So, we've talked about all these newer scans that are coming out and all this new technology,
but there's a lot of current scans that have been around for quite a while that patients
are currently using. Can you speak to those and how you feel that the results of really
what they're getting is?
Yeah, so these days, of course, we divide prostate cancer into low, intermediate, and
high risk and what these patients need is a little different depending on their status.
But the typical historical bone scans to make sure there's nothing spread to the bones which
are done for intermediate and high risk and advanced disease are things like the T99 nuclear
bone scan which has been around for 30 years. F-18 PET bone scans which are more accurate,
unfortunately, not covered by insurance. It was a medicare decision, I think a big mistake.
Those sorts of things are often done routinely and in men with advanced disease they're performed
every six months to see what the status is or the effectiveness of the existing therapy.
Then you have your body scans. The CAT scans and you can also use MRIs to look at the whole
body. And that can pick up some information about the bones, but it's primarily looking
for soft tissue metastasis like lymph nodes, lung, problems with the liver, and those typically
are also performed in newly diagnosed men, and then periodic basis in men with advanced
disease as well.
We've utilized that technology for several decades. It's certainly useful and would be
considered the standard way to treat prostate cancer even to this day. You know, you have
the same problems making sure you get quality readers, quality equipment, and then there's
a larger interpretation factor which means that the doctors treating the patient have
to look at the information on the scan and integrate it with the PSA and the previous
treatments and learn or make a judgement as to what's cancer and what's not cancer. Some
of those problems will go away with a PSMA PET scan because it only lights up for prostate
cancer. That's a very unique thing about this new scan. It will be a bit more push button
and people won't have to have the vast experience to interpret what do these scans, these older
scans, mean.
So, what are the limitations of these older scans? Like the, you know, technetium scan
and these different bone scans that people are having.
Well, of course, they can miss small tumors. That's one problem. And then the other issue
is because they are sensitive, if someone kicks you in the shins, the scan can light
up there. So, it is possible for these things to be over-interpreted where someone will
see a spot and then jump to the conclusion that it's gotta be prostate cancer because,
you know, when the radiologist get these reports it'll say a diagnosis on the requisition "prostate
cancer," so the radiologists are, like, on edge looking for any possible spot because
they don't want to be made to look like fools if they miss something. So, the tiniest little
ditzel, they say, "well, possible cancer," but it could be from old arthritis, it could
be from a variety of different things. So, there are patterns that come out and then
there are ways to cross-check these abnormalities. If someone has a hotspot on a bone scan that
you can order or a regular x-ray to see if there's scarring there. You can order an MRI
and see if there's any destruction of the calcium in the bone structure. And cross-check
and double-check to make sure that these supposed cancer spots really are cancer.
How do you see the treatment landscape changing in the future? Are we going to have a lot
more strategic treatment? How do you see that changing?
It's hard to predict, but I do think that these new PSMA PET scans will allow people
to use less aggressive treatment because for the first time we'll have much greater confidence
that nothing has spread. We've always had to buy insurance against the possibility that
there's some microscopic spread out there and PSMA PET scans won't eliminate that ambiguity
altogether, but it will reduce it to a great degree and perhaps in the somewhat more elderly
where you're not playing such a high stakes game, you can use a PSMA PET scan and if it's
clear, maybe that person who otherwise would've needed hormone therapy won't. Maybe someone
who would've needed radiation treatment could just do active surveillance. These are just
speculations at this point though.
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