As a nationally recognized leader in medical innovation and high-quality health care, Atlantic Health System is once again leading the way with a novel imaging approach to brain tumors, which has the added benefit for theranostic potential (diagnosing and treating cancer through radiotracers).
According to James Cassuto, MD, PhD, associate medical director of nuclear medicine and a diagnostic radiologist and nuclear medicine doctor with Atlantic Health System, nuclear medicine is going through a renaissance, with more cancer-specific diagnostic tools and treatment options available than ever before.
“Nuclear medicine uses small amounts of radioactive materials to examine organ function and cancer and then target disease for treatment,” Dr. Cassuto explains. “PSMA PET-CT imaging is part of the current standard of care for prostate cancer, and we are now studying, in collaboration with the Gerald J. Glasser Brain Tumor Center, the same methodology to aid in the diagnosis and hopefully treatment of certain types of aggressive brain tumors at Atlantic Health.”
As one of only a select few hospitals in the entire tri-state area to offer PMSA PET-CT for high-grade gliomas (fast-growing, aggressive brain tumors originating in the glial cells), Atlantic Health System is able to deliver this promising new care option for brain cancer patients.
PSMA PET-CT: An Overview
To understand why this approach to brain cancer care is revolutionary, we need to understand how it works for prostate cancer.
PSMA stands for prostate-specific membrane antigen, a protein that is expressed on the surface of prostate cells when cancer is present. PSMA PET-CT is a molecular imaging technique that uses a small probe attached to a radioactive molecule to precisely localize prostate cancer cells that express PSMA when intravenously injected. When imaged, the cancerous cells appear as bright spots on the PET scan (positron emission tomography) and their exact location is marked on the CT scan (computed tomography).
With this knowledge, doctors can detect and treat sites of recurrent prostate cancer earlier.
For patients with advanced metastatic disease, doctors can specifically target and kill the PSMA-expressing cells with intravenous radiotherapy, such as PluvictoTM. Because this therapy specifically targets prostate cancer cells, the surrounding healthy tissue is spared.
“We use this same imaging technique for estrogen receptor-positive (ER+) breast cancer, and the same imaging technique and therapy (LutatheraTM) for neuroendocrine tumors,” says Dr. Cassuto. “We just use a different small molecule probe to bind to those specific cancers.”
These targeted methods help Atlantic Health doctors find cancer that they wouldn’t normally see, leading to earlier detection and treatment.
How Atlantic Health is Using PSMA PET-CT for Brain Cancer
Researchers recently discovered that PSMA is expressed in high-grade gliomas like glioblastoma, an aggressive brain cancer. While FDA-approved for prostate cancer, the off-label use of PSMA PET-CT for brain tumor detection is now available at Atlantic Health — and nowhere else in the state.
Nuclear medicine doctors and neuroradiologists help neuro-oncologists, neurosurgeons, and radiation oncologists at Overlook Medical Center’s Atlantic Neuroscience Institute assess post-treatment disease progression using the same PSMA PET-CT methodology in complex and high-grade brain tumor cases, such as glioblastoma multiforme.
When it’s not obvious that the disease is worsening or progressing, this technique, combined with brain MRI (magnetic resonance imaging), affords Atlantic Health specialists increased confidence in characterizing what’s happening — post-treatment change, post-radiation change, or if the cancer has recurred, progressed, or metastasized.
“In conjunction with traditional follow-up imaging methods, we have shown great promise in detecting progressive disease,” says Dr. Cassuto. “A specialized test that can detect aggressive brain tumor recurrence earlier and allow for more timely treatment means hope for better patient outcomes.”
Dr. Cassuto believes that the success of these early cases shows true value for both Atlantic Health’s patients and clinicians. “By supporting these types of advancements in nuclear medicine, Atlantic Health gives clinicians the tools to deliver superior patient care and treatment.”
The next step, he explains, is to open clinical trials to confirm current findings, evaluate other types of brain tumors (such as base of skull meningiomas) that can benefit from off-label PET-CTs, and ultimately assess if targeted radiotherapy with small molecule probes, such as for PSMA in prostate cancer, can be used for treatment.
“The off-label use of PSMA PET-CT imaging for brain tumors is innovative, and we’re investigating other uses and partnerships in order to continue advancing the field of theranostics at Atlantic Health,” says Dr. Cassuto. “It’s an exciting place to be right now.”
With cutting-edge technology like PSMA PET-CTs and early access to new drugs and therapies, Atlantic Health is more than just a community hospital. We’re a referral center for high-quality, revolutionary care that is second to none.
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