Diagnostic of Prostate Cancer with PSMA-PET

To diagnose prostate cancer, the best hospitals in developed countries often use PET. This examination is not used to detect new cases of the disease, but to clarify the stage, detect signs of relapse and metastases. PET is also used in the process of radionuclide treatment of metastatic prostate cancer. The cost of an examination for suspected prostate cancer using PSMA-PET ranges from 5,100 EUR to 7,780 EUR.

Content

1. What is PSMA Therapy (PSMA-PET)?
2. When do patients need PSMA-PET?
3. Where can the patient undergo PSMA-PET?
4. Organization of treatment abroad

What is PSMA Therapy (PSMA-PET)?

PET is a scan of body areas with the primary cancer and its metastatic foci. Prior to that, a radiopharmaceutical is injected into the body. It accumulates in the tumor cells and "highlights" them. Thus, the doctor can see them.  

Although fluorodeoxyglucose is used as a biomarker in most countries, it is not very informative for diagnosing prostate cancer. In particular, this biomarker cannot reliably distinguish a local recurrence from a postoperative scar. It effectively accumulates in metastases, but at the same time it penetrates the organs of the gastrointestinal tract and liver, which can have no metastatic foci.

Other markers also have certain disadvantages. Therefore, in modern medicine, they are supplanted by substances capable of binding to the prostate-specific membrane antigen (PSMA). This is a membrane glycoprotein formed in the epithelium of the prostate of all people: both completely healthy men and prostate cancer patients. Other organs almost do not contain it. In benign prostatic hyperplasia, the amount of PSMA does not increase significantly.

PSMA expression in prostate cancer cells is 100-1000 times higher than in any other tissues of the body, including in healthy prostate cells. Moreover, the intensity of expression may also increase in case of:

• advanced cancer;
• metastatic cancer;
• hormone-dependent cancer.

PSA may be detected in the blood, whereas PSMA may not be found there. Thus, it is an ideal marker of prostate cancer cells, which provides both high sensitivity and specificity of PET. The increased sensitivity means that if there is a metastatic focus, it necessarily contains PSMA. The high specificity is the ability of the radiopharmaceutical to accumulate only in cancer cells, but not in healthy tissues.

Various clinics use various radionuclides as a radiopharmaceutical. This may be radioactive iodine, lutetium, actinium and other substances. To conduct PSMA-PET, the German Hospital Heidelberg started to use small peptide molecules modified with urea. They have high affinity for PSMA, good pharmacokinetics, high long-term accumulation, and rapid elimination from the body. This radiopharmaceutical has a very high coefficient of differential accumulation (minimal number of nuclides in the healthy tissues) and it is able to image even the smallest metastatic foci.

When do patients need PSMA-PET?

The cancer clinics use PSMA-PET not to initially diagnose oncological diseases, but to plan cancer treatment. Positron emission tomography helps to identify metastases, so with its application the doctor can understand the following things:

• is it possible to perform surgery;
• if it has already been performed, whether the cancer has developed after surgery again;
• if the applied cancer treatment is effective (radiation therapy, chemotherapy, hormone therapy);
• is it possible to use radionuclide cancer treatment.

PSMA-PET should be necessarily used before the prescription of radionuclide therapy and in the process of its implementation. This is a treatment option for prostate cancer, in which radionuclides capable of binding to PSMA are introduced into the body. They bind to the antigen, accumulate in cancer cells and destroy them. At the same time, the radiation is so short that the healthy tissues remain almost unaffected.

PSMA-PET is carried out prior to this procedure to determine whether the radiopharmaceutical will accumulate in the sufficient quantity. In the case of its sufficient accumulation, the doctor prescribes radionuclide therapy. PSMA-PET is then performed after each radionuclide therapy procedure in order to evaluate the results and understand how many more sessions are required to ensure the desired effect.

Where can the patient undergo PSMA-PET?

Thanks to Booking Health, every person, regardless of his place of residence, has the opportunity to contact the best cancer clinics for a full-fledged diagnostics. Here are some examples of reputable German medical facilities:

University Hospital Carl Gustav Carus Dresden. The diagnostics is provided in the Department of Radionuclide Medicine. There are available both PET-CT and PET-MRT. The latter does not cause any radiation exposure, therefore, it is safer for the patient. The department has been working for 60 years. Consequently, the treatment options offered here are among the most effective in the world.

University Hospital of Ludwig Maximilian University of Munich. The hospital has at its disposal the largest Department of Nuclear Medicine in Germany, which doctors conduct PSMA-PET for patients.  Since August 2013, the department has launched a new center for the production of radiopharmaceuticals. The department conducts PSMA therapy for the patients who cannot undergo surgical treatment, in case if chemotherapy is not effective or is not indicated for them.  

University Hospital Frankfurt am Main. The Department of Nuclear Medicine examines about 8,000 patients every year. Many of them undergo PSMA-PET. The department widely uses lutetium PSMA therapy for prostate cancer as a more effective and safe alternative to chemotherapy. Even in the case of advanced metastatic cancer, it allows for a long-term remission of the disease.

Organization of treatment abroad

If you want to restore your health, undergo examination and treatment in the best cancer clinics of the planet, the best option will be to contact the specialists from Booking Health. Below you can see our services and benefits:

• Selection of the best cancer clinic with a modern Department of Nuclear Medicine for diagnosing, treating or rehabilitating prostate cancer patients.
• Since we agree on the lack of extra charges and coefficients for foreign patients, you will benefit from a more affordable cost of treatment.  
• Preparation of the examination and treatment program without repeating previously performed diagnostic procedures.
• Reduced waiting time for an appointment with the doctor and provision of both diagnostics and treatment in the cancer clinic at the most suitable dates for the patient.
• Provision of communication with the doctor.
• Program control at all its stages.
• Control of the cost of treatment, the cost of various procedures, the return of unused funds upon the program completion.
• Communication with the clinic after examination and treatment abroad.
• Assistance in buying and forwarding medicines.
• The possibility of organizing additional procedures, such as chemotherapy, rehabilitation and other methods aimed at the improvement of the health of cancer patients.

Booking Health will provide you with all the necessary services. We will fully arrange your treatment abroad, help you to draw up documents, book a hotel and airline tickets, provide you with the interpreting service, meet you at the airport and take you to the clinic by car.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

National Center for Biotechnology Information

National Library of Medicine

National Cancer Institute

American Cancer Society