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15 december 2016: Bron: J Nucl Med. 2016 Nov;57(11):1713-1719. Epub 2016 Jun 3

Veel prostaatkankerpatiënten ervaren progressie van hun ziekte en optredende hormoonresistentie door het oplopen van hun PSA maar vaak zijn in het begin van het oplopen van de PSA nog geen aantoonbare tumoren te vinden. Sinds enkele jaren wordt voor deze groep kankerpatiënten een MP-MRI of PSMA pet-CT scan ingezet. Een PSMA Pet / CT scan is tegelijk een behandeling omdat er gericht "bestraald" wordt op een zogeheten PSMA ligand, een eiwit dat gevoelig blijkt voor de radionuclide Gallium 68, een stofje dat gebruikt wordt in de PSMA pet / CT scan en tegelijk met de diagnose (de tumorcellen lichten op) de tumorcellen ook vernietigt.

Zie ook hoe Jacob Zijlstra daarmee zijn prostaatkanker onder controle kreeg.

Tekst gaat onder grafiek verder.

PSMA patienten scan

Foto: scanbeelden van 50 jarige prostaatkankerpatient die PSMA scan kreeg.

Mensen met prostaatkanker met een stijgende PSA maar nog geen zichtbare tumoren neem aub contact op met het St. Antonius in Nieuwegein voor een PSMA pet-CT scan.

Citaat van hun website: 

Het St. Antonius Ziekenhuis Utrecht/Nieuwegein is het eerste en vooralsnog enige ziekenhuis in Nederland waar het mogelijk is om een PET scan te maken waarmee terugkerende prostaatkanker snel ontdekt kan worden. Het St. Antonius produceert zelf de nieuwe radioligand (radioactieve stof) waarmee al in een zeer vroeg stadium gezien kan worden of er terugkeer is van prostaatkanker (recidief). Hierdoor is snelle behandeling van het recidief mogelijk en dat geeft een betere prognose voor de patiënt.

De nieuwe scan biedt uitkomst voor patiënten die al behandeld zijn voor prostaatkanker (operatie of bestraling) en een verhoogd PSA hebben (PSA is een eiwit in de prostaat; verhoogde PSA-waarden kunnen duiden op prostaatkanker). Bij de eerste verhoging kan de scan, de zogenoemde PSMA PET-scan, al uitgevoerd worden. De scan geeft dan aan welke lymfklieren of andere locaties actief zijn. Voor deze metastasen kan dan naar een gerichte behandeling gezocht worden. Hiermee kan soms verdere uitzaaiing van prostaatkanker voorkomen worden.

Deze vorm van diagnose en tegelijk behandelen zou ook bij andere vormen van kanker kunnen worden ingezet. Zo is er ook een kleine studie gedaan met PSMA aanpak bij uitgezaaide schildkliertumoren en met succes. Zie deze studie: Imaging of Prostate-Specific Membrane Antigen Expression in Metastatic Differentiated Thyroid Cancer Using 68Ga-HBED-CC-PSMA PET/CT.

Hier het persbericht dat ik kreeg toegestuurd:

Identifying and destroying the tumour through nuclear medicine therapy

(Vienna, December 13, 2016) Prostate cancer patients who are resistant to hormone treatment used to have a poor prognosis. Until recently, the diagnostic and therapeutic possibilities had been limited, but now innovative developments in nuclear medicine imaging and therapy open up promising pathways. Novel substances used with PET/CT (positron-emission tomography combined with computed tomography) not only allow for better diagnosis but also offer treatment options where other therapies have failed. "This offers a glimpse of hope to patients who suffer from this particularly severe form of prostate cancer," says EANM expert Prof. Markus Luster.

Prostate cancer is the second most frequently diagnosed cancer in men and causes around 90.000 deaths per year in Europe. Up to every second patient who has his prostate surgically removed or has undergone radiation therapy suffers from relapse. In severe cases the level of testosterone upon which the tumour is dependent to a large extent has to be reduced drastically in order to fight the disease. This is usually done by hormone therapy. However, a considerable number of patients are or will become resistant to this kind of treatment (so called castration-resistant prostate cancer / CRPC). This means that in spite of therapy the tumour has not been destroyed definitively and in many cases is now affecting the lymph nodes or has even extended to the stage of often painful bone metastases. Prognosis of patients who progress to this stage is poor.

Detecting cancer cells by nuclear imaging
A common means to detect prostate cancer and assess the stage of the disease is the measurement of the level of prostate-specific antigen (PSA), which serves as a biomarker for the presence of cancer cells. However, in patients whose testosterone production has been suppressed medically PSA levels are often too low to be measured. This includes CRPC patients in whom this therapy has failed to eradicate or halt the tumour. Moreover, PSA measurement provides no information about the sites and the extent of the recurrent cancer. However, newly developed nuclear medicine methods have opened up promising diagnostic avenues that might more sensitively and accurately enlighten both patient and physician about the location and extent of disease. At the same time, this new approach also provides new therapeutic modalities which can improve the still poor prognosis of CRPC-patients in the future. The leading part is played by a protein called Prostate-Specific Membrane Antigen (PSMA). It is found abundantly on the surface of prostate cancer cells and its number appears to be increasing with the aggressiveness of the disease. This makes PSMA an ideal target for detecting cancer cells by nuclear imaging. The essential means to achieve this is the Ga-68-PSMA-ligand, a substrate that binds to PSMA – comparable to a key that fits into its lock – which is labelled with the radionuclide Gallium 68. This tracer has already been used successfully in a large number of PET/CT examinations: After the patient has been injected with Ga-68-PSMA-ligand the tracer is taken up by the cancer cells which are made visible for the examining physicians by the radiation. "The substance has proven to be highly sensitive and reliable in detecting carcinoma in lymph nodes as well as metastases in other body regions. Over the past decade or so other substances such as choline have been evaluated and applied but in terms of accuracy and diagnostic outcome Ga-68-PSMA is now state of the art," says Prof. Markus Luster.

Tekst gaat verder onder grafiek

PSMA beelden 2

Foto: werkingsmechanisme van PSMA

Combining diagnosis and therapy
As he points out PSMA is not only useful for diagnostic but also for treatment purposes: The PSMA-ligand can be labelled with another radionuclide called Lutetium-177 that is able to destroy the cancer cell from inside through radiation. "Several tests have demonstrated that Lu-177-PSMA-therapy can reduce tumour mass and alleviate pain. Patients who have no other treatment options left and whose cancer cells have been shown to take up PSMA-ligands are very likely to benefit from the diagnostic and therapeutic potential of PSMA imaging and therapy," says Prof. Markus Luster.

Zoals eerder gezegd, in Nederland is een PSMA behandeling aan te vragen en te verkrijgen in het St. Antonius in Nieuwegein voor een PSMA pet-CT scan.

Bronnen voor bovenstaand artikel: www.eanm.org/content-eanm/uploads/2016/11/201612_EANM_Prostate-cancer_en.pdf
  En www.facebook.com/officialEANM.
  En www.whatisnuclearmedicine.com

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Een reviewstudie die bovenstaand persbericht bevestigt is dit studierapport met lange referentielijst dat tegen betaling is in te zien: 

Current use of PSMA–PET in prostate cancer management

Hier het abstract van deze review studie:

PSMA-based imaging holds great promise to improve prostate cancer management.

Current use of PSMA–PET in prostate cancer management

Nature Reviews Urology
13,
226–235
doi:10.1038/nrurol.2016.26
Published online

Abstract

Currently, the findings of imaging procedures used for detection or staging of prostate cancer depend on morphology of lymph nodes or bone metabolism and do not always meet diagnostic needs. Prostate-specific membrane antigen (PSMA), a transmembrane protein that has considerable overexpression on most prostate cancer cells, has gained increasing interest as a target molecule for imaging. To date, several small compounds for labelling PSMA have been developed and are currently being investigated as imaging probes for PET with the 68Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC being the most widely studied agent. 68Ga-PSMA–PET imaging in combination with multiparametric MRI (mpMRI) might provide additional molecular information on cancer localization within the prostate. In patients with primary prostate cancer of intermediate-risk to high-risk, PSMA-based imaging has been reported to improve detection of metastatic disease compared with CT or mpMRI, rendering additional cross-sectional imaging or bone scintigraphy unnecessary. Furthermore, in patients with biochemically recurrent prostate cancer, use of 68Ga-PSMA–PET imaging has been shown to increase detection of metastatic sites, even at low serum PSA values, compared with conventional imaging or PET examination with different tracers. Thus, although current knowledge is still limited and derived mostly from retrospective series, PSMA-based imaging holds great promise to improve prostate cancer management.

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