Practice Updates in Prostate Cancer Imaging - Episode 5

The Learning Curve of PSMA PET Scans

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Michael Gorin, MD, describes his experiences with prostate cancer imaging both in academia and community-based practices.

Lawrence Saperstein, MD: Just 2 quick issues if I may. With any new modality in imaging of this nature. There are 2 challenges. One is the comfort level of the radiologist interpreting the scans accurately and obviously, the other 1 is the education of the referring doctors and their embrace of the new technology. Those were great points and we're getting there but those are the 2 challenges in terms of disseminating the technology.

Neal Shore, MD, FACS: There's a learning curve, there must be education on how to interpret the images undoubtedly. What is the potential for false positives and false negatives? What are the PSA [prostate-specific antigen] metrics for where you would get greater negative predictive value, positive findings? Michael, I think Steven made a comment about academic and community. You've now had tremendous experience in both arenas and this is what's always interesting to me is bringing in nuclear medicine radiology colleagues like Dr Saperstein on the academic side but how that will evolve in the community setting? What's been your experience in terms of academia and community-based practices?

Michael Gorin, MD: When I was at Johns Hopkins, [Baltimore, Maryland,] we were very lucky because Martin Pomper, MD, PhD, who's one of my mentors, was essentially part of the team that led the team that developed the DCF PyL [fluorine-18-DCFPyL] molecule. We had the earliest access to this radiotracer and with a large team. including Drs Stephen P. Rowe, Mohamed E. Allaf, and Ashley Ross. We put together a portfolio of trials that took advantage of our early access to this agent. And for several years now, virtually every patient who is coming to Hopkins for their care was enrolled in some sort of imaging protocol and we had access to those results and could tailor their care based on it. When I moved to Urology Associates in UPMC Western Maryland in Cumberland, there was a period of time where we did not have access to PSMA imaging. Thankfully, we have a great imaging center here at advanced diagnostic radiology and we have access to OxyMon. Very quickly though, after the FDA approval, Lantheus medical imaging, they came right in and onboarded our imaging site with access to PyL. And we've had access to this agent now since a month or 2 after it's FDA approval and we've had outstanding experience ordering it. Our radiologist has done a nice job learning how to read the scans in short order and that's partially because these are some phenomenally clean scans that have little in the way of false positives so long as you know what you're looking for. That's been outstanding. Now as of January 1st, we have a full pass-through coverage for the radiotracer and it's affordable for patients especially if they're on Medicare to have access to it. And from what I seen of Lantheus, they've basically gone around the country onboarding as many imaging sites as possible. And just being very aggressive about getting this in the hands of folks both in the community and at academic centers.

Neal Shore, MD, FACS: That's a great point and assuredly, we have the team from Lantheus which is clearly trying to make sure they have as much national applicability and accessibility. And right on their heels is going to be the folks from Telix pharmaceutical and their elusive product. And then as you mentioned earlier, the rhPSMA from Blue Earth Diagnostics and there's more to come. There's some interesting PSMA PETs using copper. Having this greater accessibility and ultimately ubiquity of accessibility, it only raises the opportunity for patients to get optimal diagnostic testing and then ultimately optimal therapeutics.

Transcript edited for clarity.