option.

Furthermore, PET scans are frequently faster and more comfortable for the patient than CT scans. While CT scans necessitate the patient to remain still for a longer period of time, PET scans typically take a few minutes to complete. Additionally, PET scans do not require the patient to hold their breath, unlike CT scans, which some people find uncomfortable.

PET Scans do have some restrictions.

Due to the need for some specialized tools and qualified workers, PET scans are not as commonly accessible as CT scans. This means that patients may need to go to another place in order to receive a PET scan because not all hospitals and medical facilities have PET scanners. Due to the use of a radiotracer, which must be created and delivered by qualified persons, PET scans can also be expensive. Some people who might not have insurance coverage for the treatment or who might have high deductibles or copays may find this to be a hurdle.

Another drawback of PET scans is that they are less capable than CT scans of generating accurate images of specific bodily structures, such as bones and blood vessels. X-rays, which can penetrate bone and produce precise images of the bone’s structure, are used in CT scans. Contrarily, because bone cannot be penetrated by PET scans, they might not be as useful for identifying abnormalities with the bones as CT scans are.

A possible disadvantage of PET scans is that they aren’t as competent as CT scans in producing reliable images of specific body structures such as bones and blood arteries. CT scans utilize X-rays, which can penetrate bone as well as provide exact images of the bone’s structure. PET scans may not be as effective as CT scans at detecting problems in the bones because they cannot penetrate bone.

Despite these drawbacks, PET scans are superior to CT scans in many ways, including their capacity to reveal functional information about the body’s tissues and organs, their capacity to detect cancer early on, and their usefulness in identifying and diagnosing other conditions like heart disease and brain disorders. The fact that they are quicker, more comfortable, and radioactively safer is also advantageous to patients.

PET Scan vs. CT Scan

In conclusion, both PET scans and CT scans are useful methods for diagnosing medical conditions. PET scans are particularly helpful for identifying and diagnosing cancer as well as other conditions like heart disease and brain disorders because they have the unique advantage of being able to provide functional information about the body’s tissues and organs. PET scans are an important tool in the field of medical imaging, despite having some drawbacks and perhaps not being as widely or inexpensively available as CT scans.

PET Scan vs. MRI: What’s the Difference?

Posted on by intio

PET Scans

The nuclear medicine imaging test known as a PET scan creates finely detailed three-dimensional images of the body’s functional processes, such as metabolism and blood flow. Cancer, heart disease, and neurological disorders are just a few of the conditions that are frequently diagnosed and monitored using PET scans.

Benefit of PET Scans

The ability to provide functional data about the body’s tissues and organs is one benefit of PET scans. PET scans produce images based on how the body’s cells are functioning rather than the density of tissues like conventional X-ray or CT scans do. This can be especially helpful in the detection and treatment of cancer since PET scans enable medical professionals to determine whether a tumour is malignant and whether it is actively growing or spreading.

High sensitivity is another benefit of PET scans. The ability of PET scans to identify extremely minute abnormalities in the body’s tissues and organs makes them valuable for the early diagnosis of cancer and other diseases. Furthermore, false-positive results from PET scans are extremely uncommon and have a high accuracy rate.

In comparison to other imaging modalities, PET scans also have a relatively quick examination time, with most scans taking less than an hour. For patients who might have trouble staying still for extended periods of time or who might become anxious during medical procedures, this can be especially crucial.

PET Scans do have some restrictions

One drawback of PET scans is their cost, which is typically higher than that of CT or MRI scans or other imaging modalities. A small amount of radioactive tracer must also be injected into the patient’s bloodstream prior to a PET scan, which may raise concerns for some people.

MRI

Using strong magnets and radio waves, the medical imaging technique known as MRI (Magnetic Resonance Imaging) creates precise images of the body’s tissues and organs. Cancer, heart disease, and neurological disorders are just a few of the many medical conditions that MRI is frequently used to diagnose and assess.

Advantages of MRI

Detailed images of the body’s soft tissues, such as muscles, tendons, and ligaments, which may not be as visible on other imaging modalities like CT or X-ray, can be produced by MRI, which is one of its advantages. MRI is helpful for the diagnosis and treatment of neurological conditions because it can produce precise images of the brain and spine.

The ability of MRI to image the body in multiple planes (slices) gives medical professionals the opportunity to view the body from various perspectives and get a more comprehensive understanding of the patient’s condition. Due to the lack of ionising radiation, MRI is typically more comfortable for patients than other diagnostic imaging modalities.

MRI does have some restrictions

The price of MRI exams, which are typically more expensive than other imaging modalities like CT or PET, is one drawback. Additionally, MRI uses a sizable, enclosed machine that some patients, particularly those who have claustrophobia, may find intimidating. MRI exams typically last 30 to 60 minutes, which is longer than other imaging modalities.

It is crucial to remember that both MRI and PET are useful diagnostic and therapeutic tools for treating medical conditions, and a healthcare provider should choose which modality to employ based on the unique requirements of the patient.

PET Scan vs. MRI: What’s the Difference?

In conclusion, both PET scans and MRI are beneficial medical imaging techniques, but they each have particular benefits and drawbacks. While MRI is particularly useful for creating detailed images of the body’s soft tissues and has the ability to image the body in multiple planes, PET scans are particularly useful for providing functional information about the body’s tissues and organs and are highly sensitive and accurate. The decision regarding which modality to employ in a given circumstance is based on a number of variables, including the patient’s unique medical condition and the objectives of the imaging examination. The most thorough and precise diagnosis and treatment plan may every once in a while, be produced by combining PET and MRI.

Lung cancer screening programs are catching more disease while still curable

Posted on by intio

Story: https://www.healio.com/news/hematology-oncology/20221212/lung-cancer-screening-leads-to-more-stage-i-less-stage-iv-disease-incidence

Implementation of lung cancer screening across five diverse health care systems led to higher rates of stage I diagnoses and lower rates of stage IV disease, study results showed.

Overall incidence of lung cancer did not increase during the study period, indicating a limited impact of overdiagnosis, according to the findings published in Journal of Thoracic Oncology.

Data derived from Vachani A, et al. J Thorac Oncol. 2022;doi:10.1016/j.jtho.2022.08.011.

Methods

Although results of clinical trials have indicated favorable shifts in disease stage and improvements in lung cancer-specific mortality, “the effectiveness of lung cancer screening in clinical practice has not been clearly demonstrated,” Anil Vachani, MD, MS, associate professor of medicine at Hospital of the University of Pennsylvania and Pittsburgh Veterans Administration Medical Center, and colleagues wrote.

The multicenter cohort analysis included 3,678 patients (median age, 69 years [interquartile range, 64-74]; 52% women) diagnosed with a primary lung cancer between Jan. 1, 2014, and Sept. 30, 2019, across five IU.S. health care systems — Henry Ford Health System, Kaiser Permanente Colorado, Kaiser Permanente Hawaii, Marshfield Clinic Health System and University of Pennsylvania Health System.

Primary outcomes included cancer stage distribution and annual age-adjusted lung cancer incidence. Receipt of at least one low-dose CT scan before lung cancer diagnosis served as the primary exposure variable.

Findings

Overall, 11% (n = 404) of all patients were diagnosed with incident lung cancer after the health care systems initiated low-dose CT screening.

Researchers found that as the volume of lung cancer screening increased, the percentage of patients diagnosed with lung cancer after initiation of screening also increased, from none in 2014 to 20% in 2019. However, lung cancer screening did not correlate with a significant change in the overall incidence of lung cancer between 2014 and 2018 (average annual percentage change [AAPC], 0.8; 95% CI, -4.7 to 3.2).

Researchers additionally observed an average 8.4% increase in the annual rate of stage I cancer (AAPC, 8; 95% CI, 0.8-15.7) and a 6.6% decrease in stage IV disease (AAPC, 6; 95% CI, 11.2 to 0.5).

Implications

“This is the first study to determine the impact of lung cancer screening on cancer stage migration using a population-based multicenter cohort,” Vachani and colleagues wrote. “The distribution of [disease] stage was similar to rates observed in prior clinical trials despite limitations, such as lower adherence to annual screening that have been observed outside of trial settings.”

“As screening implementation progresses,” they added, “future population-based studies are needed to assess the impact of screening on other effectiveness outcomes, including rates of harms related to screening and the impact on lung cancer mortality.”

Dr. Robert Tarzwell, MD, FRCPC

In this study of lung cancer screening at 5 sites, in 3678 individuals, physicians detected 8% more stage 1 lung cancer, which is curable with surgery, and 6% less stage 4 (incurable) cancer. Overall, therefore, the program was catching lung cancer earlier in a screening population, offering a greater prospect of cure. If you’ve ever been a smoker, ask your physician or nurse practitioner about a lung cancer screening low dose CT scan of the chest, which we would  be happy to provide for you at INITIO.

Patient calls nuclear medicine treatment “a beam of light”

Posted on by intio

Story: https://www.nbcboston.com/news/local/dont-give-up-hope-man-describes-cutting-edge-cancer-treatment/2830563/

‘Don’t Give Up Hope’: Man Describes Cutting-Edge Cancer Treatment

Paul Bristow was the first patient at Dana Farber Cancer Institute in Boston to undergo a new nuclear medicine treatment for his metastatic prostate cancer

Paul Bristow loves being active. So when the 69-year-old was diagnosed with metastatic prostate cancer, it came as a gut punch to him and his wife, Kathy.

“It is almost like an out of body experience. He’s talking to me saying that we think it could be cancer, you can’t believe it,” Bristow said.

“When you hear that word cancer, it hits you in your heart so hard,” Kathy added.

When prostate cancer gets to later stages, doctors say they are turning to new kinds of nuclear medicine.

“Even the smallest amount of cancer spread beyond prostate can now be detected with these techniques,” said Dr. Munir Ghesani, the chief of Nuclear Medicine at Mt. Sinai in New York.

The FDA recently approved this new treatment that helps extend the quality and quantity of life, he said.

“That’s targeting that same radioactive drug, but using the treatment delivery so that those cancer cells, no matter where they are in the body, can be selectively identified by these drugs,” Ghesani said.

Bristow was the first patient at Dana Farber Cancer Institute in Boston to undergo the injections.

“The side effects are kind of like chemo fatigue — joint/muscle pain, manageable. Today I mowed the lawn, I got outside, hit the pool,” he said.

Bristow said he hopes his story will help inspire others to talk with their doctors about getting screened and the treatment options out there.

“Don’t give up hope. I learned early on they had no cure for this cancer but there is always hope and again this radioactive medicine was a beam of light,” he said.

Dr. Rob’s comment

69 year old Boston man currently undergoing successful treatment for advanced prostate cancer with newly approved Pluvicto, which precisely targets cancer cells while avoiding healthy tissue.

Lutetium PSMA targeted radiotherapy for prostate cancer

Posted on by intio

Article: https://www.cancernetwork.com/view/phillip-h-kuo-md-phd-reviews-rationale-of-phase-3-vision-trial-of-117lu-psma-617-in-mcrpc

At the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, CancerNetwork® spoke with Phillip H. Kuo, MD, PhD, professor of medical imaging, biomedical engineering, and medicine as well as member of the Graduate Faculty at The University of Arizona College of Medicine in Tucson, about the rationale behind the phase 3 VISION trial (NCT03511664) which examined 177Lu-PSMA-617 (Pluctivo) in patients with previously treated metastatic castration-resistant prostate cancer. He and his colleagues presented findings from a substudy of the trial which aimed to correlate 68GA-PSMA-11 PET/CT imaging with outcomes from 177Lu-PSMA-617.

Transcript:

The VISION trial is the only completed phase 3 trial using the theragnostic paradigm of imaging with a PSMA [prostate specific membrane antigen]–PET targeted agent to select patients whose tumors express PSMA. Then we treat that with a radioligand therapy. Instead of a positron emission tracer radioactive isotope, we put in a beta-emitting therapeutic isotope that targets the same PSMA molecule in prostate cancer. The prostate cancer population that we were going after in this trial was metastatic castrate-resistant prostate cancer, [specifically] the subgroup that had already failed taxane therapy and an androgen receptor pathway inhibitor. These are patients that have few options left for therapy.

Reference

Kuo P, Hesterman J, Rahbar K, et al. [68Ga]Ga-PSMA-11 PET baseline imaging as a prognostic tool for clinical outcomes to [177Lu]Lu-PSMA-617 in patients with mCRPC: A VISION substudy. J Clin Oncol. 2022;40(suppl 16):5002. doi:10.1200/JCO.2022.40.16_suppl.5002

Dr. Rob’s comment

In this video, Dr. Philip Kuo discusses the VISION trial, which investigated the use of radiotherapy with lutetium, bound to the molecule PSMA-617, to treat metastatic prostate cancer which no longer responds to hormone therapy. This treatment option will be available in Canada soon, and when it is, INITIO will have all the special safety licensing in place to offer it.

Advantages of PSMA-PET imaging in prostate cancer care

Posted on by intio

Article: https://healthimaging.com/topics/medical-imaging/nuclear-medicine/video-advantages-psma-pet-imaging-prostate-cancer-care

Munir Ghesani, MD, FACNM, FACR, president of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), system chief of nuclear medicine at Mount Sinai Health, and associate professor of radiology at Icahn School of Medicine at Mount Sinai, explains prostate-specific membrane antigen (PSMA) targeted radiotracers used in positron emission tomography (PET) scans are seeing rising adoption because it can significantly improve prostate cancer detection and treatment. 

Prostate cancer tumors over-express PSMA proteins, making the radiotracer bind to them more readily. This makes the prostate cancer much easier to visualize and target for treatment with PSMA-PET. This includes even very small levels of tumor cells that have metastasized to other areas of the body and are often missed with convention prostate imaging. 

“It is an exciting new technology that is in many ways changing the way prostate cancer is managed,” Ghesani explained. “I can say without any hesitation see the literature that will evolve from the widespread use of PSMA-PET in the coming years is going to result in a quite different management algorithm for prostate cancer in the future.”

Prostate cancer tumors over-express PSMA proteins, making the radiotracer bind to them more readily. This makes the prostate cancer much easier to visualize and target for treatment using PSMA-PET imaging. Ghesani said has revolutionized prostate cancer care. This is because even very small levels of tumor cells that have metastasized to other areas of the body can be seen, but are often missed using conventional prostate image techniques. This is helping catch and treat these areas of cancer beyond the prostate bed. 

Ghesani said PSMA-PET also helps radiation oncologists zero in and target metastases. He said the imaging makes it much easier to contour images and make sure these areas of small tumors are included in the treatment plan. 

Costs and time might be reduced by eliminating other exams and just using PSMA-PET

The ability of PSMA-PET to clearly see prostate cancer and its spread to other parts of the body may change the current workflow and reduce the need for extra exams. 

“We are still in the transition stage to PSMA-PET, but I can see the evolving pattern for patient workups, that it may in many instances eliminate the need for a CT scan and a bone scan first before a PSMA-PET exam,” Ghesani explained.

Related PSMA-PET Content:

GE Healthcare and Theragnostics announce global commercial partnership for late stage PSMA diagnostic for prostate cancer
‘Game changer’: FDA approves first PSMA-targeted PET imaging tracer for men with prostate cancer
‘Practice changing’: New research underscores clinical benefits of PSMA-PET for prostate cancer
PSMA-PET alters care for nearly 50% of patients with metastatic liver cancer
PSMA PET/CT better detects prostate cancer spread, long-term outcomes over conventional imaging
FDA approves Telix’s prostate cancer imaging product, improving access to PSMA-PET
Dr. Rob’s comment

SNMMI President Dr. Munir Ghesani said the use of PSMA-targeted radiotracers in PET imaging is increasing because they can help improve detection and treatment of prostate cancer. “It is an exciting new technology that is in many ways changing the way prostate cancer is managed.”

68Ga-PSMA PET/CT Protocols May Differ for RP, BCR

Posted on by intio

Article: https://www.docwirenews.com/gu-oncology-now/gu-psma-knowledge-hub/68ga-psma-pet-ct-protocols-may-differ-for-rp-bcr/

New Research on Persisting PSA after Prostatectomy Suggests PSMA PET

New research suggests that men with PSA level persistence after undergoing radical prostatectomy (RP) should be recommended 68Ga-PSMA PET scans even if their PSA level is considered low.

Whereas patients with biochemically recurrent (BCR) prostate cancer after RP should be monitored based on their PSA levels, as additional scans may not provide benefits.

A study presented at the 37th congress of the European Association of Urology in Amsterdam analyzed 207 patients with prostate cancer who received 68Ga-PSMA PET/CT. Researchers found that the PSA levels of patients, as well as the time to BCR during PSMA PET/CT, can have an effect on the chances of positive findings during PSMA PET.

Patients were organized by their time to BCR, and researchers examined the correlation between PSA level at the time of PSMA PET and the likelihood of positive results. The median level of PSA at the time of PSMA PET/CT was 1.0 ng/ML. In the study, 38% of patients had early BCR or PSA persistence after RP.

A high PSA level and early versus late BCR at the time of PSMA PET was associated with a 2.2- and 2.6-fold increased odds of positive results. In patients with early BCR, the chance of receiving positive PSMA PET results was high even when their PSA levels were considered low, and their results continued to increase with a higher PSA level; the positive findings rate increased from 63% to 93%. Moreover, in patients with late BCR, the probability of receiving positive findings was lower than 40% if PSA values were under 0.5 ng/ml.

José Ramón García Garzón, MD, of Ascires Cetir Viladomat in Barcelona, said that “it is important to know which patients may benefit the most; screening in relation to the time after PSA elevation and the PSA value is an appealing strategy to increase the sensitivity of the test.”

Professor Otis W. Brawley, MD, of Johns Hopkins University in Baltimore, noted that “some patients are insisting on [PSMA PET scans] for routine evaluation of response…some want them with very low PSA’s where chances of a false negative are high. When doctors do not have guidelines as to when a test should be used and there is a lot of patient request, things are ripe for waste and abuse.”

To counteract unnecessary PSMA PET use, low-risk patients and those with late BCR should be monitored closely based on their PSA levels to determine if they would benefit from additional PSMA PET scans.

Dr. Rob’s comment

“New research suggests that men with PSA level persistence after undergoing radical prostatectomy should be recommended PSMA PET scans even if their PSA level is considered low.”

PSMA PET/CT Lymph Node Staging Can Predict Prostate Cancer Surgery Outcomes

Posted on by intio

Article: https://www.renalandurologynews.com/home/news/urology/prostate-cancer/psma-pet-ct-lymph-node-staging-can-predict-prostate-cancer-surgery-outcomes/

Patients with prostate cancer who have pelvic lymph node metastases visualized on preoperative PSMA PET/CT staging (prostate-specific membrane antigen positron emission tomography/computed tomography) have a significantly higher risk for biochemical disease progression after robot-assisted radical prostatectomy (RARP) compared with those without pelvic lymph node metastases on imaging, recent study findings suggest.

PSMA PET/CT lymph node staging can provide useful prognostic information for men undergoing robot-assisted
radical prostatectomy for prostate cancer. Source: Getty Images

The retrospective study included 145 patients who underwent PSMA PET/CT lymph node staging prior to RARP and had pelvic lymph node metastases found on extended pelvic lymph node dissection. The median biochemical progression-free survival was 7.9 months among the 49 patients (34%) whose preoperative imaging revealed pelvic lymph node metastases compared with 13.7 months for the 96 patients (66%) whose preoperative imaging did not, Dennie Meijer, MD, of Amsterdam University Medical Center in The Netherlands, and colleagues reported in BJU International.

In addition, the presence of more than 2 tumor-positive lymph nodes, compared with 1-2, was significantly associated with a nearly 2-fold increased risk for biochemical progression, after adjustment for multiple variables. A larger diameter of the largest nodal metastasis was significantly associated with a 12% increased risk.Today’s top picks on the Haymarket Medical NetworkNew Machine Learning Tool to Predict Pneumonia Progression Outperforms PSIAI Can Help Identify Incidental PE on Conventional Chest CT ExamsArtificial Intelligence and the Hunt for Neuroprotection in Glaucoma

The investigators defined biochemical progression as a PSA level of 0.2 ng/mL or higher during follow-up or the initiation of additional treatment.

The median diameter of the largest nodal metastasis was significantly larger among the patients with vs without nodal metastases found on preoperative PSMA PET/CT lymph node staging (6 vs 3 mm).

At final histopathologic evaluation, the median biochemical progression-free survival for patients with 1 or 2 tumor-positive lymph nodes was 14.9 months compared with only 3.9 months for patients who had more than 2 tumor-positive lymph nodes, Dr Meijer’s team reported.

Among patients with nodal metastases visualized on preoperative PSMA PET/CT, only the diameter of the largest nodal metastasis was significantly associated with biochemical progression; the number of tumor-positive lymph nodes was not. Among patients with no nodal metastases seen on PSMA PET/CT, both the presence of more than 2 positive lymph nodes and the diameter of the largest nodal metastasis were significantly associated with biochemical progression.

Reference

Meijer D, Ettema RH, van Leeuwen PJ et al. The prognostic value of lymph node staging with prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and extended pelvic lymph node dissection in node-positive patients with prostate cancer. BJU Int. Published online September 7, 2022. doi:10.1111/bju.15881

Dr. Rob’s comment

The evidence continues to grow that PSMA PET/CT used pre-operatively can predict which patients will relapse and which will not. In this study, investigators looked at a group of 145 patients who had scans and then went on to get surgery. Patients with as few as only 1 or 2 positive lymph nodes on the scan were more likely to have a rising PSA in the future, even when those nodes were removed at surgery. One role of PSMA PET/CT is to spare patients from potentially disabling surgery who are unlikely to have a long term benefit.

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