In December 2020, the U.S. Food and Drug Administration (FDA) announced that positron emission tomography (PET CT or PET MRI) targeting prostate-specific membrane antigen (PSMA) is suitable for use in cases of suspected prostate cancer recurrence or metastasis. Among them is the gallium 68 PSMA-11 (Gallium 68 PSMA-11) tracer that has passed the clinical test. In May 2021, the FDA approved another F18 PSMA tracer for use in prostate cancer patients with suspected recurrence or metastasis. Compared with traditional computerized drawing (CT) or bone scan (Bone scan), this technology pinpoints the location of cancer cells more accurately.
Prostate-specific membrane antigen (PSMA) is overexpressed on the surface of prostate cancer cells. Of course, prostate cancer metastases lymphatic, bone and lung tissue can also occur. The signal from the short-lived radionuclide on the tracer will be picked up by PET CT or PET MRI, which will show on the image where the prostate cancer has recurred and where it has spread. Therefore, if the patient is determined to have prostate cancer, and the clinical judgment is that the risk of metastasis is high, PSMA PET can be considered to determine whether there is cancer metastasis. This information directly affects the direction of treatment.
Prostate-specific antigen (PSA) in the blood should drop to undetectable levels in patients with prostate cancer after prostatectomy. Once the PSA level rises to a certain value, it is defined as a biochemical recurrence. At this time we can also enable PSMA PET to detect the location of recurrence and its spread. Prostate cancer patients who have received radiotherapy can also use this method to detect the location of cancer recurrence and spread, so as to develop a blueprint for treatment.
Does this sketch apply to every prostate cancer patient? of course not. Men with prostate cancer with a Gleason score of less than 6 do not use this sketch because of their low risk of spreading.
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Title edited by TOPick, originally titled “Frontline Cancer — Recent Developments in Detecting Spread and Cancer Recurrence”
Written by: Shum Shing Fai, Specialist in Radiology