Category: Publications

Article: https://medicalxpress.com/news/2022-09-psma-petct-imaging-prostate-cancer.html

Research shows PSMA PET/CT imaging changes management for close to 50% of prostate cancer patients

by Society of Nuclear Medicine and Molecular Imaging

In prostate cancer patients experiencing recurrence following a radical prostatectomy, imaging with ¹⁸F-DCFPyL PSMA PET/CT has been shown to considerably improve detection of active disease as compared to imaging with CT alone. As reported in the September issue of the Journal of Nuclear Medicine, detailed PET/CT scans resulted in a change in treatment plans for nearly 50% of patients.

Prostate specific antigen (PSA) recurrence—defined as a PSA level higher than 0.2ng/mL—occurs in 20 to 50% of all radical prostatectomy cases. In more than half of these patients, subsequent treatment with salvage radiotherapy (most commonly to the prostate bed) results in five-year biochemical control.

“For those patients who are experiencing a recurrence, it’s important to determine exactly where the cancer has spread so that it can be treated effectively with salvage radiotherapy,” said Michael Ng, MBBS (Hons), FRANZCR, radiation oncologist at GenesisCare St Vincent’s Hospital in Melbourne, Australia. “We know that prostate specific membrane antigen (PSMA) radiotracers have increased sensitivity in the detection of prostate cancer compared to conventional imaging. In this study we assessed the management impact of a novel PSMA tracer, ¹⁸F-DCFPyL PSMA PET/CT, in patients being considered for salvage radiotherapy.”

This study included 100 patients presenting with a detectable PSA following radical prostatectomy. Following patient registration and prior to any imaging, radiation oncologists outlined each patient’s “original intent” treatment plan on a questionnaire. All patients then underwent diagnostic CT and ¹⁸F-DCFPyL PSMA PET/CT. The CT results were released first, and a second “post-CT intent” questionnaire was completed. Next, the ¹⁸F-DCFPyL PSMA PET/CT results were released and a final “post-PSMA intent” questionnaire was completed. Change in management was graded based on impact and defined as major, minor, or no change demonstrated.

¹⁸F-DCFPyL PSMA PET/CT detected disease in 46.9% of patients compared to 15.5% on diagnostic CT. Major changes in the treatment plan were more likely to occur after PSMA imaging (12.5%) than after CT imaging (3.2%), and moderate changes were noted in 31.3% of patients after PSMA imaging versus 13.7% after CT imaging. The most common changes were recommendations for additional treatment, such as elective pelvic radiation, nodal boost, or concurrent androgen deprivation therapy.

Follow-up data were available at 18 months for 59 of the individuals in the study. At that timepoint, 92.5% had a PSA of below 0.20ng/mL and 74.5% had an undetectable (less than 0.03ng/mL) PSA.

“This research is novel as utilization of PSMA PET/CT allows earlier detection of prostate cancer after radical prostatectomy. The prospective study carefully collected changes in decision making and tracked the impact on patient management with outcome data available in patients who underwent radiotherapy,” noted Dr. Ng. “The group of patients studied—all post-surgery without other confounding treatments (no prior radiotherapy and no prior drug therapy) with a low and focused PSA range between 0.2-2.0ng/mL— reflects a common management problem. The study’s results are timely and applicable for patients experiencing their first recurrence after prostate surgery.”

Article: https://www.physiciansweekly.com/psa-pet-features-to-select-slnd-persons-in-recurrent-pca

For a study, researchers sought to assess the association between pre-operative PSA value, ⁶⁸Ga-prostate-specific-membrane-antigen (PSMA) PET performance, and oncologic results following salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).

In the analysis, 164 patients who had undergone pelvic±retroperitoneal sLND at 11 high-volume centers between 2012 and 2019 and had at least 2 pelvic lymph node recurrences of PCa were included. In terms of PSA readings at the time of sLND, pathologic results were divided into 4 categories: early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml), and high (>1.5 ng/ml). Multivariable analyses were used to compute the clinical recurrence (CR)-free survival following sLND and display that data over the pre-operative PSA levels.

About 131 (80%) of the patients had one positive spot on the PET scan, and the median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml. All patients had a retroperitoneal dissection in addition to pelvic sLND, whereas 91 (55%) males did so. Around 15 (6, 28) was the median (IQR) number of nodes eliminated. As a function of pre-operative PSA value, the rate of positive pathology increased, with the greatest rates occurring in patients with pre-operative PSA values>1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, 67 (41%) males had PSA levels≤ 0.3 ng/ml. Pre-operative PSA was connected to PSA response in multivariable analysis (P<0.0001). Fifty-one CRs were recorded following sLND. After correcting for covariates, they discovered a strong, non-linear correlation between PSA level at sLND and the 12-month CR-free survival (P<0.0001), with patients who got sLND at PSA ≥1 ng/ml having the best likelihood of being free from CR.

Salvage surgery was done on males with PSA 1 ng/ml and was linked with the best short-term oncologic outcomes in cases with PET-detected nodal recurrences amenable to sLND. The findings may assist medical professionals in choosing the best time for ⁶⁸Ga-PSMA PET in patients with biochemically recurrent PCa while awaiting confirmation from prospective studies.

Reference: 

bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.182

Article: https://www.medscape.com/viewarticle/979929?reg=1&icd=ssl_login_success_221019

Nearly 123,000 cancer deaths – or almost 30% of all cancer deaths – in the United States in 2019 were linked to cigarette smoking, a new analysis suggests.

That corresponds to more than 2 million person-years of lost life and nearly $21 billion in annual lost earnings.

“During the past few decades, smoking has substantially declined in the U.S., followed by great declines in mortality from lung cancer and some other smoking-related cancers,” says lead author Farhad Islami, MD, senior scientific director of cancer disparity research at the American Cancer Society.

Despite this “remarkable progress, our results indicate that smoking is still associated with about 30% of all cancer deaths and substantial lost earnings in the U.S., and that more work should be done to further reduce smoking in the country,” he says.

The study was published online Aug. 10 in the International Journal of Cancer.

Islami and colleagues had found that lost earnings from cancer deaths in 2015 came to nearly $95 billion. Other research showed that a substantial portion of lost earnings from cancer deaths could be traced to cigarette smoking, but estimates were more than a decade old.

To provide more recent estimates and help guide tobacco control policies, Islami and colleagues estimated person-years of life lost (PYLL) and lost earnings from cigarette smoking-related cancer deaths in 2019.

Of the 418,563 cancer deaths in adults ages 25 to 79 years, an estimated 122,951 could be linked to cigarette smoking. That corresponds to 29.4% of all cancer deaths and roughly 2.2 million PYLL. Translated to lost earnings, the authors estimated $20.9 billion total, with average lost earnings of $170,000 per cancer death linked to smoking.

By cancer type, lung cancer accounted for about 62%, or $12.9 billion, of the total lost earnings linked to smoking, followed by esophageal cancer (7%, or $1.5 billion), colorectal cancer (6%, or $1.2 billion), and liver cancer (5%, or $1.1 billion).

Smoking-related death rates were highest in the 13 “tobacco nation” states with weaker tobacco control policies and a higher rate of cigarette smoking. These states are Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia.

The lost earnings rate in all 13 tobacco nation states combined was about 44% higher, compared with other states and the District of Columbia combined, and the annual PYLL rate was 47% higher in tobacco nation states.

The researchers estimated that if PYLL and lost earnings rates in all states matched those in Utah, which has the lowest rates, more than half of the total PYLL and lost earnings nationally would have been avoided. In other words, that would mean 1.27 million PYLL and $10.5 billion saved in 2019.

Ending the “Scourge of Tobacco”

To kick the smoking habit, health providers should “screen patients for tobacco use, document tobacco use status, advise people who smoke to quit, and assist in attempts to quit,” Islami says.

Getting more people to screen for lung cancer in the U.S. is also important, given that only 6.6% of eligible people in 2019 received screening.

In a statement, Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said this report “further demonstrates just how critical reducing tobacco use is to ending suffering and death from cancer.”

To end the “scourge of tobacco,” local, state, and federal lawmakers need to pass proven tobacco control policies, she said.

These include regular and significant tobacco tax increases, thorough statewide smoke-free laws, and enough funding for state programs to prevent and stop smoking. It also means ensuring all Medicaid enrollees have access to all services that can help smokers quit as well as access to all FDA-approved medications that help users stop smoking.

“We have the tools to get this done, we just need lawmakers to act,” Lacasse said.

The study had no commercial funding. The authors have declared no competing interests.

Sources

International Journal of Cancer: Person-years of life lost and lost earnings from cigarette smoking-attributable cancer deaths, United States, 2019.”

American Cancer Society: “New Study Shows Two Million Life-Years Lost and $21 Billion in Lost Earnings Annually Due to Smoking Associated Cancer Deaths.”

Credits:

Lead image: Olga355/Dreamstime

WebMD Health News © 2022 
Cite this: Nearly 30% of US Cancer Deaths Linked to Smoking – Medscape – Aug 29, 2022.

Article: https://globalnews.ca/news/9178252/new-prostate-cancer-drug-canada/

‘Very exciting treatment’: New advanced prostate cancer drug available in Canada

Just looking at Ward Carson, you would never know he’s sick.

The 79-year-old Halifax man has lived with metastatic prostate cancer for the past 19 years.

“It hasn’t had a big impact on the way I live my life,” he said. “My wife has periodically said to me, ‘I can hardly believe you’re sick.’”

READ MORE: Moncton photographer donates his work, aims to raise awareness for prostate cancer

But he is sick, and according to his latest prostate-specific antigen (PSA) test, his PSA count — an indicator of prostate cancer — is increasing.

“I think it’s only in the last six or eight months that it’s jumped a bit, and now it’s jumping again,” Carson said.

His enlarged prostate was first detected back in 2003, and he subsequently had a prostatectomy, a procedure to remove part or all of the prostate gland. But cancer cells stayed behind and spread, or metastasized. He’s had hormone therapy, radiation, and most recently, drug treatment to keep the cancer spread at bay.

“And (those measures) have been working for the last number of years, but they seem to have tapered off in their effect,” he told Global News.

“Unfortunately, my cancer has metastasized on my spine and there is no procedure to operate and remove part of my spine.”

“Eventually the cancer cells learn to live under the influence of those treatments and they start to grow again,” said Dr. Ricardo Rendon, a urologic oncologist and Dalhousie University professor in the department of urology.

Usually when the prostate cancer advances through all the treatments, there’s not much more doctors can offer, he said.

That is, until now.

“We have a new treatment that is brand new and available to our patients who had nothing else to receive when their disease was progressing,” he said.

Pluvicto was approved in Canada just last month, and it will allow doctors, for the first time, to target and treat specific cancer cells.

“So instead of being a shotgun approach to treating cancer, it’s a missile directly to the prostate cancer cells,” Rendon said.

This targeted approach will not only help patients live longer and with a much better quality of life, he said, but it will also produce fewer of the side effects that come with other treatments.

“It is very difficult talking to a patient telling them that we have nothing else to offer for the disease … So it is amazing to be able to off this to these patients,” Rendon said.

READ MORE: B.C. researchers hail ‘breakthrough’ in blood-based technology for cancer research

Only four per cent of advanced prostate cancer cases are preventable, based on currently-known risk factors, which is why advancements in prostate cancer treatment are critical, Rendon said.

“Since 2004, we have about six to eight new drugs approved, thanks to hundreds of clinical trials and many thousands of patients who have gone through this,” he said. “In these 15 years, we have been able to almost triple the life expectancy of patients with advanced prostate cancer.”

The ongoing research is not lost on Carson, who understands that this new drug may be his last treatment option.

“Dr. Rendon hasn’t said ‘we can either put you in the trial or try drug B,’ so I’m not sure what else is out there for me,” said Carson.

“The idea that this radioactive drug will seek out the prostate cancer cells and attach to them and radiate just them — that sounds brilliant to me, and hopefully it will work.”

Article: https://telixpharma.com/news-views/health-canada-approves-illuccix-for-prostate-cancer-imaging/

Health Canada Approves Illuccix® for Prostate Cancer Imaging

Telix announces that Health Canada has approved Illuccix® [kit for the preparation of gallium (68Ga) gozetotide injection] for use in staging and re-staging intermediate and high-risk prostate cancer and localizing tumour tissue in recurrent prostate cancer.

Illuccix™ [kit for the preparation of gallium (68Ga) gozetotide injection], after radiolabeling with gallium (68Ga), is indicated for use with the positron emission tomography (PET) of prostate specific membrane antigen (PSMA) positive lesions in men with prostate cancer:
• with suspected metastasis who are suitable for initial definitive therapy
• with suspected recurrence with elevated serum prostate specific antigen (PSA) level.

“PSMA PET” (or the imaging of Prostate-Specific Membrane Antigen (PSMA) via a positron emission tomography (PET) scan) is a diagnostic tool demonstrated to detect advanced prostate cancer.

Illuccix is the first PSMA PET imaging agent to be granted regulatory approval in Canada. Health Canada is the third regulatory body worldwide to approve Illuccix, which is commercially available in Australia and the United States.

Dr. Norman Laurin, current president of the Quebec Association of Nuclear Medicine Specialists and past president of the Canadian Association of Nuclear Medicine said, “On average, 67 men in Canada are diagnosed with prostate cancer each day. Early detection, along with better understanding of the spread and stage of the disease can lead to more informed disease management decisions. Tools such as Illuccix are valuable as we look for better ways to detect prostate cancer in men.”

Kevin Richardson, CEO Telix Americas said, “PSMA PET imaging has been one of the most important developments in prostate cancer detection in recent years and we are very pleased that we can now bring this important diagnostic imaging agent to physicians and their patients across Canada.”

Illuccix will be made available in Canada to physicians and eligible patients through Telix’s partner, Isologic Innovative Radiopharmaceuticals (ISOLOGIC), whose distribution network services 265 hospitals and clinics nationwide.

About Prostate Cancer in Canada

According to the Canadian Cancer Society, prostate cancer is the most common cancer and the third-leading cause of death from cancer among Canadian men. More than 24,000 men in Canada are estimated to be diagnosed with prostate cancer this year, and 4,600 will die from the condition. Reliable and flexible diagnostic tools are essential for medical teams in narrowing the gap between understanding the spread of disease and the development of individualized treatment plans.

According to the Canadian Cancer Society, prostate cancer is the most common cancer and the third-leading cause of death from cancer among Canadian men. More than 24,000 men in Canada are estimated to be diagnosed with prostate cancer this year, and 4,600 will die from the condition. Reliable and flexible diagnostic tools are essential for medical teams in narrowing the gap between understanding the spread of disease and the development of individualized treatment plans

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Article: https://www.cancernetwork.com/view/fdg-and-naf-pet-ct-predictive-for-overall-survival-in-genitourinary-malignancies

Genito-urinary cancers include the kidneys, ureters (which carry urine from the kidneys to the bladder), bladder, testicles, and hormone resistant prostate cancer. For patients on this chemotherapy combination, the PET scan was able to identify who went on to have a more favourable outcome, including using newer indicators such as the metabolic volume of the tumor, which software techniques have only permitted the calculation of in the past few years. The second generation Discovery PET/CT scanner at INITIO includes the ability to calculate the metabolic volume of a tumor, and we routinely report these emerging biomarkers to our referring physicians.