PSMA PET scan is catching cancer earlier and with greater accuracy than ever before

For some men with prostate cancer, there may be a more effective imaging approach to detect the spread of cancer.

Accurate imaging is a crucial component of prostate cancer management for a number of reasons, including tumor localization, disease staging and detecting recurrence. Prostate-specific membrane antigen positron emission tomography (PSMA PET) scans offer an imaging approach that has the ability to detect recurrence earlier and enable clinicians to implement tailored treatment sooner.

“PSMA imaging offers the upper hand for health care providers when it comes to treating prostate cancer,” said Chandler H. Park, M.D., genitourinary medical oncologist at Norton Cancer Institute. “We can more accurately design treatments for our patients, because now we can stratify risk and pinpoint cancer earlier for faster treatment.”

What is PSMA PET scan?

PSMA is a protein on the surface of many prostate cancer cells. Radiotracers targeting PSMA can identify early, low-volume sites of lymph node or distant metastases of prostate cancer.

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The first PSMA-targeted PET imaging drug for prostate cancer — gallium 68 PSMA-11 (Ga 68 PSMA-11) — was approved by the U.S. Food and Drug Administration in 2020 for patients with suspected prostate cancer recurrence and metastasis. This approval was based on phase 3 clinical trials that demonstrated a significant increase in accuracy for the detection of prostate cancer, compared with standard imaging modalities. In 2021, FDA approval followed for Pylarify (piflufolastat F-18) for the same indication. As of 2022, Norton Cancer Institute uses Illuccix, which was approved in 2021.

The conventional imaging methods used for prostate cancer patents, including CT, MRI and bone scan, have limitations when it comes to disease detection. Compared with these other imaging options, PSMA PET scan has greater sensitivity and can detect metastases sooner, allowing clinicians to better serve patients and make treatment decisions earlier.

“PSMA PET scan makes it possible to see a smaller volume of prostate cancer cells,” Dr. Park said. “This lets oncologists localize the disease and determine the best approach to treatment.”

How PSMA-PET changes the landscape of prostate cancer treatment

“PSMA PET scans have revolutionized prostate cancer treatment,” Dr. Park said. “In the past, if a patient had a rising PSA [prostate-specific antigen level], we would get a CT scan and a bone scan. Either we wouldn’t see anything obvious, or we did and it was widespread throughout the body — at which point there’s really no option for curative measures.”

PSMA PET scan can find sites of recurrent prostate cancer, identify recurrence before it spreads, and help physicians intervene earlier.

“If we can get to the cancer earlier rather than later, we possibly can change the trajectory of the disease and improve a patient’s quality of life with less intensive treatment,” Dr. Park said.

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