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Posted 5/30/2016 10:43 AM (GMT -5)
Anybody hear of this:
>>>>>>>>>>
http://www.urotoday.com/index.php?option=com_content&view=article&id=89071:fda-approves-axumin-to-detect-recurrent-prostate-cancer&catid=1134:prostate-cancer&Itemid=2818&utm_source=newsletter_3617&utm_medium=email&utm_campaign=prostate-cancer-daily
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It sounds like Auxumin is an agent similar to choline?
I don't know anything else about it. Perhaps it has a longer half life and hence can be used in various places?
(Choline has a 20-minutes half-life and is only done at Mayo)

Mel
Posted 5/30/2016 11:04 AM (GMT -5)
Not sure how Auxumin compares with (68)Ga-labelled PSMA? - Not sure why this PSMA has not been approved in the US yet?

http://www.ncbi.nlm.nih.gov/pubmed/24072344

Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer.

Afshar-Oromieh A1, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG, Holland-Letz T, Hadaschik BA, Giesel FL, Debus J, Haberkorn U.



Author information



Abstract

PURPOSE:

Positron emission tomography (PET) with choline tracers has found widespread use for the diagnosis of prostate cancer (PC). However, choline metabolism is not increased in a considerable number of cases, whereas prostate-specific membrane antigen (PSMA) is overexpressed in most PCs. Therefore, a (68)Ga-labelled PSMA ligand could be superior to choline tracers by obtaining a high contrast. The aim of this study was to compare such a novel tracer with standard choline-based PET/CT.

METHODS:

Thirty-seven patients with biochemical relapse of PC [mean prostate-specific antigen (PSA) 11.1 ± 24.1 ng/ml, range 0.01-116] were retrospectively analysed after (18)F-fluoromethylcholine and (68)Ga-PSMA PET/CT within a time window of 30 days. Radiotracer uptake that was visually considered as PC was semi-quantitatively analysed by measuring the maximum standardized uptake values (SUVmax) of the scans acquired 1 h after injection of (68)Ga-PSMA complex solution (median 132 MBq, range 59-263 MBq) and (18)F-fluoromethylcholine (median 237 MBq, range 114-374 MBq), respectively. In addition, tumour to background ratios were calculated.

RESULTS:

A total of 78 lesions characteristic for PC were detected in 32 patients using (68)Ga-PSMA PET/CT and 56 lesions were detected in 26 patients using choline PET/CT. The higher detection rate in (68)Ga-PSMA PET/CT was statistically significant (p=0.04). In five patients no lesion was found with both methods. All lesions detected by (18)F-fluoromethylcholine PET/CT were also seen by (68)Ga-PSMA PET/CT. In (68)Ga-PSMA PET/CT SUVmax was clearly (>10 %) higher in 62 of 78 lesions (79.1 %) and the tumour to background ratio was clearly (>10 %) higher in 74 of 78 lesions (94.9 %) when compared to (18)F-fluoromethylcholine PET/CT.

CONCLUSION:

(68)Ga-PSMA PET/CT can detect lesions characteristic for PC with improved contrast when compared to standard (18)F-fluoromethylcholine PET/CT, especially at low PSA levels
Posted 5/30/2016 1:18 PM (GMT -5)
This has been in tests for a long time by David Schuster at Emory and in Europe, and I'm glad it finally got approved (I've been advocating it on HW since I got here). It is aka F18-FACBC or fluciclovine. Mel, it's not choline that has the 20 minute half-life, it's carbon 11. That's why everyone's been looking for alternative radioisotopes like Ga68, F18, Zr89, Cu64, etc. that last longer and don't have to be manufactured on site. They've also been hunting for molecules with more specific uptake in PC cells than choline or acetate.

FACBC is a synthetic amino acid that is preferentially metabolized by prostate cancer cells. Unfortunately, it is also highly absorbed by BPH cells, so it can only be used post-prostatectomy. Like C11-Choline, it also seems to have a high false negative rate. It's still in trials at Emory. Howard Sandler at Cedars-Sinai told me they will be doing a trial there, so if you have plans to visit California again, you may want to do it there.

- Allen
Posted 5/30/2016 2:35 PM (GMT -5)
Allen:

Thanks for the info. My intent is to do the same scan I did last time, the one at Mayo. But I am unsure about the insurance situation. It appears that MediCare covers it and my particular MediCare Advantage Plan apparently covers everything that MediCare does. But, also, I don't think that Mayo accepts MediCare as payment in full. So I'll have to estimate my cost. Last time, the total cost for everything (MRI + blood tests + scan) was (as I recall) over $15K. But my insurance was great and they even covered my travel and hotel bill (a special feature of that insurance). My out of pocket cost was a few hundred bucks for the entire trip, including expenses. That will not be the case this time.

Mel
Posted 5/30/2016 4:26 PM (GMT -5)
That's the nice thing about clinical trials - if it's sponsored by the manufacturer/patent-holder, who is eager to get adequate sample size for FDA approval, the manufacturer often (not always) covers the cost. The downside is that it's experimental -- its accuracy is unproven.

- Allen
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