A new imaging technology forecasts the likelihood of recurrence.

Variability in Outcomes

After prostate cancer surgery, outcomes can differ significantly among men. For some, the cancer may never return, while for others, it might recur. To assess the likelihood of recurrence, doctors analyze various clinical factors. For example, if a biopsy reveals highly aggressive cancer, there is a higher chance of the cancer coming back. Similarly, very high or rapidly increasing prostate-specific antigen (PSA) levels before surgery are linked to worse outcomes.

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Advancements in Predicting Recurrence

Researchers are continually developing improved tools to identify which men may benefit from additional therapy or closer monitoring. Genetic testing plays a crucial role in risk-based classification, as do advances in medical imaging.

Promising New Imaging Technology

In December, scientists at Stanford University reported encouraging results using a new technology that highlights prostate tumors in specialized imaging scans. This technique involves a minimally-radioactive tracer, known as 68Ga-PSMA-11, which is administered intravenously. The tracer specifically targets and binds to prostate-specific membrane antigen (PSMA), a protein found in higher concentrations on prostate cancer cells compared to normal cells. When flagged by 68Ga-PSMA-11, tumors appear on scans like glowing matches in a dark room.

Doctors are already utilizing PSMA scans to detect early metastatic cancer, and this tracer is also being explored to deliver drugs directly to malignant tumors.

Research methodology and results

For this research, the Stanford team wanted to know if the scanning technology would predict prostate cancer recurrence after initial treatment. The researchers enrolled 73 men with intermediate or high-risk features on tumor biopsies, and gave them each a dose of 68Ga-PSMA-11. Then they measured how much of the tracer was taken up by the prostate, as well as any bits of cancer that were potentially spreading in the body. Following that, the men had their prostates taken out.

Cancer recurrence was assessed by evaluating changes in PSA levels. The levels should fall to zero if a man's prostate has been removed, so continued elevations or a sudden spike in PSA after surgery indicate that cancer still lurks in the body. This type of recurrence is called biochemical failure.

The men were followed for roughly three years. According to the final results, men with lower tracer uptake values before surgery fared better over time than men who had higher uptake values. The men with lower tracer uptake values avoided biochemical failure for at least two years after their operations. Conversely, men with the highest tracer uptake values and/or PSMA-detected metastases prior to surgery were more likely to experience biochemical failure during the study period.

The Role of PSMA Scanning in Prostate Cancer Diagnosis

"We found that the information we could get from PSMA scanning in patients with newly diagnosed prostate cancer before surgery was at least as reliable and useful as other information from biopsy, PSA levels, or clinical exams for predicting how patients would fare after surgery or other treatments," says Farshad Moradi, a radiologist at Stanford and co-author of the study.

He further emphasizes, "The data from PSMA scans can assist patients and their doctors in making more informed decisions about treatment options and follow-up care, which we hope will lead to improved long-term outcomes."

Expert Insight on the Impact of PSMA Scans

"This study adds to the growing excitement over PSMA scans and their potential to predict prostate cancer outcomes," says Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.

He highlights, "The advancements brought by PSMA are significantly enhancing prostate cancer management and follow-up care after diagnosis and treatment. This study further underscores the value of this critical technology."