New type of PET scan for prostate cancer

“Going to Germany and the subsequent surgery provided the best chance of hitting the cancer that is ‘getable’. The surgery is major and not for everyone but I have made a steady recovery and believe that I made the best decision for myself.”
Peter Davis*, Birmingham Prostate Clinic prostate cancer patient

Peter Davis* was treated for prostate cancer, but subsequently found his PSA was rising. Mr Davis explains why he travelled to Germany for a special type of PET scan developed for men with prostate cancer.

Your experience of prostate cancer

My father died of prostate cancer in 2000 and my mother told me that her father, my grandfather, also died from the disease. I knew there was a strong genetic link and because of this, I had a PSA test. My result was high and after further investigations I discovered that like my father and grandfather, I had prostate cancer. I was 56 at the time.

I chose to have brachytherapy and it appeared to be a complete success. But after 18 months my PSA started to rise. It was fairly gradual – the lowest level was 0.5ng/ml and it rose steadily, then stayed at 2.5ng/ml for some time, before going up to 3.5 and finally reaching 6.0ng/ml in June 2013.

What happened after first treatment?

In 2008, I had an MRI scan and a biopsy of my prostate which came out as being clear. My PSA continued to increase, so in 2012 I had another MRI scan and a bone scan, but again that came out as being clear. I would have a PSA test every six months and it was worrying and unsettling to know that something was wrong, but it was not possible to pin-point exactly what and where.

I had my follow-up treatment at a clinic in London, but as I spend time in the Midlands, it was proving inconvenient having to regularly travel for appointments. I did my own research, observed the way Mr Doherty interacted with his patients and decided to come to the Birmingham Prostate Clinic.

How did you find out about the PMSA PET scans in Germany?

PET scans are used to detect other types of cancer but have not been widely used to detect prostate cancer. In the UK, the main tracer used in PET scans is glucose bonded with a radioactive fluorine atom. Because cancer cells require high levels of energy input they preferentially absorb this glucose and by detecting where the fluorine is decaying indicate where cancer cells are located.

The problem with this in the context of prostate cancer, is that the absorption of glucose by prostate cancer cells, compared to its absorption by other tissue, is not sufficient to distinguish them in a PET scan, so using glucose as a tracer is less effective. In the UK, they are at an early stage of using a different tracer, Choline, for men with prostate cancer. However in Germany, they are using a tracer known as Gallium-PSMA that has shown even better results than the choline scan. The scan, developed by the German cancer Institute in Heidelburg, is available there and in Munich.

I chose to go to Munich because I wanted to have the best possible chance of finding out what the problem was. I knew Munich and the unit offering the scans, having lived there, and I also knew that they had the most advanced PET scanner. The costs were comparative with having a choline scan in the UK and were paid by my insurance company.

Next steps

I travelled to Germany for my scan in late June 2013. The scan showed there were a number of lymph nodes where cancer cells were present, located in the lymph system in the para rectal space and also higher up adjacent to the para-aortal artery. There were no indications in the remnants of my prostate gland.

Using this information, Mr Doherty performed an operation removing all of the lymph nodes where cancer was identified, together with my prostate. The histology report on the tissues removed during the operation revealed 11 locations where cancer cells were found in the lymph system but found no traces of cancer in the prostate. This confirmed the findings from the scan. I have just learnt that three months after this surgery, my PSA is less than 0.01ng/ml – the benchmark of the lowest possible level and best indicator.

I suppose – and we will never know for sure – that around the time of my brachytherapy, there was already some spread of cancer cells beyond the prostate and that over time they began to develop and spread. It explained why my PSA was rising and why focusing initially on the prostate was not getting to the grips with the problem.

Overall reflections

Before I went to Germany for my scan, we discussed the possibility of hormone therapy. I wasn’t comfortable with it; with a treatment that accepts the presence of prostate cancer. Going to Germany and the subsequent surgery provided the best chance of hitting the cancer that is ‘getable’. The surgery is major and not for everyone but I have made a steady recovery and believe that I made the best decision for myself.

There are no guarantees and I may need hormone therapy one day. But by having the scan and surgery based on information from that scan, I have given myself the best chance of making a real difference to my life expectancy.

*The patient wished to remain anonymous so his name has been changed.