A new molecular imaging agent aims to detect recurrent prostate cancer earlier, when used in conjunction with PET (positron emission tomography) imaging.
Recently approved by the U.S. Food and Drug Administration, AxuminTM (fluciclovine F 18) is the first FDA-approved F-18 PET imaging agent indicated for use in patients with suspected recurrent prostate cancer. Northside Hospital is the first hospital in the country to use the new drug commercially.
Georgia Urology, the largest urology practice in the Southeast, played an important role in Northside Hospital’s becoming the first hospital in the United States to commercially use Axumin, a tool to detect recurrent prostate cancer, according to Dr. Vahan Kassabian, Georgia Urology’s medical director.
More cases of prostate cancer are diagnosed and treated at Atlanta’s Northside Hospital than anywhere else in Georgia. The hospital offers a comprehensive prostate cancer treatment program, which includes screening and advanced diagnostic capabilities, leading-edge treatment and support.
Dr. Kassabian said a “handful” of Georgia Urology’s physicians have used the technology, which has only been available commercially for about six weeks after it received approval from the FDA. Dr. Kassabian said he met with representatives from Blue Earth Diagnostics, the manufacturer of Axumin, which is how he first learned of its existence. Some of the tool’s medical research studies were performed at Emory University, he said.
While most primary prostate cancer can be successfully treated, recurrence occurs in up to one-third of patients. Of those who experience biochemical recurrence (elevated PSA following a prostatectomy or radiation therapy), approximately one-third develop metastatic prostate cancer.
Axumin is designed specifically to target prostate cancer cells. Whereas typical imaging agents (tracers) contain glucose that is absorbed by cancerous cells, prostate cancer cells have a very low sensitivity to sugar. This new agent, rather, consists of a synthetic amino acid that studies show prostate cancer cells prefer.
The drug is administered to patients prior to having PET imaging. The PET scan then detects the tracer and creates an image of the patient’s anatomy. Because more of the tracer is absorbed by the prostate cancer cells, the physician can better see if disease is present, the location and extent of disease and how rapidly it is spreading.
“To date, we have had few imaging tools available for the evaluation of men with biochemically recurrent prostate cancer, said William C. Lavely, M.D., nuclear medicine specialist, Northside Radiology Associates. “The approval of F-18 fluciclovine (Axumin) allows us to have an effective molecular imaging tool to evaluate these patients and assist clinicians in directing further management.”
Urologists use a test known as the Prostate-Specific Antigen (or PSA), which measures the amount of a protein produced by the prostate gland, to detect prostate cancer. At times, the current tests — bone scans and CT scans — can have trouble detecting where the cancerous cells are when PSA is on the rise after definitive therapy, such as surgery or radiation. Axumin provides an important tool for finding where the cancerous cells are located. “So far, it’s excellent,” Dr. Kassabian said of Axumin. “What I can tell is there was a big need for patients whose PSA is rising after prostate cancer treatments and we wouldn’t know where the cancer is with our current imaging. Technetium bone scans or regular CT scans are not very sensitive at picking up small areas of cancer that would otherwise be missed. This is a test that looks at where the PSA membrane may lie in the body and can therefore find cancer earlier and more precisely, which would translate into earlier and more accurate treatment.”
“Our initial experience is positive, demonstrating abnormal uptake in locations of potential metastatic prostate cancer,” Dr. Lavely added.
Early detection is key in successfully treating many cancers. Next to skin cancer, prostate cancer is the most frequently diagnosed cancer in men (1 in 6 men will get it). However, it can be slow growing and take years to develop.
Beginning at age 50, men at average risk (no family history) for developing prostate cancer should begin to discuss the pros and cons of screening with their doctor. Men at high risk for developing prostate cancer should begin discussing screening even sooner.