Manoj K. Jain, MD, nuclear medicine specialist, radiologist, Mayo Clinic, discusses diagnostic tracers in prostate cancer.

F-18 fluciclovine (Axium) is commonly used at academic institutions because C-11 choline has a short half-life and requires an onsite cyclotron for the production of the tracer and for use, says Jain. However, one of the drawbacks of F-18 fluciclovine is that the supply from the vendor is only accessible on limited days.

However, Mayo Clinic is in the process of getting a cyclotron approval. After that, Mayo Clinic will be using C-11 choline, because it will be more readily available and will allow for easier scheduling, says Jain.

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Manoj K. Jain, MD, discusses diagnostic tracers in prostate cancer.

Dr. Jain on the Use of Diagnostic Tracers in Prostate Cancer

Manoj K. Jain, MD, nuclear medicine specialist, radiologist, Mayo Clinic, discusses diagnostic tracers in prostate cancer.

F-18 fluciclovine (Axium) is commonly used at academic institutions because C-11 choline has a short half-life and requires an onsite cyclotron for the production of the tracer and for use, says Jain. However, one of the drawbacks of F-18 fluciclovine is that the supply from the vendor is only accessible on limited days.

Manoj K. Jain, MD, nuclear medicine specialist, radiologist, Mayo Clinic, discusses the use of radioligand therapy in prostate cancer.

Radioligand therapy with prostate-specific membrane antigen (PSMA) is performed using Lutetium-177 PSMA, which attaches to the prostate cancer cell's surface receptor and is internalized, causing cell destruction, explains Jain.

Radioligand therapy is emerging for patients with metastatic prostate cancer, though it is still investigational in the United States. The therapy is useful for smaller lesions, Jain says, because the particle itself travels about 2 mm once it is within the cell. Radioligand therapy limits the destruction of the normal cell tissue, concludes Jain.

Manoj K. Jain, MD, discusses the use of radioligand therapy in prostate cancer.

Dr. Jain on Radioligand Therapy in Prostate Cancer

Manoj K. Jain, MD, nuclear medicine specialist, radiologist, Mayo Clinic, discusses the indications for PET imaging in prostate cancer.

PET imaging modalities are indicated for patients with biochemical recurrence. However, biochemical recurrence can vary according to the therapy that patients received, explains Jain. If the patient underwent a prostatectomy, any rise in prostate-specific antigen (PSA) level > 0.2 ng/mL of blood would be considered abnormal and warrant PET imaging to screen for metastatic disease. If the patient received definitive radiation therapy, any rise of 2.0 ng/mL of blood would be considered abnormal, adds Jain.

Radionuclide imaging, specifically with prostate-specific membrane antigen (PSMA)-targeted agents, is an emerging imaging modality that can be used to screen for metastatic lesions. Diagnostic procedures such as PET/computed tomography with Gallium 68-labeled PSMA or Fluorine-18-labeled amino acid tracers have been shown to be more sensitive at lower PSA levels than the currently available tracers, concludes Jain.

Dr. Jain on the Indications for PET Imaging in Prostate Cancer

Manoj K. Jain, MD, nuclear medicine specialist, radiologist, Mayo Clinic, discusses new imaging modalities to detect disease in patients with prostate cancer.

The conventional imaging modalities that have been used for imaging of prostate cancer for diagnosis as well as biochemical recurrence in the past are MRI and CT scan of the body and bone scans. These have lower sensitivity, especially when the prostate-specific antigen (PSA) level and the size of the lesions are small, explains Jain. Therefore, different imaging technologies need to be considered, especially in molecular imaging where much smaller lesions at lower PSA levels are able to be detected.

The newer imaging tools that are being used in PET imaging, which are FDA approved, are choline C-11 PET scan and 18F-Fluciclovine PET/CT scan. These help to visualize local recurrence as well as small metastatic disease. Therefore, the sensitivity of these tracers is higher and is more specific than the conventional imaging methods.

Manoj K. Jain, MD

Articles

Dr. Jain on the Use of Diagnostic Tracers in Prostate Cancer

Dr. Jain on the Use of Diagnostic Tracers in Prostate Cancer

Dr. Jain on Radioligand Therapy in Prostate Cancer

Dr. Jain on the Indications for PET Imaging in Prostate Cancer

Dr. Jain on Novel Imaging Technologies for Prostate Cancer