Prostate Cancer: New Considerations on Risk, Screening, Diagnosis and Treatment

Prostate cancer is the most common cancer to affect men. About one out of eleven men will be diagnosed with prostate cancer; however, not all prostate cancers are “clinically significant”. There are many ways to define this term, but an easy one is a cancer that will affect a man in his life time. For example, a low grade, low volume prostate cancer diagnosed in a man with heart disease, poorly controlled diabetes and hypertension, will probably not be clinically significant to that individual. But an aggressive prostate cancer in a healthy individual clearly is.

Prostate Cancer TreatmentThe ideal time to treat a clinically significant cancer (of any type) is when it is still “organ confined”; in other words, before it has spread. In the case of prostate cancer, treatment of organ confined cancer is mostly accomplished either by surgery (surgical removal of the prostate and seminal vesicles) or radiation therapy (killing prostate cancer cells with energy in the form of radiation).
Both forms of therapy are very effective; but neither are foolproof. With both treatments, there is a chance of cancerous cells being left behind. This can lead to a “local recurrence”. Another way either treatment can fail is if there was already a “micro-metastasis” (cancerous cells that already spread prior to treatment, but still undetectable by imaging) prior to treatment.

The conundrum therefore arises after definitive local therapy, what to do when there are signs of recurrence of the cancer. A local recurrence may be treated locally by surgery, radiation, cryosurgery, but distant recurrence (usually) needs to be treated by chemotherapy, and there is literature that supports that earlier treatment maybe superior.

Axumin

Axumin offers a new way to differentiate between the two. It is a tool which can identify where prostate cancer recurrence is located in the body. Axumin is actually a radioactive tracer used in PET-CT (positron emission tomography-Computerized Axial Tomography) imaging.
Axumin works in the following way: It contains the fluorine 18 (F 18) labeled synthetic amino acid analog fluciclovine. This is a synthetic amino acid which is normally transported across mammalian cell membranes, but in prostate cancer (as well as normal prostate cancer cells) , the uptake is “up-regulated” relative to other cells in the body.

Fluciclovine F 18 is a radionuclide with a half life of about 110 minutes which makes it ideal to use for imaging, and adverse reactions are rare. At this time, the biggest disadvantage of Axumin appears to be its cost with the price of the test (including imaging) adding up to several thousand dollars. However, in appropriately selected patients. Axumin may offer a breakthrough in the effective treatment of prostate cancer.

For more information on Axumin, visit their website http://www.axumin.com/

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