Clinically significant prostate cancer cells glow in PSMA PET/CT scan despite normal inconclusive MRI Scan SWNS
Scans that make prostate cancer cells ‘glow’ can eliminate the need for invasive biopsies—and they are already available in Australia and Europe.
The state of the art imaging test uses a molecule that binds to prostate cancer cells, causing them to “light up in a remarkable way”—appearing as bright spots in the scanning image.
The process could safely halve the number of men who need to undergo a biopsy for suspected prostate cancer following inconclusive results from an MRI scan, said the Australian scientists.
Their PSMA PET/CT scan identifies the more aggressive prostate cancer cells, which are potentially harmful and may need treatment—and could help reduce the risk of over-diagnosis by determining which cancers are low-risk and will never cause harm.
“It’s rare to see such strong imaging that could be so powerful in the clinic,” said Dr. James Buteau, a nuclear medicine physician at the Peter MacCallum Cancer Centre in Melbourne who led the trial in coordination with St Vincent’s Hospital in Sydney.
A common cause of cancer deaths in men, about 1-in 8 males receive a prostate cancer diagnosis, and they usually undergo an MRI scan to look for abnormal growths.
If MRI results are suspicious or inconclusive, patients usually undergo a biopsy that takes small pieces of prostate tissue and looks for cancer cells, but the invasive procedure can be uncomfortable and sometimes worrying for patients, and is also associated with side effects.
“Incorporating this testing into clinical care could help to address the major challenge of prostate cancer over-diagnosis, which leads to at best unnecessary and at worst harmful treatment for cancers that would never cause any harm.”
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The study
The Primary2 trial recruited men considered at higher risk of prostate cancer—such as having a strong family history—and randomly assigned them to get either a standard biopsy or a PSMA PET/CT scan.
Glowing prostate cancer cells PSMA PET/CT Scan – SWNS
Primary2 found that PSMA PET/CT scanning could identify people who either did not have cancer, or whose cancer was so low-risk or slow-growing it would likely never cause harm.
Those patients did not need a biopsy, while patients with a ‘positive result’ for cancer according to the PSMA PET/CT scan had a biopsy.
Researchers say the approach halved the number of patients who needed a biopsy, without missing any harmful cancers.
For patients who still needed a biopsy, their scan results ensured the procedure was targeted to the suspicious areas identified in the test to minimize complications and improve accuracy.
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The results are the first released from the Primary2 trial, which will follow the 660 patients for two years.
Already, the PSMA PET/CT scan is widely available in Australia, and it is becoming increasingly accessible in the UK and Europe, primarily for diagnosing high-risk or recurrent prostate cancer—but its cost and availability remain limitations to widespread use.
“PSMA PET/CT scanning makes prostate cancer cells light up in a remarkable way, particularly in more aggressive cancers,” said Dr. Buteau.
“Getting told you have a risk of prostate cancer is a huge cause of anxiety and concern,” said study co-leader Professor Louise Emmett.
“Our findings show that PSMA PET/CT after MRI offers a ‘belt-and-braces’ approach that can determine which people have a clinically significant cancer, and which people are at low risk and don’t need a biopsy or further testing.”
Primary2 is the largest of a series of studies undertaken by the team, exploring whether PSMA PET/CT scanning could improve prostate cancer diagnosis and reduce unnecessary biopsies for patients.
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Dr. Buteau was due to present the findings of the trial at the European Association of Urology Congress in London on Friday.
“This well-conducted trial shows that incorporating PSMA PET/CT in men with low or intermediate risk lesions significantly reduced the number of unnecessary biopsies and the diagnosis of clinically insignificant prostate cancer,” said Dr. Derya Tilki, an Association member and senior urologist at Martini-Klinik Prostate Cancer Centre in Germany.
“Importantly, this didn’t compromise the detection of clinically significant disease,” she said, congratulating the researchers on their study.
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