San Francisco, California (UroToday.com) contains more images being used in all stages of prostate cancer. Dr. Richard Lee from Massachusetts General Hospital Cancer Center supports the use of various imaging modalities across the spectrum of prostate cancer disease.
Traditional reception (defined as CT / MRI and bone scanning) is widely available and its test characteristics are well defined. CT and MRI show high-resolution anatomical details, but do not show disease activity. As a reference to comparing with high-level imaging modalities, assessing metastatic nodes disease, both have a sensitivity of approximately 40% and a specificity of approximately 80% and an MRI. Positive bone scan rates for post-radical prostate prostate PSA are 4% for patients with PSA less than 10 ng / ml. Bone scanning involves the need for a multi-modal image with CT or MRI often to guide treatment decisions.
The next generation imaging modalities use novel molecules to identify prostate cancer and tracers (positron emitting radioisotopes) for images. The molecules used include flciclovine membrane antigen, sodium fluoride, choline, acetate and prostate (PSMA). Tracers include 18F, 11C, and 68Ga.
The FDA was approved in 18F-Fluciclovine PET / CT in 2016 and is widely available at> 1000 locations in the United States. PSA detection is 68% overall with the following sensitivity at different PSA thresholds: 41% by the PSA 6.0. When test characteristics were better compared to 18F-Fluciclovine compared to CT and bone scan as shown below:
Moreover, potential data from the LOCATE study showed that a lot of CT / CT 18F-Fluciclovine was detected in males with biochemical recurrence (median PSA 1.0) and that 57% lesions changed and 18F-Fluciclovine PET / CT changed in 59% cases. .
Deciding when next generation images will be used is an important consideration of the likelihood of a positive outcome on different PSA thresholds. The slide below gives a summary of PET / CT 18F-Fluciclovine detection rates at different PSA portals:
PSMA is a cell surface protein specific to prostate cancer and is over-clarified in 90-95% of prostate cancer cells, making it an ideal imaging target. It is notable that it is not available commercially in the United States at this time. A comparative study found that PSMA PET / CT had higher detection rates in all stages of the disease than in an ordinary image. In particular, traditional imaging in non-disease patients had more positive positive rates.
The slide below summarizes PET / CT PSMA detection rates at different PSA portals.
With 18F-Fluciclovine PET / CT and PET / CT PSMA indicating better than normal imaging characteristics, Calais et al made a possible comparison on PSMA and PET Fluciclovine in 50 men with PSA between 0.2 and 2.0. and especially in pelvic lymph nodes and extra-pect disease (M1).
Due to the data supporting improved detection compared to traditional image, high imaging modalities are proposed at both the NCCN and ASCO guidelines.
Presented by: Richard J. Lee, MD Professor of Stem Cells and Regenerative Biology at Harvard Medical School, Boston, Massachusetts t
Written by: Jacob Berchuck, MD, Medical Oncology Fellow at Dana-Farber Cancer Institute (Twitter: @jberchuck) at the Genetic Genesis 2020 Symposium, ASCO GU # GU20, February 13-15, 2020, San Francisco, California