Gallium-68 PET/CT scans prior to first-line treatment of some men with prostate cancer

A newly-reported set of data from an Australian clinical research team has now shown that 68Ga PSMA PET/CT scans changed the staging and the management of men after initial diagnosis and prior to first-line treatment compared to traditional CT and bone scanning.

About a year ago we saw a report from the UK showing that the results of 68Ga PSMA PET/CT scans could change the proposed form of treatment for 39 percent of men who had shown signs of progression after first-line therapy with either surgery or radiation therapy.

A new paper by Wong et al. has now reported a similar effect on the clinical staging of men newly diagnosed with prostate cancer whose initial treatment had yet to be administered.

The study was based on a total of 131 patients who were

  • Newly diagnosed with prostate cancer
  • Initially staged using conventional methods, inclusive of traditional bone scans and CT scans as appropriate
  • Subsequently also given a 68Ga PSMA PET/CT scan
  • Re-staged based on the results of the 68Ga PSMA PET/CT

The research team report that use of the 68Ga PSMA PET/CT scan led to

  • Re-staging of 37/131 patients (28 percent), of whom
    • 17 patients (13 percent) were upstaged
    • 20 patients (15 percent) were downstaged
  • Exclusion of oligometastatic disease in 11 patients (8 percent) suspected to have an oligometastatic lesion or lesions based on conventional imaging
  • Changes in the proposed management of at least 24 patients (18 percent)

The authors conclude that

The use of 68Ga-PSMA PET scans in initial staging can have a significant impact on staging and management when compared to current conventional imaging modalities.

68Ga PSMA PET/CT scanning is now becoming relatively common — at least at major academic medical centers — in European and some other countries (like India and Australia) around the world. However, it has yet to become common here in the US. We also suspect that the cost of such scans in the US when they do become more easily available will be high and that healthcare insurance providers will want to limit the use of such scans to select groups of patients.

A recent article by Lenzo et al. (again from Australia) provides a review of the past few years’ research into the actual use of this type of scanning in Australia and elsewhere. It is becoming increasingly clear that this type of imaging (along with others like Axumin-based PET scanning) provide clinical data that is superior to the data provided by traditional bone scans and CT scans. Such data allow better treatment planning for relevant patients and will — or at least should — rapidly become the standard of care compared to traditional bone and CT scans.

The “New” Prostate Cancer InfoLink does not believe, however, that every newly diagnosed man with prostate cancer should necessarily be given this type of scan. This type of scanning, for example, would be neither necessary not appropriate for most men diagnosed with lower-risk forms of prostate cancer who are potentially good candidates for initial monitoring on active surveillance. Conversely, however, we do believe that such scanning may be appropriate and applicable for every man at high risk for extraprostatic prostate cancer — either at diagnosis or after initial progression of their disease. In addition we now appear to have sufficient data to indicate that such scans should be used in most men for whom the presence of extraprostatic disease is questionable based on bone and/or traditional CT scans in order to ensure the most appropriate form of care.

One Response

  1. The jury is still out for a few months to determine if targeted radiation to the only 1 cm site locating prostate cancer cell activity near the site of the anastomosis that occurred 26 years ago as the result of [18F]fluciclovine (Axumin) PET/CT imaging from top of head to mid thigh has been successful in eradicating that cancer that I apparently maintained under control and management all these years with the gamut of ADT medications. Need to allow time for the fractured DNA to disperse before an imaging check to see if I have finally rid myself of this insidious disease. Prayers welcome.

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