Diagnostic of Prostate Cancer with PSMA-PET in Germany

A PSMA PET scan is the most accurate method for staging prostate cancer. The technique makes it possible to detect even small metastases of any localization, including metastatic lesions of non-enlarged lymph nodes. The technique is superior in accuracy to CT, MRI, and scintigraphy and is often used at clinics in Germany for aggressive forms of prostate cancer. You are welcome to make an appointment for diagnostics for your preferred dates through the Booking Health service if you want to undergo a PSMA PET scan in Germany. On our website, you can see prices for diagnostic tests at leading German hospitals. The cost of an examination for suspected prostate cancer using PSMA-PET ranges from 5,100 EUR to 7,780 EUR.

Content

1. Why is a PET CT scan performed?
2. What is a PSMA PET scan?
3. Who may need a PSMA PET scan?
4. Where to perform a PSMA PET scan?

Why is a PET CT scan performed?

Prostate cancer is the second most common cancer among men and the fifth most common in terms of mortality. The process of its treatment depends on the stage. Without exception, all patients with newly diagnosed prostate cancer are indicated for staging, which involves determining the size of the tumor, its localization, boundaries, relationships with surrounding anatomical structures, and detecting possible metastases in the lymph nodes and distant organs, primarily in the spine.

CT or MRI scans are usually used to stage prostate cancer in oncology. Patients also undergo bone scintigraphy to check for metastases in the bones and spine.

However, MRI and CT staging are not without their drawbacks. The main one is that the conclusion about the presence or absence of metastases in the lymph nodes is made solely on the basis of their size. Indeed, the lymph node affected by metastases is usually enlarged. However, this does not always happen and not immediately, so diagnostic errors happen. Some affected lymph nodes are normal in size. There are also opposite situations where the lymph nodes become enlarged for other reasons, for example, due to inflammation, but do not contain any cancer metastases.

A PET CT scan is therefore a more accurate method of cancer staging. During this diagnostic examination, a radiopharmaceutical agent is injected into the body, which accumulates in the tumor tissue. Follow-up scanning of the body allows doctors to detect tumor foci of any localization.

What is a PSMA PET scan?

A PET can be performed in different ways, depending on the radiopharmaceutical used. As a rule, this is radioactive glucose or another substance that is intensively absorbed by cancer cells. Healthy tissues accumulate fewer radiopharmaceutical agents, which is why they do not "glow" so intensely in the images.

This technology is used for most oncological diseases, but its disadvantage is the inability to detect small tumor foci. Specific radiopharmaceuticals are therefore used whenever possible, which can be accumulated only in the tumor tissue since they bind to certain molecular targets. These are molecules that are found in large quantities in cancer cells but are absent in normal tissues or present in negligible concentrations.

PSMA (prostate-specific membrane antigen, also known as folate hydrolase I and glutamate carboxypeptidase II) is such a molecule in the case of prostate cancer. This is a protein that is found in the normal prostate, but in a malignant tumor, its concentration is increased hundreds of times. The more aggressive the tumor, the higher the PSMA levels it contains. Studies have shown that PSMA expression correlates with the rate of cancer progression, the risk of detection of distant metastases, and the transition of the disease to a castration-resistant form when the cancer ceases to respond to hormone therapy.

A PSMA PET scan thus involves the administration of a radioactive agent that targets PSMA. This diagnostic method is superior in accuracy to any other test, including PET with other radiopharmaceuticals. The technique allows doctors to detect even small metastases, and most importantly, it helps to estimate their exact number, which affects the choice of treatment tactics.

Who may need a PSMA PET scan?

A PSMA PET scan is not used for all patients, without exception. According to current European recommendations, the examination is used to:

• clarify the stage in patients with newly diagnosed prostate cancer in the case of very high, high, or intermediate risk;
• clarify the results of CT scans or other imaging methods if they show the presence of less than 5 distant metastases (if in fact there are more, this will affect treatment tactics);
• determine the absence of a biochemical response to prostate cancer treatment (PSA levels do not decrease).

At the same time, a PSMA PET scan is not necessary if multiple metastatic lesions have already been established by other diagnostic methods, since the results will not affect the tactics of cancer treatment. The test is also not used for cancer staging in low-risk patients, although discussions about this are still ongoing, and it is possible that PSMA PET scans will be shown to be beneficial in this category of patients in the near future.

The Departments of Nuclear Medicine in Germany use PSMA-targeted radiopharmaceuticals not only to diagnose cancer but also to treat it. Before starting therapy, doctors use a PSMA PET to assess the spread of the disease and check if the cancer is PSMA-positive. The procedure is then repeated after every two cycles of PSMA therapy to check how successful the treatment was (to assess the objective response by changing the size of the tumors).

Where to perform a PSMA PET scan?

You can go to one of the German Radiology Centers to undergo a PSMA PET scan. You are welcome to use the Booking Health website to find out the cost of the examination and make an appointment for your diagnostics. Our company's employees will help you select a clinic, schedule an appointment for the examination for your preferred dates, and also arrange your trip to Germany. We will book a hotel room and airline tickets for you, meet you at the German airport, take you to the hospital, and provide you with interpreting services. After the completion of the examination, a return transfer and remote consultations with the attending physician will be organized for you.

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 Library of Medicine

Johns Hopkins Medicine

Google Scholar