So, Dr. Scholz, there's a lot of different types of prostate cancer imaging out there.
Can you kind of explain the best imaging that you think is on the market for localized prostate
cancer?
So, I think for localized prostate cancer, you mean scans that can look right at the
prostate and then the patients that have the high-risk type of prostate cancer, they need
scans that look around the body and make sure that nothing has spread to the lymph nodes,
to the bones. Right now what's available is different, probably, than what's best. We've
talked in the past about PSMA PET scans and these are sort of one-stop shopping scans.
I'm expecting them to get FDA-approved in the next 6-12 months perhaps, but right now
they are available on a clinical trial basis at some of the large universities like UCLA,
and if you're going to use one scan that would be it because it can detect prostate cancer
inside the prostate and outside the prostate and it's a lot more accurate than anything
we've ever had before, so I think it will become the de facto standard when it gets
approved. And other than retaining prostate MRIs and ultrasounds for getting really high-resolution
images of the gland itself, I think the PSMA PET scans will replace all the body scans
and it will also be useful for information about whether people have cancer in their
prostate. The resolution won't be quite as tight as an MRI or an ultrasound, but it will
show if there's any cancer in the prostate, so it's kind of going to end the conversation
I think, these new scans.
So, do you think that future protocol in order to get really tight on the prostate but also
see in the body that people will go for a 3T (or maybe a 5t MRI in the future) or something
like that and a PSMA scan?
Yes, actually Dan Margolis, who has spoken at our conference a few times, has new equipment
that allows them to do both an MRI of the prostate and a PSMA PET scan in one scan.
So then you have really amazing information because you get clear pictures of the gland
and where the cancer may be, and then the PSMA PET scan tells you with 100% or 90% certainty
is it prostate cancer or is it a shadow from something else? So, that will—I don't know
whether those scanners will become widely distributed and people just have an MRI and
a PSMA PET scan, but the information when you put it together, it's really fabulous
and very accurate.
Until we get to that point, we have Axumin. Now, can you speak to its accuracy? I know
that PSMA is definitely a lot stronger, but in the meantime, a lot of people have access
to Axumin currently.
Yeah, so that's FDA-approved. This is a scan, Axumin is a scan that is designed to detect
lymph nodes when they're at a smaller stage than what we could previously do with CT scans
and MRIs, and that is a super important question, "Is cancer getting outside the prostate?"
Lymph nodes are the first jumping-off spot. Axumin was a real advance over the older CAT
scans and MRIs that we had. It's not as precise or specific as PSMA PET, but it is better
than what we had previously. So, we do use Axumin PET scans. The scans are a little tricky
to read and so it's good to go to a center that does a certain number of these, that
has experience, that knows how to interpret them, but they can certainly be useful to
detecting the early spread of prostate cancer to the lymph nodes which is a super important
question.
So, currently, I mean, I think that 3T MRI is the most common that I hear about when
it comes to men calling our helpline and getting imaging, but when they Google different prostate
cancer imaging, they hear about color Doppler, they hear about 1.5 MRI, and then they kind
of get concerned about which is the best or what's the best for which circumstance. So
out of those three, can you tell us what you think that context would be?
So, a 3T MRI is just a more powerful imaging tool than a 1.5T MRI, so I'm concerned when
centers are using 1.5T MRIs to do prostate imaging these days because we know that we
get better pictures with 3T MRIs. So, it's, you know, getting quality images of the prostate
isn't just having the right equipment, but you want to start with the right equipment
and you do need good technicians, you need trained radiologists to read this information.
In terms of color Doppler, there are only a few centers—my office does color Doppler—but
there are just a handful around the country. The doctors that do it need to have a lot
of experience and have a large volume and a lot of practice and they are not as specific
(or accurate) as an MRI is, but they approach the accuracy. But it's a simple office procedure.
It's easy to do targeted biopsies. So, the usefulness of color Doppler is a lot to do
with its convenience, being available right in the doctor's office.
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