So this patient has a recurrence of cancer after radiation. Now,
they didn't specifically talk about what type of radiation, but they would like to know what
routes they would have next since the recurrence is present.
Well, first step is to decide is the cancer still in the prostate area or somewhere else in the
body, and that's determined by an Axumin or a PSMA PET scan and other factors that are used when that
is ambiguous are, "what's the psa doubling time? What was the original Gleason score?"
So, the process of treating all kinds of prostate cancer is really defining
what variant of prostate cancer are we dealing with. One of the most common mistakes patients
make and even doctors make is assuming it's sort of one process on a linear timeline and really
prostate cancer is a variety of different, you know, some spread quickly, some spread slowly,
some are very sensitive to treatment, some are very resistant to treatment. These are
all different types of prostate cancers. So it's first important to gather all the information
and understand as much about that particular individual's prostate cancer before thinking
of now how do we treat it. The treatment comes after you really understand what you're treating.
You mentioned an Axumin PET scan versus a PSMA PET.
Can you explain the differences and how you see imaging of playing out in the future?
So, Axumin PET scans were a significant advancement over CAT scans and MRIs to detect
metastatic lesions particularly in the lymph nodes which is the first jumping off spot for
prostate cancer. They're useful once the PSA gets up to around 1.0. Somewhat more difficult to read
than perhaps the PSMA PET scans which are useful even when the PSA is as low as 0.2 or 0.4. So,
PSMA PET scans are not really on the market yet although they probably will be shortly and that
will probably replace the Axumin PET scan given the fact it's got greater precision and accuracy.
It's more accurate in the bones whereas the Axumin PET scan is not very accurate in the bones.
There may be select situations where we'll continue to use Axumin PET scans,
but I would predict that PSMA will take over the market.
This next patient says they had an MRI and a biopsy that discovered only Gleason 6
prostate cancer. They had a PSMA PET scan that discovered two lesions on the ribs.
My doctor wants to treat those lesions with spot radiation and hormone therapy. Am I
right in thinking that further investigation is needed first? How specific is the PSMA PET scan?
I would say certainly you need further investigation. So let's assume that the PSMA PET
scan is showing something in the ribs with Gleason 6. Well basically, we know that Gleason 6 doesn't
spread. So if the ribs are prostate cancer, which PSMA is specific for prostate cancer,
how could we have disease in the ribs? Well, one possibility would be that there's another tumor
inside the prostate that was missed on the MRI, missed on the biopsy, that has a higher Gleason
score, but that should show up on the PSMA PET scan. So, if someone needs to go back and look
at the PSMA PET scan and see if the hot spots in the prostate match the areas of where Gleason 6
disease was before and if there's no unexplained lesions detected on the PSMA PET scan, then
one has to suspect that there's some kind of a problem with the readout on the rib
lesions and that maybe those aren't real. This is, you know, a diagnostic dilemma; we've got
information that's clearly contradictory. Gleason 6 doesn't spread, yet PSMA PET scan
says there's metastasis in the ribs. One of them is wrong, and so all the information needs to be,
you know, vetted again, and someone needs to figure out why things don't add up.
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