Another thing that came out in 2020 for FDA approval, and this is super exciting because
we've been talking about PSMA scans on the PCRI channel for quite some time, and the exciting
things that are going to happen because we can now see so much more of what's going on inside the
body. So, can you explain how PSMA works and also what type of approval it got by the FDA in 2020?
PSMA PET scans are sort of a dream come true for prostate cancer. The question in someone with
prostate cancer is, "where has the disease spread to or has it spread at all?" And historically, the
scans that we've used—bone scans, CAT scans—have given sort of a rough and ready answer to that
which is not adequate. PSMA PET scans are not only far more accurate in terms of finding little tiny
specks of cancer, but they're also very specific only for prostate cancer. So, if they light up,
unlike other scans where you see a shadow and you have to kind of assume it might be prostate cancer
based on patterns, if the PSMA PET scan lights up, it basically says, "that is prostate cancer."
So, it is going to change the way we practice. One of the fascinating issues—and
I just talked to Dr. Margolis about this last week—is the possibility that men
could—maybe elderly men who are nervous about having a prostate biopsy—could they just have
a PSMA PET scan? And if it doesn't light up in the prostate, why bother to do a biopsy? So, the idea
that the scan is almost as accurate as getting an MRI or a prostate biopsy is very exciting.
And then also men who are on active surveillance with rising PSAs, the more elderly ones, the big
concern is, "has the cancer spread?" and if it hasn't spread in someone in their late 70s or 80s,
can they just keep watching their prostate cancer even if the PSA is going
higher than what we would normally be comfortable with? Because it's really the spread of the cancer
that hurts people, not the rising PSA. And then the other applications are pretty obvious. I mean,
in newly diagnosed men, if there's no early spread of cancer outside the prostate, are they still
going to need hormone therapy which is so commonly given to these men with higher Gleason scores?
Maybe yes, maybe no. And then when they do find cancers that are outside the prostate,
they can be targeted with IMRT or SBRT. So, it's a totally revolutionary technology
that's going to have an impact in all stages of prostate cancer.
So, when will we see this be widely available in the US for patients?
So, right now the research centers like UCSF and UCLA can obtain these scans and there may be a
charge associated with it whereas when things are FDA approved and insurance takes over,
Medicare will pay for it. So, right now, they're trying to assign the billing codes, and that may
take 3-6 months or something of that nature. So, people that have to have a scan right now can
go to some of the university centers around the country. For people that can afford to wait
another 3-6 months, it's going to be available in multiple locations. The infrastructure for
PET scans is already installed across the United States. It's just the actual PSMA substance that
gets injected into the bloodstream that needs to be manufactured and distributed commercially.
So, should all newly diagnosed patients be getting a PSMA scan from the start?
Men that are candidates for active surveillance with low-grade Gleason 6 prostate cancer shouldn't
do the scan. We already know that they don't have any spread and if the scan showed something, you'd
have to wonder if it was a false positive and that could just confuse things, but in anyone who we
feel there's a risk, Gleason 7s and above, it's a very natural thing to consider getting a scan.
And anyone who has relapsed, should they be getting a PSMA scan? I think it's the standard
of care right now. The whole idea with relapse in prostate cancer is the hope that you can cure it
and if you can find it and treat it, that offers the opportunity for cure.
Thank you so much for watching. If you would like more information,
you can visit our website at PCRI.ORG.
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