PET/CT with gallium-68-psma

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Arline Lambert
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1 PET/CT with gallium-68-psma

3 After consultation of your attending physician you have decided to undergo a gallium-68-psma PET/CT at the department of Nuclear Medicine of the Radboud University Medical Center. What does a PET/CT-examination mean? A PET/CT-scan is a combined examination. PET stands for Positron Emission Tomography. To perform this type of PET-scan a radioactive substance is used, which is administered intravenously (through a blood vessel). CT stands for Computed Tomography. A CT-scan can image different anatomical structures (organs, tissues and structures) in a highly detailed manner. To perform a CT-scan X-rays are used. Purpose of the examination After treatment for prostate cancer, you have been diagnosed with a (significantly) increased blood count of the protein PSA (Prostate Specific Antigen). Elevation of the PSA-level may indicate that somewhere in the body an increase in prostate cancer cells is present. Of course, it is critical to localize the exact location of this metastases (growth) as soon as possible. When this is known, an adequate treatment can have the desired response. In current techniques, localization of metastases is usually less accurate. This may be the case when the PSA-level is very low or metastases are very small in size. In these cases, conventional imaging might not show any abnormalities. In clinical trials gallium-68-psma PET/CT has shown to be able to detect recurrence of prostate cancer in above mentioned situations in a much more sensitive manner than current imaging techniques, including fluorine-18-choline PET/CT, bone scan, CT or MRI. Preparation for the examination In order to spend the waiting time, you can bring a portable device with you to listen to music. Choose clothing without metal; also think about your underwear. You can better leave jewelry and piercings at home; you will have to remove them for the examination. 1

4 Medication use You can continue taking any medication in the usual manner. It is important that you keep an up-to-date medication list with you at all times, so any physician can see what medication you use, and in what dosages. It is possible to obtain this medication list at your local pharmacy, free of charge. Claustrophobia (fear of enclosed spaces) If you suffer from (severe) claustrophobia, please inform the nuclear medicine technician (the person performing the examination) at the beginning of the examination. If needed, the nuclear medicine physician can prescribe a medicine to keep calm (benzodiazepine). Please note that after taking this kind of medication, your responsiveness can be temporarily impaired, and you should refrain from controlling any motor vehicles for a period of 24 hours. Please bear in mind that in this case you may have to arrange your own return transportation. Possible cancellation of the examination To perform this examination, a radioactive substance is used. This radioactive substance has to be prepared at the department of Nuclear Medicine thru a labor-intensive production. The finished product needs to comply to strict requirements before it can be used. Unfortunately there is a possibility that the finished product does not meet the requirements and has to be rejected for use. The examination will necessarily have to be cancelled then. Because this can happen at the latest possible moment, you might already be in transit to or even arrived in the hospital. Your understanding for this situation will be asked. Due to its radioactive nature, the radioactive substance can only be effectively used for a short period of time. In cases of unforeseen delay or when you show up late for your appointment, it could mean that the examination is necessarily cancelled. Your understanding for this situation will be asked. In both cases a new appointment can be made. 2

5 Radioactive substance The radioactive substance is gallium-68-psma. Gallium-68 is bound to the protein PSMA (Prostate Specific Membrane Antigen), which has a high presence in prostate cancer cells. Through the administration of gallium-68-psma, prostate cancer cells can be imaged specifically by using the PET/CT. Because of the minimal amount of radioactive substance used for this examination, it will not adversely affect your health or the health of people in your environment in any way. Examination Before starting the examination, you will receive half a liter of tap water to drink and after this you are asked to empty your bladder. The nuclear medicine technician will take you to a private examination room. You will be lying on a bed and you will be administered the radioactive substance intravenous. After administration it is important that you remain on the bed during approximately 60 minutes. In this time, some movement and the use of the restroom is permitted. After the waiting time you are asked to empty your bladder again, after which the PET/CT-scan is made. During the examination you are positioned on a scan bed in a supine position with your arms above your head. It is very important to lie as still as possible. The scan bed slides stepwise through the opening in the scanner. The front and rear of the scanner are open (see illustration) and no loud noises are heard during operation. In most cases, it takes about 30 minutes to complete the scan. Images are made from the groin area up to the base of the skull. 3

6 PET/CT-scanner Duration of the examination The total duration of the examination takes about two hours. Video of the examination To give you and others a general idea how the examination is performed, the department of Nuclear Medicine provides a short informative video about the PET/ CT-scan. This video can be viewed through our website: Please keep in mind that your examination might be performed somewhat differently compared to the one featured in our video. Side effects If you took medication to keep calm (e.g. benzodiazepines) this can temporarily impair your responsiveness. Therefore you should, among other things, refrain from controlling any motor vehicles for a period of 24 hours. 4

7 There are no known side effects of the radioactive substance. After the examination Drinking a bit more fluids during the rest of the day further improves excretion of the radioactive substance. You are asked to keep extra distance to children and childbearing women within the first four hours after the examination. Results The nuclear medicine physician dresses a detailed report of your scan and informs your attending physician who will, in term, inform you about the results. Guidance Guidance may not be present during the actual examination. At the department of Nuclear Medicine a radioactive substance is administered to all of the patients. A radioactive substance emits radiation and already administered patients are also in the waiting room. You will be asked for this reason not to bring children and/or pregnant women as guidance (also not when they only stay in the waiting room). Communicable and infectious diseases It is very important for a hospital to know if you belong to a risk group for infection, virus, bacterium or other communicable diseases. When you are familiar with or when you are suspected to carry one of the above diseases, or when you visited a foreign hospital within the last two months or when you visited a Dutch institution where a transferable virus prevails, you will be prompted to contact the department of Nuclear Medicine prior to your appointment. Impediment/change appointment The radioactive substance is custom-made, prepared to your situation, just before your arrival to the department. The preparation process is costly, labor intensive and can, unfortunately, only be effectively used for a short period of time. If for some reason you have to cancel your appointment, please inform the department of Nuclear Medicine as soon as possible. A new appointment can be made. 5

8 Disclaimer The information in this leaflet is general by nature, therefore the examination is described the way it is usually performed. Depending on your personal situation, the examination might be performed somewhat differently. Questions If you have (urgent) questions after reading this leaflet, please contact the department of Nuclear Medicine or you can ask the nuclear medicine technician during your appointment. 6

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12 Visiting Address Location Nuclear Medicine Part of the department Radiology and Nuclear Medicine Main Entrance Geert Grooteplein-Zuid GA Nijmegen The Netherlands Follow route 757, zone D-1 Postal Address Radboudumc 757 Nuclear Medicine P.O. Box HB Nijmegen The Netherlands Contact on Monday to Friday from 8.15 AM till 4.15 PM (response within two working days) This handout is also available on Radboud universitair medisch centrum

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care. PATIENT EDUCATION patienteducation.osumc.edu PET stands for Positron Emission Tomography. The scan looks at metabolic activity (cell activity) inside the body. Your doctor uses this information to help