PET/CT scan with PSMA

• Detection of biochemical recurrence. It is prescribed if a relapse is suspected after a radical treatment (prostatectomy or radiation therapy), when the level of PSA in the blood begins to rise. Allows you to define the exact location of the relapse (local relapse, metastases to the lymph nodes or bones) even at low values Serum PSA (at a level of 0.2 ng/ml).
• Staging of the tumor process. Allows you to determine the prevalence for the first time diagnosed prostate cancer in patients from the groups of high and unfavorable intermediate risk (at a PSA level ≥ 20 ng/ml, Gleason ≥ 7 (4 + 3)); to clarify the stage of the disease in case of doubtful or conflicting data from CT, MRI and other imaging methods.
• Diagnosis of disease progression in case of suspected castrate-resistant cancer prostate gland. Allows you to identify signs of the development of castrate-resistant cancer with unconfirmed progression according to standard methods (CT, MRI, osteoscintigraphy).
• Planning radiation therapy. PET/CT data is used for more accurate field planning irradiation to maximize the effect on the tumor and minimally affect healthy tissues.
• Planning and evaluation of the effectiveness of PSMA-targeted radioligand therapy. Used for selection of patients with metastatic prostate cancer (177Lu and 225Ac) and evaluation of the effectiveness of therapy.

Absolute (categorical) contraindications for PET/CT with [18F]-PSMA does not exist. Research can be perform almost all patients while observing the necessary safety measures. However, there are relative contraindications and conditions that may require postponement or special preparation:

• Acute serious condition. Any acute condition requiring urgent assistance (acute heart attack, stroke, severe trauma, etc.) is a temporary contraindication until stabilization.
• Very severe general condition. If the patient cannot lie still for a long time or is ill tolerates loads — a study after improving well-being.
• Acute infection or inflammation. With an active infectious process, the procedure is recommended postpone until recovery.
• Conditions that make it difficult to conduct research. Severe neuropsychiatric disorders, uncontrolled claustrophobia, severe pain syndrome, etc. — solved individually (including with prior administration of sedatives / painkillers).

In the absence of contraindications, an iodine-containing contrast agent is administered intravenously. PAT/CT with contrast improves visualization of internal organs and vessels, increasing diagnostic accuracy.

It is necessary to submit the result of the creatinine analysis (prescription — no more than 30 days).

According to the MHI policy.

Visit a specialist doctor (oncologist). If there is evidence, the doctor will issue a referral for PET/CT with [18F]-PSMA. Registration via the Unified Coordination Center (ECC): +7 (499) 444-04-53 (daily 08:00-20:00).

According to the LCA policy.

Check the coverage with the insurance company. To register as part of the LCA: +7 (916) 757-81-07, +7 (495) 304-30-40 or e-mail: dms@mknc.ru .

On a paid basis.

Office reception: +7 (495) 304-30-35 (ext. 4034, 4033), weekdays 08:00-15:00. Specialists will clarify the indications, the cost (link to the price list) and write it down at a convenient time.

On the day of the study, take with you:

• Passport.
• The original of the PET/CT referral (for CHI patients). Direction — in EMIAS or on paper a letterhead with a seal and signature.
• MHI policy (for MHI patients) — original or QR code with the policy number.
• A blood test for creatinine (if contrast is planned) is no more than 30 days old. If the data is in EMIAS, you do not need to bring/print it out.
• Protocol of the oncological consultation (for patients on compulsory medical insurance) — according to the orders on routing.
• Data from previous examinations (CT, MRI, ultrasound, PET/CT, SPECT/CT, scintigraphy, etc.): conclusions + media with DICOM (CD/DVD/flash).
• Additionally (if necessary): personal items (diapers/urological gaskets — it is advisable to replace them with new ones before scanning).

Detailed preparation memo

No special training is required, but on the day of the study:

• Fast 6 hours before PET/CT. You can and should drink water (non-carbonated, in small portions). Unsweetened tea/coffee is allowed.
• Do not chew gum and do not dissolve lollipops.
• Take water and a change of shoes. Recommended ~1.5 liters of water (drink during the waiting period), slippers or a light change of shoes, a bag for storing outdoor shoes.
• Clothes — comfortable, warm, without metal. Jewelry / watches / belts are better not to wear.
• Patients with diabetes: training on the recommendations of an endocrinologist. Temporarily stop taking biguanides (metformin / glucophage®) at least on the day of the study and the day after.
• If you have previously had allergic reactions (especially to iodine—containing drugs) - warn staff in advance.

Memo/document on the procedure (PDF)

The day before, the administrator will contact you and remind you of the details. On the day of the study, arrive at the appointed time (the radiopharmaceutical has a limited decay time). The total duration of stay is about 4-5 hours, the The scan takes about 30 minutes.

• Registration. The office of the department (1st floor, 1st building, sector 1B, office 1B10). Present documents.
• Preparation before injection. Changing clothes if necessary, height/weight measurement, clarification well-being, glucose control. Venous catheter installation.
• Introduction of the RFP. [18F]-PSMA is injected intravenously through a catheter.
• Waiting (~80-90 minutes). Quiet rest, drink water in small portions (usually ~1-1.5 liters if there are no restrictions).
• Before scanning. Empty the bladder, replace the pad/diaper if necessary.
• PET/CT scan (25-35 minutes). It is important to lie still, communication with the staff is by audio.
• Contrast (optional). In the absence of contraindications — the introduction of iodine-containing contrast.
• Completion. Catheter removal, changing clothes. If necessary— a disc (DVD) with data.

Diagram/instructions on how to get there (PDF)

Radiation dose for PET/CT is small, however, it is recommended to take precautions on the first day:

• Avoid very close and prolonged contact for 24 hours, especially with children and pregnant women.
• Drink more fluids (usually up to 1.5–2 liters of water in the absence of contraindications).
• If possible, limit very salty foods on this day.
• On request, a certificate of the introduction of the RFP can be issued (it may be necessary for air travel — control framework sometimes they react to residual radiation).

You will receive the finished conclusion in 2-3 working days. In the center, the conclusion is uploaded to EMIAS — the attending physician will be able to see him. If necessary, you can get a printed result at the registry and a disk with a record of the study.

After receiving the results, discuss them with your doctor to determine further treatment tactics or observations.