What A PSMA Imaging & the Potential Role of PSMA Radioguided Surgery?

Professor of Urology at UCLA School of Medicine, and UCLA health and I am the director of the prostate cancer program, and head of the urological department of oncology I'm here to talk to you today about a new program at UCLA that we are taking advantage of the most advanced forms of molecular Prostate cancer imaging to help guide us operative to remove all sites from the spread of disease or metastatic disease, so plasma PET imaging is something that we're almost doing It at UCLA seven years now, and was recently FDA approved in 2022. It's now winning a greater acceptance worldwide very much partly uh because of the work that we've done at UCLA for the past seven years leading to FDA approval, so what is plasma imaging is a form of imagery in which we can identify ourselves any site of prostate cancer based on the presence of this gene called plasma or prostate-specific membrane antigen the surface of a cancer cell, so that It allows us to really see where prostate cancer may be much better in the body than we ever could before, and It's real changes the way we look, and manage this disease, and I'll just show It you here on the uh right this is a patient with a traditional bone scan to see If he had metastatic disease to his bones, and you can see that he does indeed have metastases to his rib and his shoulder but with the newer form of spam PET imaging you can unfortunately see that this man has a much more widespread disease, and that's because this test is so much more sensitive than ours traditional imaging, and, so we could to see much more, and consequently nowadays we find more men who have one or two or three sites of metastatic disease, even at the earliest points after diagnosis or after,  the patient can repeat their cancer after radiation or surgery, so only a few slides on plasma Pet Imaging again this is a test that is approved for site identification of metastatic disease in men who had previous treatment for prostate cancer, and have a repeat the question we clinicians have always been true the disease and if we can find It, we can actually, focus It on treatment, so that this is some work of the paper we published together with the university from California, San Francisco, and UCLA showing that, depending on the level of PSA or prostate-specific antigen in the bloodstream we could have a spread of disease or the location of the disease in somewhere between 40 and 100 percent of men before the advent of this imaging test we could never identify the site of disease really until the PSA was a lot higher, so this changes radically what we see, and how we see it next to men who have a recurrence after radiation or surgery it is also: helpful in men who are newly diagnosed the disease in particular what we call a medium-high-risk disease is a disease that we believe this can be special aggressive and with this study too published shows that 40 percent of the men who had illnesses outside the prostate this test allowed us to actually, see it and locate It and this is, while not perfect, much better than the five to ten percent that we could detect historically, so the question has arisen what do we do? If a man has a plasma pet scan, he has two or three deposits of cancer most often in the lymph nodes in the pelvis which is a common area where prostate cancer spreads to before the advent of plasma, we would not identify this disease, but now we see It the question is how can we treat It? It, and the two ways to treat it are: either to target it with specific radiation, and then the other potential the way is to actually remove it surgically whether robotic, so the question is for men with a limited number of metastases we call this cliometric, metastatic disease one to three sites of disease surgery is used to remove cancer lymph nodes in men with newly diagnosed or recurrent prostate cancer, and until the advent of plasma PS de current technology we start with to do here at UCLA uh and being done in some places in Europe, It is real was not quite possible, so this is an uh, this is an article published by another group, and what they showed is that this is a man with a plasma pet scan, and you will see where the arrows are being here that It was a single site of disease in a lymph node, the surgeon said: ok let's go on we go to see if we can remove this because we pretty much knows where it is and as this example shows the patient operated on and unfortunately the surgeons didn't find it because Na, operation was still there, and the reason is we have hundreds of them lymph nodes in this area, and It is very difficult for a surgeon to determine which one? The lymph node can have cancer that: lymph node maybe not and then when they? They really looked like they really could demonstrate that this is a common event that the surgeon could not find the site of the disease and consequently the sure,