How PSMA-PET scans are changing clinical practice

Accurate imaging is an essential part of prostate cancer management for a number of reasons, including tumor localization, disease staging, and detection of recurrence. The PSMA-PET scan – named among the best medical innovations by the Cleveland Clinic in 2022 – offers a new imaging approach for this patient population that has the ability to detect recurrences earlier and, in turn, allow clinicians to implement treatment earlier.

“PSMA imaging is an exciting innovation that holds great promise for the treatment of prostate cancer,” notes Rahul Tendulkar, MD, radiation oncologist at the Cleveland Clinic. “To better tailor treatments to our patients, we need to be able to stratify the risk and accurately determine the stage of the disease. Therefore, imaging capabilities are key to the successful management of these patients.

What is PSMA-PET analysis?

Conventional imaging methods typically used for prostate cancer patents, including CT scans, MRIs and bone scans, have limitations in detecting the disease, according to Steve Huang, MD, Department of nuclear medicine, Cleveland Clinic.

Compared to other imaging options, the PSMA-PET scan has greater sensitivity and can detect metastases earlier, allowing clinicians to better serve patients and make treatment decisions earlier, he says. “The PSMA-PET scan allows a smaller volume of cells to be seen, allowing oncologists to locate the disease and determine the best treatment approach.”

“PSMA, or prostate-specific membrane antigen, is a protein on the surface of many prostate cells and it has been shown that PSMA-labeled radiotracers can identify early, low-volume lymph node sites or metastases. distant from prostate cancer,” explains Dr Tendulkar.

The first PSMA-targeted PET imaging drug for prostate cancer – Gallium 68 PSMA-11 (Ga 68 PSMA-11) – was approved by the FDA in 2020 for patients with suspected prostate cancer recurrence and metastasis prostate. This approval was based on Phase III clinical trials that demonstrated a significant increase in the accuracy of prostate cancer detection compared to standard imaging modalities. In 2021, a second FDA approval followed for Pylarify (piflufolastat F 18) for the same indication.

Several institutions have since adopted the technology, including the Cleveland Clinic, which incorporated PSMA-PET scans into practice in September 2021. However, this is not a new area of ​​focus for experts at the facility. Warren Heston, PhD, a basic scientist at the Cleveland Clinic Lerner Research Institute, first discovered and cloned the PSMA protein in the early 1990s. Researchers have also been involved in clinical tests evaluate the PSMA imaging agent rhPSMA-7.3 (18F).

Practice changing your approach

While the use of this approach has only recently begun in clinical practice, Dr. Tendulkar has already seen a shift in the management of prostate cancer patients at the Cleveland Clinic.

“Our ability to get PSA-PET scans was really a game-changer, and I don’t use that term lightly,” he says. “Historically, if a patient had an elevated PSA, we would receive a CT scan and a bone scan. in which case there really was no curative option.

“Since integrating this new approach, we have discovered that the PSMA-PET scanner can find a few sites of recurrent prostate cancer,” he continues. “And so, if we can identify the recurrence before it becomes widespread, we may be able to intervene earlier and perhaps modify the natural history of their disease in a way that is associated with a low risk of toxicity. “

For example, a patient, who has undergone previous radiotherapy to the prostate, develops an increasing PSA and a local recurrence is discovered. “A PSMA-PET ultrasound that demonstrates no evidence of spread into lymph nodes or distant metastatic sites gives us further reassurance to treat the recurrent area of ​​the prostate in a potentially curative way for a second chance of success,” says Dr. Tendulkar. “If we can be more selective about who can be treated with salvage retreatment, we can improve our selection criteria to pick the patients most likely to benefit.”

To date, the PSMA-PET scan has been used in a few hundred patients at the Cleveland Clinic and efforts are underway to continue its growth and expansion. “There is significant demand for this technology among our patients,” says Dr. Huang, who notes that they are currently planning about a month off. “Given the potential impact of this approach, improving access to PSMA-PET scans is a top priority. We are working hard to open more scanning sites and expand availability across our system. »

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