PET/CT Tracer Scan for the Detection of Recurrent Prostate Cancer

PET Imaging Institute is proud to announce a newly available tracer indicated specifically for Recurrent Prostate Cancer.  Prostate cancer affects one in seven men in the US, up to a third treated for prostate cancer will experience recurrent disease, most often detected only by rising Prostate Specific Antigen (PSA) levels.  Often the location and extent of the disease cannot be detected by conventional imaging in the early stages of recurrence. Although there is an ever-increasing number of treatment options, an estimated 26,100 men died of the disease in the US in 2016, generally after primary local and systemic treatments for prostate cancer failed.  Current diagnostic measures are frequently unable to reliably detect the exact location(s) of disease relapse at a time when curative treatment is still possible.

What’s New About This PET/CT Scan?

Conventional imaging tools such as traditional FDG PET/CT scans and bone scans frequently fail to identify the site of recurrent disease when it comes to Prostate Cancer, presenting a serious challenge to urologists and radiation oncologists charged with the selection of secondary treatment, and causing significant anxiety for patients.

FDG-PET is of limited use in Biochemical Recurrence because uptake in Prostate Cancer is generally suboptimal until the patient has metastatic castrate resistant disease. Physiologic excretion of FDG in the bladder may interfere with image interpretation of adjacent structures in the pelvis.  Salvage Radiation Therapy (SRT) to the prostate should be initiated well before a PSA of 10 – 20 ng/mL is reached, as studies have demonstrated that outcomes are better if treatment is initiated at low (e.g.

Enter Axumin™: On May 27, 2016 the FDA approved Axumin [fluciclovine F 18 Injection; Blue Earth Diagnostics Ltd, Oxford UK] for PET imaging in men with suspected prostate cancer recurrence based on elevated PSA levels following prior treatment.  The approval of Axumin ushers in a new era of F18 PET/CT for the detection of recurrent prostate cancer in the USA.  Data submitted to FDA included results from prospective studies at Emory University and the University of Bologna and from clinical use at two sites in Norway; the pooled data for n= 595 subjects were retrospectively analyzed.  Overall, fluciclovine F 18 PET/CT detected sites of recurrence in 68% (403/595) of patients.  For patients with baseline PSA values in the lowest quartile ( 1.78 ng/mL had a positive scan, of which 58 were confirmed as positive.

Sources:

• Axumin Full U.S. prescribing information
• www.axumin.com
• EVERYDAY UROLOGY: Axumin™ [Fluciclovine F18]: An Accurate Imaging Approach for Patients with Biochemically Recurrent Prostate Cancer-Full text article
• https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/92386-everyday-urology-axumin-fluciclovine-f18-an-accurate-imaging-approach-for-patients-with-biochemically-recurrent-prostate-cancer-full-text-article.html

A novel PET/CT tracer for the detection of Neuro Endocrine Tumors (NETs)

NETSPOT, the new tracer for Gallium 68-Dotatate scan, is the next generation of OCTREOSCAN.

It is a form of octreotide, which binds to a receptor on many NETs called the Somatostatin Receptor.  Use of NETSPOT changed patient treatment and management in 71% of patients due to greater specificity compared to Octreoscan.

Gallium PET/CT is more accurate for staging and superior to Octreoscan SPECT in the detection of overall number of lesions in the body as well as organs and bones. Gallium PET/CT also allows for calculation of standardized uptake value, has less whole body radiation, and is performed in less time versus Octreoscan.

What makes NETSPOT different?

NETSPOT™ offers superior sensitivity and accuracy compared to previously available diagnostics for NET patients. In a clinical study, NETSPOT™ demonstrated the ability to change management decisions regarding patients in 71% of cases previously imaged with Octreoscan. Saving just one patient from futile surgery can improve the treatment experience overall and significantly reduce the cost of care by reducing repetitive, often frustrating, and limitless diagnostics.

NETSPOT™ is a significant improvement over existing diagnostic tools and will enable us to more accurately stage and better manage patients.

NETSPOT™ is a novel patented kit developed by AAA for the preparation of gallium Ga 68 dotatate for injection, for localization of somatostatin receptor positive neuroendocrine tumors (NETs) in adult and pediatric patients using Positron Emission Tomography (“PET“).

This product has been designated as an orphan drug by the EMA and the FDA.

Please contact PET Imaging Institute of South Florida at 954-981-6668 for further information.

Lymphoma Diagnosis in Southern Florida

Lymphoma is a cancer of the lymphatic system, which plays an important role in the body’s immune system. In the United States, the risk of developing Non-Hodgkin lymphoma is 2.1 percent and getting Hodgkin Lymphoma is approximately 0.2 percent, and survival depends on a timely diagnosis so that treatment can be given. PET/CT scans are performed when a doctor believes that lymphoma may be present.

How PET Scans Work to Find Lymphoma

PET scans tend to be most useful in those who have Hodgkin lymphoma or high-grade non-Hodgkin lymphoma because the lymphoma cells are typically more active. The PET scan will help the doctor determine which cells are cancerous and which ones aren’t. A PET scan will be combined with a CT scan, which provides accurate images of the body’s organs, lymph nodes, tumors.

When PET Scans are Used

PET scans are typically performed at the beginning or end of a treatment cycle. Before treatment begins, a PET scan is commonly used to determine what stage the lymphoma is and which parts of the body are affected. After treatment, diagnostic imaging will be performed to:

• Determine the effectiveness of the treatment.
• Create a future treatment plan based on the results.
• Determine if the lymphoma has returned a few months or years after treatment.

During and After the Scan

The patient should not eat or drink anything other than water at least four to six hours before the scan. The PET scan will not be painful and should take less than an hour. Once the scan is completed, the patient will be able to go home afterward. The results of the scan will not be immediate. The doctor will typically receive the scan within a few days, determine their results, and talk to you about what the results mean.

Sources:

Lymphoma Association 

Alzheimer’s Diagnosis in Pembroke Pines, FL

A more recent development in diagnostic imaging is using PET/CT scans to detect brain diseases such as Alzheimer’s and dementia. In the past, detecting such brain diseases relied heavily on documenting mental decline. The issue is, by the time the disease can be confirmed, the symptoms are already in full effect and there’s no way to reverse them. Many researchers now are trying to find ways to detect Alzheimer’s and dementia early on, so possible treatment can be done to slow down or reverse symptoms.

What Causes Degenerative Brain Disease?

Diseases like Alzheimer’s are caused by continual brain cell death. A connection scientists have made is a connection between brain cell death and plaque buildup. These plaques are clusters of built up proteins called “beta-amyloid”. This kills the brain cell, and from within the dead brain cell, “tangles” are formed. These are fibers of a protein called “tau”. Normally, tau helps transport nutrients between brain cells, but in the presence of tangles, they do just the opposite.

Using PET/CT to Detect Alzheimer’s and Dementia

PET/CT scans work by using a “tracer” to detect during the scan. Each kind of scan uses a different tracer depending on what the radiologist is trying to find. For brain scans, the tracer is called Amyvid. This tracer was developed recently and approved by the FDA in 2012. It binds to those beta-amyloid proteins, the cause of brain plaque leading to brain cell death. The PET/CT scan picks up the tracker and it allows for early detection of plaque build up.

Who would be a candidate for PET/CT brain scans?

According to an article published in 2014, appropriate candidates for amyloid PET imaging evaluation would include:

1. Patients complaining of persistent or progressive unexplained mild cognitive impairment (MCI)
2. Patients meeting tests for possible AD but who have unclear clinical presentation, either atypical clinical course or etiologically mixed presentations
3. Patients with progressive dementia and atypically early age of onset (defined as before the age of 65 years)

Additionally, inappropriate candidates for amyloid PET imaging include

1. Patients who are 65 years or older and meet standard clinical criteria for probable AD
2. Those whose severity of disease has to be determined
3. Those undergoing imaging solely based on a family history of dementia or presence of other risk factors for AD, such as the ApoE-ε4 gene
4. Patients with a cognitive complaint but no clinical confirmation of impairment
5. Those undergoing imaging in lieu of genotyping for suspected autosomal mutation carriers
6. Asymptomatic individuals
7. Those undergoing imaging for nonmedical use, such as insurance coverage and legal or employment screening.

Prostate Cancer Scanning

The prostate is a gland that is only found in men that is used to assist in reproduction and sperm cell growth and production. It grows during puberty due to the rapid increase in male hormones and can sometimes slightly grow with age, but mostly stays about the size of a walnut.

Prostate Cancer Overview

The most common type of prostate cancer is adenocarcinoma, which is cancer that starts in the gland cells. There are other, more rare types of prostate cancer such as small cell carcinoma, sarcomas and neuroendocrine tumors, but most of the time a prostate cancer patient suffers from adenocarcinoma.

Prostate cancer is the most common non-skin cancer in men. Approximately 1 in 6 men will be diagnosed with prostate cancer in the U.S. Luckily, 5-year survival of prostate cancer is up to over 99% and deaths have reduced greatly due to overall awareness and advancements with treatment.

Prostate Cancer Signs and Diagnosis

Many patients don’t experience any symptoms, especially in early stages. More severe prostate cancer patients can experience:

• Blood in the urine
• Erectile Dysfunction
• Urinary Incontinence
• Pain in the spine or hips

Some of these symptoms can also just be symptoms of benign prostate hyperplasia (BPH), so it’s really hard to detect. Therefore, it’s extremely important to get screened by either digital rectal exam (DRE) or prostate-specific antigen (PSA) blood test.

PSA – This method is usually for men in early stages without symptoms and is the first test done most of the time.

DRE – In this method, the doctor will probe for lumps on the prostate with a lubricated glove. If you do have prostate cancer, this way is good to detect which side the cancer may be on, rather than just knowing whether you have cancer or not.

Axumin (fluciclovine F 18 Injection) scan – PET/CT Tracer Scan

Risk Factors for Prostate Cancer

The following risk factors can increase your chances of getting prostate cancer:

Age – Prostate cancer is most common in men after the age of 50, and 60% of cases are men over the age of 65. There’s not a lot of reason to get examined before the age of 40-50.

Race – Prostate cancer is more prominent in African Americans

Family History – Some evidence suggests that prostate cancer may be a genetic factor and inherited. Having a direct relative with prostate cancer increases your risk

Diet – It’s not a definitive factor, but some studies link men who eat a lot of red meat and high-dairy products and eat less fruits and vegetables have more of a risk to develop prostate cancer.

Treatment for Prostate Cancer

Once you are diagnosed with prostate cancer, it is important to work closely with doctors to go over your case and discuss the best treatment option for you. Some of those include:

• Active surveillance to monitor cancer growth or lack thereof
• Surgery to remove the cancerous cells
• Radiation therapy
• Minimally-Invasive Prostatectomy
• Chemotherapy
• Cryosurgery
• Vaccine treatment
• Bone-directed for cases where the cancer has spread to the bones

Treatment is done entirely on a case-by-case basis. Consult with your doctor after you’re diagnosed to discuss what the best option may be. Prostate cancer can be easily treatable if detected early and avoided altogether if the right precautions are taking. Visit www.cancer.org for specific information on prostate cancer prevention on treatment

Regular visits with your doctor can also help with prevention, especially if you know you’re at risk. Even if you are diagnosed, it can be treated in its early stages. If you have an questions about prostate cancer, contact PET Imaging Institute of South Florida in Hollywood at (954) 981-6668 or in Pembroke Pines at (954) 450-2202.