Peter L. Choyke, MD, FACP, director, Molecular Imaging Program, head, Imaging Section, Center for Cancer Research, National Cancer Institute (NCI), discusses the differences between PET scans in prostate cancer.

When conducing imaging on a patient with prostate cancer, there are 2 typical choices of PET scans—prostate-specific membrane antigen (PMSA) and sodium fluoride PET scans. Choyke says that through a comparative investigation done at NCI, they found that these 2 PET scans do not match up with each other. Early on in the disease course, the imaging from each of these PET scans matches up, but as the disease progresses, they match less, he explains.

Choyke says that this is important because some treatments such as radium-223 dichloride (Xofigo) are very dependent on the bone turnovers, which is reflected in the sodium fluoride PET scan. PSMA-PET, which indicates where the active disease is, does not overlap with the sodium fluoride PET scan, says Choyke. This means that there is a chance that giving radium-223 will do nothing to the cancer. Choyke says that there is work being done to better select patients for radium-223 so that the right patients get the right treatment.  

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Peter L. Choyke, MD, FACP, director, Molecular Imaging Program, head, Imaging Section, Center for Cancer Research, National Cancer Institute, discusses the differences between PET scans in prostate cancer.
 

Dr. Choyke on Differences Between PET Scans in Prostate Cancer

Peter L. Choyke, MD, FACP, director, Molecular Imaging Program, head, Imaging Section, Center for Cancer Research, National Cancer Institute (NCI), discusses the importance of multidisciplinary care in prostate cancer.

In the treatment of patients with prostate cancer, a multidisciplinary approach is very important, says Choyke. Prostate cancer stretches over multiple disciplines, Choyke explains, meaning that different management strategies are needed at different stages of disease. Historically, a patient with prostate cancer would have to go and see each specialist separately to receive care.

A multidisciplinary approach gives each specialist the opportunity to see and understand the full scope of a patient’s treatment. If clinical parameters begin pointing in a different direction, Choyke says that it is important for everyone involved to know and deal with it accordingly. For example, the NCI has weekly multidisciplinary conferences to discuss patient care.

Peter L. Choyke, MD, FACP, director, Molecular Imaging Program, head, Imaging Section, Center for Cancer Research, National Cancer Institute (NCI), discusses the importance of multidisciplinary care in prostate cancer.
 

Dr. Choyke on the Importance of Multidisciplinary Care in Prostate Cancer

Peter L. Choyke, MD, FACP, director, Molecular Imaging Program, head, Imaging Section, Center for Cancer Research, National Cancer Institute, discusses the combination of imaging techniques in prostate cancer.

The specialty of imaging is no longer as compartmentalized as it once was, says Choyke. Now, whichever tool is deemed to be best fit to handle the patient’s current problem is used, often in combination. Although MRI is helpful for anatomy, there are limitations—particularly specificity. PET offers that specificity, but not a clear image of anatomy. By combining the anatomy from the MRI and the sensitivity of the PET, a more whole image of the disease can be constructed, Choyke explains.

Choyke says that imaging today is about getting a more complete picture of where a patient stands in their disease natural history. This will allow physicians to more accurately state where the patient is in their disease course, and then choose an appropriate therapy. Accurate imaging can match the right diagnosis to the right therapy, Choyke concludes.

Peter L. Choyke, MD, FACP

Articles

Dr. Choyke on Differences Between PET Scans in Prostate Cancer

Dr. Choyke on the Importance of Multidisciplinary Care in Prostate Cancer

Dr. Choyke on Combining Imaging Techniques in Prostate Cancer