PSMA PET: The game-changing diagnostic tool in the fight against prostate cancer

The PET/CT machine for PSMA. Courtesy photo

Diagnostic technology for men with prostate cancer has gotten a lot less invasive

May 10, 2023 — As time marches on, it is our good fortune that the prostate cancer diagnostic tools that are available to urologists continue to march onward and upward in effectiveness. That, despite the efforts of COVID-19 to shut everything down.

Going back to the 1980’s and before, one might say we were at the mercy of the “fickle finger of fate” meaning our fate was resting on the finger of our urologist inserted “you know where” in performing the DRE (feeling our prostate gland). I think we are all aware of the overwhelming shortcomings of the DRE (Digital “finger” Rectal Exam) such as not indicating any change that the urologist would feel until the cancer was long-gone from the prostate.

Then along came the PSA (Prostate-Specific Antigen) Blood Test. Finally, a simple blood test to help catch prostate cancer early - before it left the prostate gland. All it took was a blood draw. Now, to be clear, this wasn’t suddenly a “one/and/done” prostate cancer test. However, it would alert the urologist that something down there needed to be checked. That would often call for a prostate biopsy and other possible diagnostic tests to see what was going on.

Even with the successful “early-warning” of the PSA Blood Test, there was a need to know where the cancer was located and particularly if it had spread beyond the prostate gland. We needed that information as the initial treatment was planned and discussed with the patient and certainly when the initial treatment failed to remove all the cancer.

Now comes the PSMA PET! This is a new type of imaging exam that can help our urologists determine if and where prostate cancer has spread outside our prostate gland, including to our lymph nodes, other organs, or bones. PSMA PET scan uses radioactive tracers that bind to prostate-specific membrane antigen (PSMA). This is a protein that’s found in high levels on the surface of prostate cancer cells.

Multiple studies have found that the PSMA PET test appears to be more accurate than conventional tests for diagnosing metastatic prostate cancer. In one 2020 study, researchers found that the PSMA PET scan was 29 percent more accurate at detecting cancer in the pelvic lymph nodes or metastases outside the prostate than the conventional tests.

Another 2020 study evaluated men with prostate cancer who had received staging with a conventional combination of CT, MRI, and bone scans followed by PSMA PET scans. The PSMA PET scans increased the level of confidence in the staging results by 20%. That is impressive – I want it on my team!

Both of those studies found that in multiple cases, results from the PSMA PET scan led to changes in people’s recommended treatment plans.

Many men, including this ole Bob, have had the experience of initial treatment coming up short on a cure and needing follow-up treatment. The scanning technology in 2001-2002 when I needed it was not up to the level that is available for men today. As a result, the information my urologist, radiologist and I had to use when planning my initial treatment and when planning my follow-up treatment was less precise information than we would get today.

I’m also thinking the PSMA PET scan would have more accurately detected the location of the prostate cancer and made my initial surgical prostatectomy totally successful. And, since I needed follow-up radiation, PSMA PET, with its detection accuracy, might have helped avoid the radiation burn to my bladder.

I cannot and will not be angry with my continuing battle due to the effects of that bladder burn. I know everyone involved in my care did their utmost to “Do No Harm.” They certainly accomplished what Marianne and I wanted done – I am Prostate Cancer FREE.

I am thrilled at the progress being made in the diagnostic technology for men with prostate cancer. Hooray for that!! Using the PSA Blood Test for its Early Alert and the PSMA PET for its Pin-Point ID, leads to more effective treatment and, best of all, lives saved!