Staging and monitoring of prostate cancer
Prostate cancer is the most common malignancy in men and accounts for approximately 30% of deaths from neoplastic disease in the male population. These statistics emphasize the importance of timely and early diagnosis.
Despite the advances in morphological imaging (CT & MRI) there are cases of lymph nodes infiltrated by cancer cells, which based on conventional imaging are not considered pathological.
Accurate staging is critical to patient management. PET/CT imaging using Ga68-PSMA, a new tracer in the study of prostate cancer, is moving in this direction.
PSMA is a transmembrane protein that is overexpressed in cancer cells compared to normal prostate cells and shows excellent results, both in the initial staging of patients and in cases of biochemical relapse (PSA rise). This includes the group of patients with low PSA.
Studies in patients with moderate- and high-risk prostate cancer demonstrate clear superiority of Ga68-PSMA in the detection of pathological lymph nodes and distant metastases compared to CT and MRI. In patients with biochemical relapse the results are also extremely satisfactory even at very low PSA values.
All this leads to a more accurate and earlier diagnosis with clearly greater chances of radical treatment.
Diagnosis and monitoring of neuroendocrine tumors
Neuroendocrine tumors (NETS) are a group of neoplasms with an ever-increasing frequency. PET/CT imaging using Ga68-labeled tracers has recently been introduced into clinical practice with excellent results. The tracers used are mainly DOTA-TOC, DOTA-TATE and DOTA-NOC. They bind to somatostatin receptors, molecules that are overexpressed in NETS cells.
Important studies demonstrate the superiority of PET tracers, both in relation to the methods of classical nuclear medicine, and to conventional anatomical imaging, and more specifically to CT, with an accuracy of PET imaging with Ga68 of about 96% versus 75% of CT . The method is sensitive both in the detection of the primary focus and secondary localizations.
The impact on the clinical management of patients is also great, with its modification in studies in almost 20% of cases compared to CT imaging.
The method also has prognostic value, as fixation of the radiopharmaceutical is associated with better differentiation of the disease and better chances of response to treatment. Regarding treatment response, Ga68-labeled somatostatin peptides are the method of choice in monitoring therapeutic outcome.
Imaging with Ga68-linked tracers is also used as a basis and prerequisite for treatment with therapeutic isotope-labeled somatostatin analogs, such as Lu177-DOTATATE.
Therapeutic Applications
The properties of the above tracers are exploited by Nuclear Medicine for the application of targeted treatments. The radioisotope of choice for the irradiation of neoplastic foci is lutetium (Lu-177).
Lu-177 is an emitter of β radiation. It is associated with PSMA and DOTATATE molecules for therapeutic administration in patients with Prostate Cancer and Neuroendocrine Tumors respectively. After its intravenous administration, the radiopharmaceutical joins with special receptors on the cancer cells, where it also exerts its cytotoxic effect.
The treatment is done in the context of day hospitalization, i.e. the patient is discharged on the same day. It is simple and short. For Prostate cancer it takes about 2-3 hours, while for Neuroendocrine tumors 4-5 hours. During the treatment the patient is constantly under the supervision of the medical and nursing staff.
After this, the attending physician informs the patient about any medication being followed, planned hematological or imaging tests and radiation protection instructions.
It is always followed after a few days by post-treatment imaging to assess the degree of response to treatment. This is done both with the qualitative analysis of the image and with the application of a modern dosimetry program which calculates the degree of radiation – response of the neoplastic foci.
The prolongation of life expectancy and quality of life ranks treatment with Lu-177 among the new valuable weapons available to Medicine in carrying out the task of healing and relieving patients.
It is written by:
Theodoros Pipikos
Nuclear Physician
Director of Nuclear Medicine & PET CT, HEALTH
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