New Test Informs Prostate Cancer Treatment Decision

"As men get older, just about all of us develop some level of prostate cancer. As a radiologist, my role is to help urologists and oncologists meet the challenge of deciding when it needs to be treated." says David Panush, M.D., section head of nuclear medicine at Hackensack University Medical Center. "Information that can't be gained from clinical examination is key to making treatment decisions."

While much of the time, prostate cancer is slow-growing and remains localized, it does have the potential to become life-threatening. The American Cancer Society reports that prostate cancer is the second leading cause of cancer death in American men, estimating that 1 man in 41 will die of prostate cancer. This is a fraction of the 1 in 8 men who will be diagnosed with prostate cancer in their lifetime, and more than 3.1 million men who have been diagnosed with prostate cancer are still alive today.

Determining who is at risk of dying from prostate cancer versus who is likely to die with prostate cancer is key to making informed treatment decisions. Historically, worried doctors and patients have erred on the side of caution after a prostate cancer diagnosis, sometimes resulting in overtreatment that often comes with unpleasant side effects such as erectile dysfunction and urinary incontinence.

Recent developments in research and testing are helping doctors better understand the difference between prostate cancers that need immediate treatment (primarily metastatic disease and biochemical recurrence) and cases that are safe to relegate to "watchful waiting" because they remain localized.

Diagnosing metastatic prostate cancer (cancer that spreads from an initial site to a different or secondary site) whether upon initial diagnosis or with a recurrence of disease, has remained challenging. Scans couldn't detect the spread until it changed the size and shape of the lymph nodes or other structures it affected, which generally happens later in the course of the disease. As with other cancers, identifying metastatic prostate cancer early leads to easier-to-tolerate treatments and better outcomes.

Today, a new, non-invasive imaging test is available at Hackensack Meridian Health that can detect the presence of small amounts of prostate cancer cells in lymph nodes, bone and soft tissue anywhere in the body. Plarify® is a prostate-specific membrane antigen (PSMA) radiotracer that is injected into a patient's vein during a PET scan.

"This tracer is the first that works at the early phase of metastatic prostate cancer. We no longer have to wait for lymph nodes to get bigger to see if the cancer has come back or spread," says Dr. Panush. "If it's caught early enough, patients may be eligible for targeted stereotactic radiation, sparing them chemotherapy or other systemic treatments."

Here's how it works:

"Plarify has been approved for initial staging of certain types of prostate cancer, as well as to check for recurrence in someone who has previously been treated," says urologic oncologist Nitin Yerram, M.D. "I can order this test anytime there is a clinical concern about metastatic prostate cancer. It can be used to evaluate people whose biopsies find intermediate- or high-risk prostate cancer, or for prostate cancer survivors whose PSA levels are rising above their post-treatment levels."

"Before its 2021 approval in the U.S., I knew of patients with prostate cancer who would fly to Europe to access PSMA-targeted PET imaging," says Michael Horton, FACHE, administrative director of clinical services and vice president of radiology at Hackensack. "Now that we have Plarify here within the Hackensack Meridian Health network, patients can benefit from this innovative technology while remaining close to home."

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

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