New Type of PET Imaging Identifies Primary and Metastatic Prostate Cancer

Excerpt:

“In the featured article from the February 2017 issue of the Journal of Nuclear Medicine, researchers document the first-in-human application of a new imaging agent to help find prostate cancer in both early and advanced stages and plan treatment. The study indicates that the new agent — a PET radiotracer — is both safe and effective.

“The new agent is a gallium-68 (Ga-68)-labeled peptide BBN-RGD agent that targets both gastrin-releasing peptide receptor (GRPR) and integrin ?v?3. Dual-receptor targeting provides advantages over single-receptor targeting by allowing tumor contrast when either or both receptor types are expressed, improving binding affinity and increasing the number of effective receptors.”

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Are Lung Cancer Survivors Getting Too Many Costly Scans for No Reason? Study Suggests So

“Once you’ve made it through lung cancer treatment, you want to make sure you catch it early if it comes back again.

“But a new study suggests that one approach to watching for a cancer’s return is being inappropriately used at many hospitals. And it isn’t helping patients survive longer, the research shows. The findings are published in the Journal of the National Cancer Institute.

“The study looked at how often survivors of lung and esophageal cancer went through a kind of imaging called PET scanning as the primary way of monitoring their condition, instead of as a backstop to other kinds of scans.

“PET scans are expensive, but potentially powerful. They let doctors see increased activity by cells inside the body — including fast-growing cancer cells — and can do so early. Many cancer patients receive PET scans as part of diagnosis, to see how advanced their cancer is, and to see how it’s responding to treatment.”


PET Imaging Detects Fast-Growing Prostate Cancer

“A molecular imaging biomarker is able to detect fast-growing primary prostate cancer and distinguish it from benign prostate lesions, addressing an unmet clinical need. The new research, published in the July 2015 issue of The Journal of Nuclear Medicine, is significant for patients with suspected prostate cancer that has not been confirmed by standard biopsy.

” ‘We were able to demonstrate in our research that PSMA PET imaging was more specific than MR imaging for detection of clinically significant high-grade prostate cancer lesions, and importantly was able to distinguish benign prostate lesions from primary prostate cancer, currently a difficult diagnostic imaging task,’ stated Steven P. Rowe, MD, PhD, resident at Johns Hopkins Medical Institutions in Baltimore, Md. ‘Additionally, this work demonstrated a direct correlation between PSMA PET radiotracer activity in prostate cancer and prostate adenocarcinoma aggressiveness (Gleason score).’ “


Recurrence of Prostate Cancer Detected Earlier with Innovative PSMA-Ligand PET/CT

“A recent study reported in The Journal of Nuclear Medicine compared use of the novel Ga-68-PSMA-ligand PET/CT with other imaging methods and found that it had substantially higher detection rates of prostate-specific membrane antigen (PSMA) in patients with biochemical recurrence after radical prostatectomy. Discovering a recurrence early can strongly influence further clinical management, so it is especially noteworthy that this hybrid PSMA-ligand identified a large number of positive findings in the clinically important range of low PSA-values (<0.5ng/mL).

“According to the CDC, prostate cancer is the most common cancer among men in the United States, after non-melanoma skin cancer. While many men with prostate cancer die from other causes, prostate cancer remains one of the leading causes of cancer death among men of all races. Treatment and survival after recurrence depend on many factors, but early detection of the recurrence is certainly key.

“Matthias Eiber, MD, corresponding author of the study, noted, ‘The study is the first to examine this highly promising PET tracer in the use of a homogeneous patient collective consisting of only those with biochemical recurrence after radical prostatectomy. It found superb detection rates compared to other tracers, like choline, or imaging modalities, like MRI. For patients, this means that the referring urologist can receive earlier and more precise information about the site and extent of metastatic disease. Physicians will also be better able estimate whether a PSMA-PET scan might be useful in a specific setting.’ “


Research Shows Value of Additional PET/CTscans in Follow-up of Lung Cancer Patients

The gist: New research shows that four or more PET/CT scans can help guide care for patients who have been treated for lung cancer. This is significant in the light of a recent announcement from Medicaid and Medicare Services that only three FDG PET/CT scans would be routinely covered after treatment.

“New research from Johns Hopkins School of Medicine reveals a high value of scans which could lead to future change of reimbursement policies for follow-up positron emission tomography/computed tomography (PET/CT) studies in lung cancer. The study, featured in the February 2015 issue of the Journal of Nuclear Medicine, establishes the value of fourth and subsequent follow-up PET/CT scans in clinical assessment and management change in patients with the disease.

“According to the American Lung Association, lung cancer is the leading cancer killer in both men and women in the United States. Approximately 402,326 Americans living today have been diagnosed with lung cancer. In 2014, diagnoses of an estimated 224,210 new cases of lung cancer were expected, representing about 13 percent of all cancer diagnoses.

“In the retrospective study, a total of 1,171 patients with biopsy-proven lung cancer who had positron emission tomography with a radioactive tracer (18F-FDG were identified at a single tertiary center from 2001 to 2013. Among these, 85 patients (7.3%) had four or more follow up PET/CT scans with a total of 285 fourth and subsequent follow up PET/CT scans. Median follow up from the fourth scan was 31.4 months. The follow-up PET/CT scan results were correlated with clinical assessment and treatment changes.”


PET Scan Could Predict Response to Pre-Surgery Treatment with Chemo + Herceptin

The gist: A recent clinical trial found that positron emission tomography (PET) scans could be used to predict how well a patient will respond to neoadjuvant (pre-surgery) treatment with chemotherapy and trastuzumab (Herceptin). Doctors might recommend a change in treatment to a patient whose PET scans show that current treatment isn’t working. In the study, researchers treated women with early-stage, HER2-positive breast cancer. Based on PET scans, the researchers were able to predict which patients would still have signs of an invasive tumor after treatment. They also found that adding the drug bevacizumab (Avastin) to the treatment plan could improve responses for some of these patients.


Lung Cancer Test Less Effective in Areas Where Infectious Lung Disease is More Common

“A new analysis of published studies found that FDG-PET technology is less accurate in diagnosing lung cancer versus benign disease in regions where infections like histoplasmosis or tuberculosis are common. Misdiagnosis of lung lesions suspicious for cancer could lead to unnecessary tests and surgeries for patients, with additional potential complications and mortality.

“Histoplasmosis and other fungal diseases are linked to fungi that are often concentrated in bird droppings and are found in soils.

“The study by investigators at Vanderbilt University and the Tennessee Valley Healthcare System-Veterans Affairs was led by Vanderbilt first author Stephen Deppen, Ph.D., and principal investigator Eric Grogan, M.D., MPH, and appeared in the Sept. 24 issue of JAMA.

“Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. To estimate FDG-PET diagnostic accuracy, the authors reviewed lung cancer abstracts published in a 14 year period and included 70 studies in the meta-analysis. The studies included 8,511 nodules, 60 percent of which were malignant.”


PSMA-Based Imaging Traces Even Treatment-Resistant Prostate Cancer

“Anti-androgen hormonal therapy, also called chemical castration, can be an important defense against further disease progression for patients with prostate cancer that has traveled and grown in other areas, or metastasized—but some cases simply do not respond to this treatment. A groundbreaking molecular imaging agent has been developed to help clinicians find as much cancer as possible, whether it is responding favorably or not, in an effort to improve clinical decision making for these patients, say researchers at the Society of Nuclear Medicine and Molecular Imaging’s 2014 Annual Meeting.”


Breath Analysis Offers Non-Invasive Method to Detect Early Lung Cancer

“Researchers are using breath analysis to detect the presence of lung cancer. Preliminary data indicate that this promising noninvasive tool offers the sensitivity of PET scanning, and has almost twice the specificity of PET for distinguishing patients with benign lung disease from those with early stage cancer.”