Hope this both updates the forum, and maybe solicits some better informed
observations about these two scans.
Although an ever-increasing number of treatment options exist, an estimated
26,100 men will still die of the disease in the US in 2016, generally after
primary local and systemic treatments for prostate cancer have failed. We don't
talk much about that here. One factor contributing to this statistic is the
frequent inability of current diagnostic methods to reliably detect the exact
location(s) of disease relapse at a time when curative treatment is still
The dilemma of biochemical recurrence (BCR): Up to a third of
men treated for PCa will experience recurrent disease, most often detected only
by rising PSA levels. Conventional imaging tools such as computerized
tomography [CT] and bone scintigraphy [BS] frequently fail to identify the site
of recurrent disease, presenting a serious challenge to urologists and radiation
oncologists charged with the selection of secondary treatment, and causing
significant anxiety for us patients.
While PCa recurrence may occur
locally in the prostate gland or prostate bed, and/or in local lymph nodes in
the pelvis, recognition of distant lymph node, bone or other tissue involvement
requires different treatment choices. Potentially curative techniques such as
salvage lymphadenectomy, radiotherapy or cryotherapy may be used for local
recurrences, especially at lower PSA levels, whereas systemic approaches such as
the use of anti-hormonal therapy and/or chemo or immunotherapy may be
recommended in the presence of distal metastatic disease.
Enter Axumin™: In May, 2016 the FDA approved Axumin
[fluciclovine F 18 Injection; Blue Earth Diagnostics Ltd, Oxford UK] for PET
imaging in men with suspected prostate cancer recurrence based on elevated PSA
levels following prior treatment. The approval of Axumin ushered in a new era
of F18 PET/CT for the detection of recurrent prostate cancer in the USA. Data
submitted to FDA included results from prospective studies at Emory University
and the University of Bologna and from clinical use at two sites in Norway; the
pooled data for n= 595 subjects were retrospectively analyzed. Overall,
fluciclovine F 18 PET/CT detected sites of recurrence in 68% (403/595) of
patients. For patients with baseline PSA values in the lowest quartile
(<0.79 ng/mL, n=128), 75 patients (59%) were negative with fluciclovine F 18
PET/CT, but 53 (41% of patients) had positive fluciclovine scans; 13 (10%) had
prostate bed findings only, and 40 (31%) had extra-prostatic disease. As the
location of disease recurrence affects appropriate therapy selection, this
finding is highly relevant.
My impression is that an Axumin scan is more valuable for Persistent PSA
source detection. For more data, and the source of most of the above:
Here is a 9/16 link comparing Axumin with Gallium 68:
Now, as for Gallium 68 PET scans specifically, which appear to me to be
more valuable with high risk PCa:
clinical research ~2014?
Clinical Utility of Gallium-68 PSMA PET/CT Scan for Prostate Cancer 6/17
Evaluation of 68Gallium-PSMA PET/CT in patients with prostate cancer
Gallium 68 PET scanning locations 6/17
Enjoy the readings. I look forward to your comments, but I don't take questions.
Post Edited (garyi) : 10/9/2017 10:51:17 AM (GMT-6)